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We were not able to recruit participants to enrol the study. As it was not able, the investigation team decided not to proced.
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In the last decades, the number of people living with chronic diseases had increased, mainly due to the aging of the population. Such chronic, progressive, life threatening and burdening diseases, play an important role in this new era of palliative care.
Despite the growing scientific and social interest in palliative care, there is still a delay in the identification of patients with palliative care needs. This leads to a late integration in a palliative care network and consequent deprivation of the major advantages of an early and progressive integration.
The aim of this study is to evaluate the role of palliative care training and the use of a structured tool, in the identification of the elderly population in need of palliative care by family physicians. And also to conduct a prevalence study to further the knowledge about how many elder people in primary care have the need of a palliative care approach.
The study consists of two phases:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | No Intervention | GPs (fellows and specialists) from Center Healthcare Administrative Region that will be given no intervention | |
| Identification tool group | Experimental | GPs (fellows and specialists) from Center Healthcare Administrative Region that will receive access to the Identification tool Supportive and Palliative Care Indicators Tool (SPICT-PT) with a brief training on how to use it. |
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| Standard Palliative Care Training | Experimental | GPs (fellows and specialists) from Center Healthcare Administrative Region that will receive palliative care training according to the Center Healthcare Administrative Region standard model of training. |
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| Clinical cases based Palliative Care Training | Experimental | GPs (fellows and specialists) from Center Healthcare Administrative Region that will receive palliative care training using a clinical cases based model. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Palliative care training | Other | Intervention will consist on providing different types of palliative care training to identify the most accurate on improving GPs' identification of palliative care patients skills |
| Measure | Description | Time Frame |
|---|---|---|
| GPs' rate of identification of patients with palliative care needs | Each GP will have to identify, before each intervention, from a set of fictitious clinical cases constructed for this purpose, which patients need palliative care. After each intervention, they will re-evaluate the same clinical cases and will be asked to identify again which patients need palliative care. Each intervention will be measured according to the identification accuracy. | 2 weeks |
| Prevalence geriatric patients with palliative care needs | Number (% of patients) of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs. | 6 months |
| Sociodemographic characteristics of geriatric patients with palliative care needs | Age (in years), sex (male or female), marital status (single, married, divorced, widow, marriage) and job of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs. | 6 months |
| Clinical characteristics of geriatric patients with palliative care need | Main diseases, main symptoms, number of contacts with GP/year of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs. | 6 months |
| Complexity of geriatric patients with palliative care need | Complexity of of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs, evaluated using ICD-Pal tool | 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Carlos Seiça Cardoso, MD | Faculty of Health Science - University of Beira Interior | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Center Healthcare Administrative Region | Coimbra | 3025 | Portugal |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25468153 | Background | Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O'Donnell M, Sullivan R, Yusuf S. The burden of disease in older people and implications for health policy and practice. Lancet. 2015 Feb 7;385(9967):549-62. doi: 10.1016/S0140-6736(14)61347-7. Epub 2014 Nov 6. | |
| 25395577 | Background | Murray SA, Firth A, Schneider N, Van den Eynden B, Gomez-Batiste X, Brogaard T, Villanueva T, Abela J, Eychmuller S, Mitchell G, Downing J, Sallnow L, van Rijswijk E, Barnard A, Lynch M, Fogen F, Moine S. Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med. 2015 Feb;29(2):101-11. doi: 10.1177/0269216314545006. Epub 2014 Nov 13. |
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The study will be conducted in accordance with the principles expressed in the Declaration of Helsinki. It has full approval from the Ethics Committee of the Faculty of Health Sciences, University of Beira Interior. Study results will be published in peer-reviewed journals and presented at national and international conferences.
Between June 2019 and October 2020
A descriptive analysis will be performed to all study variables, namely the number of valid observations, mean, standard deviation, median and range for quantitative variables and absolute and relative frequencies for qualitative variables whenever it will be considered adequate.
According to previous reports , patients with palliative care needs will be defined as ≥2 positive general indicators or ≥1 positive disease-specific indicators in the SPICT.
Comparisons between two or more independent groups of quantitative variables will be performed using Pearson's Chi2 test or Fisher's exact test, analysis of variance (ANOVA) or non-parametric Kruskal-Wallis test. All tests will be two-sided using a significance level of 0.05. Statistical analysis will be conducted using Statistical Package for the Social Sciences (SPSS) V.24.0 or higher.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jun 10, 2019 | Jun 18, 2019 | Prot_000.pdf |
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The GPs (fellows and specialists) from Center Healthcare Administrative Region will be invited to take part in this trial. The invitations will be conducted with the help of the Center Healthcare Administrative Region and by spreading the invitation in some general practice professionals' mailing lists and online platforms.
First, GPs will be contacted and those who accept to participate will be randomized into one of the four-harm study groups - 1. Control Group, 2. Identification tool group, 3. Standard PC training, 4 - Clinical cases based PC training.
The accuracy on the identification before and after intervention will be compared within each group and between the four groups using a clinical record based identification tool (CCB-PCId).
A PC expert panel will build a tool, clinical record based, to evaluate the accuracy of palliative care needs identification.
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| 12465692 | Background | Mitchell GK. How well do general practitioners deliver palliative care? A systematic review. Palliat Med. 2002 Nov;16(6):457-64. doi: 10.1191/0269216302pm573oa. |
| 7510562 | Background | McWhinney IR, Stewart MA. Home care of dying patients. Family physicians' experience with a palliative care support team. Can Fam Physician. 1994 Feb;40:240-6. |
| 21383364 | Background | Morrison RS, Dietrich J, Ladwig S, Quill T, Sacco J, Tangeman J, Meier DE. Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood). 2011 Mar;30(3):454-63. doi: 10.1377/hlthaff.2010.0929. |
| 21412898 | Background | Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ. Interventions for improving palliative care for older people living in nursing care homes. Cochrane Database Syst Rev. 2011 Mar 16;2011(3):CD007132. doi: 10.1002/14651858.CD007132.pub2. |
| 24694377 | Background | De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. General practitioners' perspectives on the avoidability of hospitalizations at the end of life: A mixed-method study. Palliat Med. 2014 Jul;28(7):949-958. doi: 10.1177/0269216314528742. Epub 2014 Apr 2. |
| 25852203 | Background | Beernaert K, Deliens L, De Vleminck A, Devroey D, Pardon K, Van den Block L, Cohen J. Is There a Need for Early Palliative Care in Patients With Life-Limiting Illnesses? Interview Study With Patients About Experienced Care Needs From Diagnosis Onward. Am J Hosp Palliat Care. 2016 Jun;33(5):489-97. doi: 10.1177/1049909115577352. Epub 2015 Apr 7. |
| Background | K, T. Using prognostic indicator guidance to plan care for final stages of life. Prim. Heal. Care 6, 25-28 (2010). |
| 21801517 | Background | Abarshi EA, Echteld MA, Van den Block L, Donker GA, Deliens L, Onwuteaka-Philipsen BD. Recognising patients who will die in the near future: a nationwide study via the Dutch Sentinel Network of GPs. Br J Gen Pract. 2011 Jun;61(587):e371-8. doi: 10.3399/bjgp11X578052. |
| 24950525 | Background | Maas EA, Murray SA, Engels Y, Campbell C. What tools are available to identify patients with palliative care needs in primary care: a systematic literature review and survey of European practice. BMJ Support Palliat Care. 2013 Dec;3(4):444-51. doi: 10.1136/bmjspcare-2013-000527. |
| 26201214 | Background | Walsh RI, Mitchell G, Francis L, van Driel ML. What Diagnostic Tools Exist for the Early Identification of Palliative Care Patients in General Practice? A systematic review. J Palliat Care. 2015;31(2):118-23. doi: 10.1177/082585971503100208. No abstract available. |
| 30447382 | Background | Hamano J, Oishi A, Kizawa Y. Prevalence and Characteristics of Patients Being at Risk of Deteriorating and Dying in Primary Care. J Pain Symptom Manage. 2019 Feb;57(2):266-272.e1. doi: 10.1016/j.jpainsymman.2018.11.006. Epub 2018 Nov 15. |
| 24403380 | Background | Gomez-Batiste X, Martinez-Munoz M, Blay C, Amblas J, Vila L, Costa X, Espaulella J, Espinosa J, Constante C, Mitchell GK. Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study. Palliat Med. 2014 Apr;28(4):302-11. doi: 10.1177/0269216313518266. Epub 2014 Jan 8. |
| 24644193 | Background | Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care. 2014 Sep;4(3):285-90. doi: 10.1136/bmjspcare-2013-000488. Epub 2013 Jul 25. |
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| 29425053 | Background | Hamano J, Oishi A, Kizawa Y. Identified Palliative Care Approach Needs with SPICT in Family Practice: A Preliminary Observational Study. J Palliat Med. 2018 Jul;21(7):992-998. doi: 10.1089/jpm.2017.0491. Epub 2018 Feb 9. |
| Background | Pimentel, J. P., Durval, M., Araújo, F. O. & Guerreiro, A. C. ACeS Baixo Mondego. (2017). |
| Background | Martin Rosello ́ ML, Fernandez Lopez A, Sanz-Amores R, et al. Instrument Diagnosing Complexity in Palliative Care, IDC-Pal. Junta Andaluc ́ıa Cons Igualdad, Salud y Pol ́ıticas Soc [Internet] 2014. Available from: http://www.juntadeandalucia.es/salud/export/sites/csalud/galerias/documentos/ p_3_p_3_procesos_asistenciales_integrados/cuidados_paliativos/idc_pal_ 2014.pdf. [Accessed 6 April 2019]. |