L. Deliens Archives

Integration of oncology and palliative care: summary of the Lancet Oncology Commission paper

BJMO - volume 14, issue 2, march 2020

N. Dhollander PhD, MSc, L. Deliens MA, PhD, MSc, S. Kaasa MD, PhD, J.H. Loge MD, PhD, T. Lundeby PhD, L. Lapeire MD, PhD, K. Beernaert MSc, PhD

SUMMARY

An international collaboration between 30 experts in oncology, palliative care, public health and psycho-oncology provided opportunities and guidelines on how to achieve full integration based on current findings of palliative care research in a Lancet Oncology Commission paper. This review provides a summary of this commission paper in which an overview is given of the different levels of palliative care and which elements of patient-centred care are crucial in the provision of optimal integrated palliative care. Due to the increase in incidence and prevalence of patients living with advanced cancer and associated care needs, palliative care should be seen as an essential component of comprehensive care throughout the life course and disease trajectory. If cure is not achievable, a combined tumour-directed approach and patient-centred approach is needed. We need to rethink and reorganise the delivery of oncology and palliative care to improve treatment and promote collaboration at the appropriate levels of care. Palliative care needs to be implemented in cancer care plans and in clinical care pathways. To guide patients and their family through the healthcare system and improve their health care outcomes, a multidisciplinary team approach is needed in which primary, secondary and tertiary palliative care providers can collaborate and communicate and in which patients can be referred to tertiary palliative care if needed.

(BELG J MED ONCOL 2020;14(2):47–55)

Preferences of advanced lung cancer patients for information and participation in medical decision-making: a longitudinal multicentre study

BJMO - volume 6, issue 4, september 2012

K. Pardon , R. Deschepper , R. Vander Stichele , J.L. Bernheim , F. Mortier PhD, D. Schallier MD, PhD, L. Deliens MA, PhD, MSc

The main objective of this dissertation was to gain insight into the preferences of advanced lung cancer patients for receiving information and participating in decision-making concerning treatment options, health-care setting transfers and end-of-life decision-making (ELDs).

In the course of one year, physicians in thirteen hospitals in Flanders, Belgium, recruited patients with initial non-small-cell lung cancer, stage IIIb or IV. The patients were interviewed with a structured questionnaire every two months until the fourth interview and every four months until the sixth interview.

At inclusion, 128 patients were interviewed at least once; thirteen were interviewed six consecutive times. Nearly all patients wanted information about diagnosis, treatment and prognosis and a small majority wanted information about palliative care and ELDs. Preferences regarding participation varied according to the type of decision. Some preferences, more specifically the preferences for information about prognosis, palliative care and ELDs and the preferences for shared decision-making, were regularly not well met by the physician. Preferences were variable over time, at least when it concerned information preferences about palliative care, ELDs and participation preferences. Family was important in medical decision-making to 69% of the patients and to almost all patients in case of incompetence.

Doctors should ask their advanced lung cancer patients at the beginning of their illness how much information and participation they want, and should keep on asking because preferences do change over time in ways they might not expect. (BELG J MED ONCOL 2012;6:132–135)