A new model of early, integrated palliative care: palliative rehabilitation for newly diagnosed patients with non-resectable cancer
The aim of this paper is to describe a model of palliative rehabilitation for newly diagnosed advanced cancer patients and present data on how it was utilised during a randomised controlled trial (RCT).
We designed a highly flexible, multidisciplinary model of palliative rehabilitation consisting of a “basic offer” and tailored elements. The model was evaluated in the setting on an RCT investigating the effect of systematic referral to a palliative rehabilitation clinic concurrently with standard oncology treatment or standard treatment alone. The basic offer of palliative rehabilitation was two consultations and a 12-week possibility of contacting a palliative rehabilitation team, if needed. In addition, patients and family caregivers could be offered participation in a 12-week patient/caregiver school combined with individually tailored physical exercise in groups, individual consultations, or both. Contacts with the palliative rehabilitation team and participant evaluation were registered prospectively.
Between December 2014 and December 2017, 132 adults with newly diagnosed advanced cancer were seen in the palliative rehabilitation outpatient clinic. Twenty percent of the participants received the basic offer only (n = 26), 45% additionally participated in the group program (n = 59), and 35% received supplementary individual consultations without participating in the group program (n = 47). The intervention was primarily led by nurses, and the main themes of the individual consultations were coping, pain, and nutrition. When asked if they would recommend the intervention to others in the same situation, 93% of the respondents agreed, 7% partly agreed, and no one disagreed.
The new model of palliative rehabilitation presented here had a flexibility to meet the needs of the participants and led to a very high degree of patient satisfaction. It could serve as an inspiration to other cancer centres wanting to integrate palliative care into standard oncology services.
KeywordsPalliative care Rehabilitation Quality of life Neoplasms Models of care Patient satisfaction
The authors first and foremost wish to thank the patients and family caregivers participating in the study and the Patient and Relatives Council of Vejle Hospital for important input and inspiring discussions. We thank the Danish Cancer Society for conducting by invitation-only workshops during the trial period with valuable exchange of knowledge with other researchers working with patient and caregiver involvement. We thank the employees in the palliative rehabilitation team, especially facilitating nurses Birgitte Skov Zellweger and Grethe Misser Hansen for their important contribution to the study. We thank Karin Larsen for linguistic editing of the manuscript.
This study is financially supported by the Danish Cancer Society, the Research Council of Lillebaelt Hospital, the Andreas and Grethe Gullev Hansen Foundation and the Hede Nielsen Family Foundation.
Compliance with ethical standards
All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.
The study protocol, including all written material intended for study participants, was approved by The Regional Committees on Health Research Ethics for Southern Denmark on April 2, 2014 (Project ID S-20140038).
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, von Roenn JH (2012) American Society of Clinical Oncology Provisional Clinical Opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30:880–887CrossRefGoogle Scholar
- 2.Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302:741–749CrossRefGoogle Scholar
- 6.Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, 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 35:96–112CrossRefGoogle Scholar
- 7.WHO | WHO Definition of Palliative Care [Internet]. WHO. World Health Organization; 2012 [cited 2018 Nov 12]. Available from: http://www.who.int/cancer/palliative/definition/en/
- 15.Nottelmann L, Groenvold M, Vejlgaard TB, Petersen MA, Jensen LH (2017) A parallel-group randomized clinical trial of individually tailored, multidisciplinary, palliative rehabilitation for patients with newly diagnosed advanced cancer: the Pal-Rehab study protocol. BMC Cancer 17:560CrossRefGoogle Scholar
- 19.Hudson P, Remedios C, Zordan R, Thomas K, Clifton D, Crewdson M et al (2012) Guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients. J Palliat Med Mary Ann Liebert Inc 15:696–702Google Scholar
- 20.Adsersen M, Hansen MB, Groenvold M. DMCG-PAL [Internet]. Danish Palliat. Database Annu. Rep. 2016 [cited 2018 May 28]. Available from: http://www.dmcgpal.dk/
- 21.Starks H, Diehr P, Curtis JR (2009) The challenge of selection bias and confounding in palliative care research. J Palliat Med Mary Ann Liebert Inc 12:181–187Google Scholar