COMPARISON OF DOCUMENTED PATIENT CARE BEFORE AND AFTER IMPLEMENTATION OF END OF LIFE CARE PATHWAY FOR TERMINALLY ILL PATIENTS AT SHAUKAT KHANUM MEMORIAL CANCER HOSPITAL AND RESEARCH CENTRE
Abstract
Purpose: Shaukat Khanum Memorial Cancer Hospital and Research Cancer primarily deals with cancer patients and has various departments which provide best-integrated lifesaving care. However, when patients who have been given all possible medical and oncological treatment still progress their disease, they are then referred for best supportive care to palliative care department. The aim of this paper was to audit documented care for palliative patients before and after implementation of end of life care (ELC) pathway.
Materials and Methods: We used a retrospective method to audit 45 terminally ill patients over a period of 3 months. Then, a re-audit was done over a period of 3 months and data were collected for patients who were started on SKM-ELC pathway.
Results: Results show that the implementation of ELC pathway, 67% of the patients were not prescribed PRN medications for symptom control, 20% of the patients were not reviewed for the need of assisted nutrition and for 20% of the patient’s primary team were not even notified that the patient is dying. After the ELC pathway implementation, it was found that 100% of patients were reviewed for PRN medications and assisted nutrition. Oncologists were timely notified that the patient is dying.
Conclusion: In summary, we can say that implantation of ELC pathway has significantly improved documented patients care in all aspects.
Key words: Cancer, care for dying, end of life care, goals of care pathway
References
Ghandourh WA. Palliative care in cancer: Managing patients’ expectations. J Med Radiat Sci 2016;63:242-57.
Hui D, Bruera E. Integrating palliative care into the trajectory
of cancer care. Nat Rev Clin Oncol 2016;13:159‑71.
Milicevic N. The hospice movement: History and curren worldwide situation. Arch Onco 2002;10:29-31.
Yusuf A. Cancer care in Pakistan. Jpn J Clin Oncol 2013;43:771-5.
Khan RI. Palliative care in Pakistan. Indian J Med Ethics 2017;2:37-43.
Casotto V, Rolfini M, Ferroni E, et al. End-of-life place of care, health care settings, and health care transitions among cancer patients: Impact of an integrated cancer palliative care plan. J Pain Symptom Manage 2017;54:167-75.
Costantini M, Ottonelli S, Canavacci L, et al. The
effectiveness of the liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial. BMC Health Serv Res 2011;11:13.
Bookbinder M, Blank AE, Arney E, et al. Improving end-of life care: Development and pilot-test of a clinical pathway. J Pain Symptom Manage 2005;29:529-43.
Main J, Whittle C, Treml J, et al. The development of an
integrated care pathway for all patients with advanced lifelimiting illness - the supportive care pathway. J Nurs Manag 2006;14:521-8.
Mirando S, Davies PD, Lipp A. Introducing an integrated care pathway for the last days of life. Palliat Med 2005;19:33-9.
Hardy JR, Haberecht J, Maresco-Pennisi D, et al. Audit of the care of the dying in a network of hospitals and institutions in Queensland. Intern Med J 2007;37:315-9.
Cummings A, Lund S, Campling N, et al. Implementing communication and decision-making interventions directed at goals of care: A theory-led scoping review. BMJ Open 2017;7:e017056.
Mellor F, Foley T, Connolly M, et al. Role of a clinical facilitator in introducing an integrated care pathway for the care of the dying. Int J Palliat Nurs 2004;10:497-501.
Khan RI. End of life care in Pakistan; some ethical issues. J Coll Physicians Surg Pak 2012;22:745-6.
Abarshi E, Echteld M, Van den Block L, et al. Transitions between care settings at the end of life in the Netherlands: Results from a nationwide study. Palliat Med 2010;24:166‑74.
Parish K, Glaetzer K, Grbich C, et al. Dying for attention:Palliative care in the acute setting. Aust J Adv Nurs 2006;24:21-5.
Lo SH, Chan CY, Chan CH, et al. The implementation of an end-of-life integrated care pathway in a Chinese population. Int J Palliat Nurs 2009;15:384-8.
Raijmakers N, Dekkers A, Galesloot C, et al. Barriers and facilitators to implementation of the liverpool care pathway in the Netherlands: A qualitative study. BMJ Support Palliat Care 2015;5:259-65.
Ellershaw J, Ward C. Care of the dying patient: The lasthours or days of life. BMJ 2003;326:30-4.
Centeno C, Lynch T, Donea O, et al. EAPC Atlas of Palliative Care in Europe 2013. Milan: EAPC Press; 2013.
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