The impact of palliative care training for oncologists and integrative palliative service in a public-funded hospital cluster—a retrospective cohort study
Oncological care of advanced cancer patients was provided by multiple departments in Hong Kong. One of these departments, the clinical oncology department (COD), introduced systematic palliative care training for its oncologists since 2002. The COD was recognized as a European Society for Medical Oncology (ESMO) Designated Centre of Integrated Oncology and Palliative Care since 2009. This retrospective cohort study aims to review the impact of integrative training and service on palliative care coverage and outcome.
Clinical information, palliative service provision, and end-of-life outcomes of patients who passed away from lung, colorectal, liver, stomach, or breast cancer in the Hong Kong West public hospital network during July 2015 to December 2015 were collected.
A total of 307 patients were analyzed. Around half (49.2%) were attended primarily by COD, and 68.9% received palliative service. There are significantly fewer patients referred to palliative care from other departments (p < 0.001), with only 19.9% of this patient group receiving palliative referral. COD patients had longer palliative coverage before death (median 65 days versus 24 days, p < 0.001), higher chance of receiving end-of-life care at hospice units (36.4 versus 21.2%, p = 0.003), lower ICU admission (0.66 versus 5.1%, p = 0.02), and higher percentage of receiving strong opioid in the last 30 days of life (51.0 versus 28.9%, p < 0.001) compared to other departments. In multivariable analysis, COD being the primary care team (odds ratio 12.2, p < 0.001) was associated with higher palliative care coverage.
The study results suggested that systematic palliative care training of oncologists and integrative palliative service model was associated with higher palliative service coverage and improved palliative care outcomes.
KeywordsPalliative care Oncology Patient outcome assessment Hong Kong
All authors made significant contributions to the conception, data acquisition, interpretation, analysis, initial draft, and final approval of this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 17-043) on 9 February 2017. For this type of study, formal consent is not required.
- 1.Ngan R (2016) Overview of Hong Kong cancer statistics of 2014. Hong Kong cancer registryhttps://www3.ha.org.hk/cancereg/pdf/overview/Summary of CanStat 2014.pdf. Accessed 1 March 2017
- 4.Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300(14):1665–1673. https://doi.org/10.1001/jama.300.14.1665 CrossRefPubMedCentralPubMedGoogle Scholar
- 6.Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner KK (2004) Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ 328(7440):607–600. https://doi.org/10.1136/bmj.328.7440.607 CrossRefPubMedCentralPubMedGoogle Scholar
- 9.Food and Health Bureau (2008) Your health your life—healthcare reform consultation document. Food and Health Bureau, Hong Kong Special Administrative Region Government http://www.fhb.gov.hk/beStrong/files/consultation/Condochealth_full_eng.pdf. Accessed 1 March 2017
- 10.Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, Moore M, Rydall A, Rodin G, Tannock I, Donner A, Lo C (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383(9930):1721–1730. https://doi.org/10.1016/S0140-6736(13)62416-2 CrossRefPubMedGoogle Scholar
- 12.Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742. https://doi.org/10.1056/NEJMoa1000678 CrossRefPubMedGoogle Scholar
- 13.Yeung R, Wong KH, Yuen KK, Wong KY, Yau Y, Lo SH, Liu R (2015) Clinical oncology and palliative medicine as a combined specialty—a unique model in Hong Kong. Ann Palliat Med 4(3):132–134. https://doi.org/10.3978/j.issn.2224-5820.2015.04.02 PubMedGoogle Scholar
- 14.ESMO (2017) ESMO designated centres of integrated oncology & palliative care http://www.esmo.org/Patients/Designated-Centres-of-Integrated-Oncology-and-Palliative-Care. Accessed 1 March 2017
- 20.Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, Morton SC, Hughes RG, Hilton LK, Maglione M, Rhodes SL, Rolon C, Sun VC, Shekelle PG (2008) Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med 148(2):147–159. https://doi.org/10.7326/0003-4819-148-2-200801150-00010 CrossRefPubMedGoogle Scholar
- 21.Higginson IJ, Finlay IG, Goodwin DM, Hood K, Edwards AGK, Cook A, Douglas HR, Normand CE (2003) Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? J Pain Symptom Manag 25(2):150–168. https://doi.org/10.1016/S0885-3924(02)00599-7 CrossRefGoogle Scholar
- 23.Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall e, Zimmermann C, Smith TJ (2017) Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35(1):96–112. https://doi.org/10.1200/JCO.2016.70.1474 CrossRefPubMedGoogle Scholar
- 25.Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD, Prigerson HG (2010) Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol 28(29):4457–4464. https://doi.org/10.1200/JCO.2009.26.3863 CrossRefPubMedCentralPubMedGoogle Scholar
- 29.WHO (2014) Global atlas of palliative care at the end of life, editor http://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf. Accessed 1 March 2017