Physicians provide ‘complex care’ for end-of-life patients
MedWire News: Physician care for palliative cancer patients is "multifaceted and complex," according to the results of an international study.
The qualitative results of OPCARE9, a European Commission Seventh Framework Project, are published in PLoS Medicine.
Palliative care staff at 16 units in nine countries (Germany, Italy, the Netherlands, Slovenia, Sweden, Switzerland, UK, Argentina, and New Zealand) contributed to the research, which aimed to identify the range of nonpharmacologic caregiving activities that they use.
"Hopefully [this research] will shed some light on, and initiate a discussion of essential parts of end-of-life care that hitherto largely have been neglected in the literature, both in research and textbooks," lead author Olav Lindqvist (Karolinska Institute, Stockholm, Sweden) told MedWire News.
He added: "As this study was based on recognition of the lack of systematic knowledge of the range of non-pharmacological interventions… this article details a landscape of important areas for further discussion and research. Even if aspects of this have been known, to the best of our knowledge, it has not been systematized in this manner previously."
The study involved placing a primary list of nonpharmacologic caregiving activities in each palliative care unit and, over a period of 4 weeks, asking staff to add any other activities that they conducted for patients in the last days of their lives to the list. The researchers specified that each caregiving activity be listed only once per patient in order to focus on variation rather than frequency of caregiving.
A total of 914 statements were collected and were analyzed in terms of the caregiving activity described and the patient recipient.
The greatest number of caregiving activities (n=332) described either carrying out or abstaining from bodily care, and contact with the patient or their family members.
Lindqvist said that one reason why systematically identifying these activities is so important is that it can help identify necessary elements of end-of-life care that are "often ignored." Oral care, he said, was one example of such a caregiving activity. It adds to the patient's well-being and eases patient contact with relatives.
"Oral care can also give relatives an opportunity to participate in the caring of a dying family member," explained Lindqvist, and can become a "complicated ethical issue" if the patient refuses care.
"Our study shows that even non-high-tech care is complex, and requires special knowledge," he said.
In Sweden, these findings have already influenced research into sensory environment matters in palliative care, and educational programs relating to this subject, concluded Lindqvist.
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By Chloe McIvor