Is shared decision making an aspect of palliative care integration? An observation of collaboration between oncologists and palliative care professionals.

Background: Early palliative care interventions in oncology, as recommended by international oncology societies, promote patient understanding and support decision-making. At the same time, shared decision-making models are being developed to enhance patient participation as part of a new model of patient-physician relationship. For patients with palliative needs, this participation is essential and helps to avoid futile and aggressive treatments at the end of life.

Assessing the implementation and effectiveness of early integrated palliative care in long-term care facilities in France: an interventional mixed-methods study protocol.

Background: Majority of residents in long-term care facilities (LTCF) have limited and delayed access to palliative care even though many suffer from incurable chronic illnesses that will likely require the provision of palliative care. We present the study protocol of "PADI-Palli", an intervention aims to advance early integrated palliative care into standard care delivered in LTCF. This study will assess the effectiveness of early integrated palliative care on palliative care accessibility for older persons in LTCF, and identify the key factors for the successful implementation of early integrated palliative care and its sustainability in the LTCF context.

Duration of palliative care involvement and immunotherapy treatment near the end of life among patients with cancer who died in-hospital.

Background: Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, but their use near the end of life in patients with advanced cancer is poorly documented. This study investigated the association between administration of ICI therapy in the last month of life and the duration of involvement of the palliative care (PC) team, among patients with advanced cancer who died in-hospital.

Methods: In a retrospective, multicentre study, we included all patients who died in 2018 of melanoma, head and neck carcinoma, non-small cell lung cancer or urothelial or renal cancer, in 2 teaching hospitals and one community hospital in France.

Building a telepalliative care strategy in nursing homes: a qualitative study with mobile palliative care teams.

Background: Despite increasing use of telemedicine in the field of palliative care, studies about the best circumstances and processes where it could replace face-to-face interaction are lacking. This study aimed to: (1) identify situations that are most amenable to the use of telemedicine for the provision of palliative care to patients in nursing homes; and (2) understand how telemedicine could best be integrated into the routine practice of mobile palliative care teams.

Methods: A qualitative study based on semi-structured focus groups (n = 7) with professionals (n = 33) working in mobile palliative care teams in France.

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Aim: This article aims to set some theoretical and practical milestones to better understand the challenges of interdisciplinary research in palliative care.

Method: A theoretical perspective of the main challenges of interdisciplinary research is provided through a review of existing literature, supported by practical experiences learnt from the implementation of two research projects on the improvement of the organization of healthcare services in palliative care in France.

Results: Palliative care is historically and philosophically grounded in interdisciplinary culture.

First referral to an integrated onco-palliative care program: a retrospective analysis of its timing.

Background: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient's profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life.

Methods: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team.

Validity of the French version of the Autonomy Preference Index and its adaptation for patients with advanced cancer.

Background: While patient-centered care is recommended as a key dimension for quality improvement, in case of serious illness, patients may have different expectations regarding information and participation in medical decision-making. In oncology, anticipation of disease worsening remains difficult, especially when patient's preferences towards prognosis medical information are unclear. Valid tools to explore patients' preferences could help targeting end-of-life discussions, which have been shown to decrease aggressiveness of end-of-life care.

[Multidisciplinary oncopalliative meeting: Aims and pratical recommendations].

Progress leads to increase life duration at the metastatic stage but metastatic disease is most often lethal. Decision-making is necessary for an increasing period of care, beyond evidence-based medicine, dealing with complexity and uncertain benefit/risk ratio. This requires to inform the patient realistically, to discuss prognostication, to develop anticipated written preferences.

Integration and activity of hospital-based palliative care consultation teams: the INSIGHT multicentric cohort study.

Background: Hospital-based Palliative Care Consultation Teams (PCCTs) have a consulting role to specialist services at their request. Referral of patients is often late. Early palliative care in oncology has shown its effectiveness in improving quality of life, thereby questioning the "on request" model of PCCTs.

Integration of Oncology and Palliative Care, a Forgotten Indicator: Shared Decision-Making.

A review article addressing the integration of oncology and palliative care is missing an important indicator: shared decision-making in patient care between oncologists and the palliative care team.

[Respecting patient's end of life wishes: feasibility study of an information on surrogate and advance directives].

This prospective interventional study aims to show the feasibility and impact of information procedure on surrogate and advance directives (AD), for patients with incurable lung or gastrointestinal cancer. The intervention consisted of two semi-structured interviews. The first included: collection of preferences for prognostic information and involvement in decision-making, initial assessment of knowledge, information and surrogate and DA.

[Use of a standard format to describe the activity of hospital-based palliative care team: a lever for improving end of life care].

Introduction: Early integrated palliative care is recommended in patients with incurable disease. Despite their development, hospital-based palliative care teams (PCT) are introduced late in the course of standard oncology care. The objective of this study is to describe the activity of an academic hospital-based PCT, using a standard format, which integrates indicators of early introduction and quality of end of life care, thus allowing a systematic analysis of its practice.

Computerized advice on drug dosage to improve prescribing practice.

Background: Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in health care could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost-effective fashion.

Development of a set of process and structure indicators for palliative care: the Europall project.

Background: By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries.

Methods: As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed.

Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients.

Objective: To examine the impact of oncologist awareness of palliative care (PC), the intervention of the PC team (PCT) and multidisciplinary decision-making on three quality indicators of end-of-life (EOL) care.

Setting: Cochin Academic Hospital, Paris, 2007-2008.

Design And Participants: A 521 decedent case series study nested in a cohort of 735 metastatic cancer patients previously treated with chemotherapy.

Terminology for the description of the diagnostic studies in the field of EBM.

Diagnostic systematic reviews is a relatively new area within the Evidence-Based Medicine (EBM). Their indexing in Pubmed is not precise, which complicates their detection when a systematic review is to be realized. In order to provide an assistance in the selection of relevant studies, we propose to develop a terminology describing this area and the organization of its terms.

Improvement of inter-services communication through a CDSS dedicated to myocardial perfusion scintigraphy.

This study addresses the question of communication between medical wards and the nuclear medicine department for the realization of myocardial perfusion scintigraphy. It analyses the effects of a reminder for completing the content of an order form. It shows that the CDSS impacted ordering practices.

Agreement between erythrocyte sedimentation rate and C-reactive protein in hospital practice.

Background: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are frequently prescribed jointly. The usefulness of this practice is uncertain.

Methods: All patients with ESR and CRP measured at the same time in an academic tertiary hospital during a 1-year period were included.

Effects of automated alerts on unnecessarily repeated serology tests in a cardiovascular surgery department: a time series analysis.

Background: Laboratory testing is frequently unnecessary, particularly repetitive testing. Among the interventions proposed to reduce unnecessary testing, Computerized Decision Support Systems (CDSS) have been shown to be effective, but their impact depends on their technical characteristics. The objective of the study was to evaluate the impact of a Serology-CDSS providing point of care reminders of previous existing serology results, embedded in a Computerized Physician Order Entry at a university teaching hospital in Paris, France.

Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis.

Background: Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient's stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the next day despite pharmacist's alert (i.e.

Parental precocious influences on offspring cardiovascular risk markers: an exploratory study in the STANISLAS Cohort.

Familial history of cardiovascular disease is acknowledged as a risk indicator in offspring. The aim of this study was to assess whether the cardiovascular risk factors in parents predicted the risk of their children developing cardiovascular disease in a French population: the STANISLAS Cohort, in which Caucasian biparental families with at least two siblings were followed for 5 years. Silent risk factors (blood pressure, lipid traits, glycemia, BMI and waist circumference) of children were compared according to their parents' risk status in a subsample of 693 families.

Effect of alerts for drug dosage adjustment in inpatients with renal insufficiency.

Objectives: Medication errors constitute a major problem in all hospitals. Between 20% and 46% of prescriptions requiring dosage adjustments based on renal function are inappropriate. This study aimed to determine whether implementing alerts at the time of ordering medication integrated into the computerized physician order entry decreases the proportion of inappropriate prescriptions based on the renal function of inpatients.

Computerized advice on drug dosage to improve prescribing practice.

Background: Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in health care could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost effective fashion.

Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review.

Aims: To determine the prognostic value of right ventricular (RV) dysfunction assessed by echocardiography or spiral computed tomography (CT), or by increased levels of cardiac biomarkers [troponin, brain natriuretic peptide (BNP) and pro-BNP] in patients with haemodynamically stable pulmonary embolism (PE).

Methods And Results: We included all studies published between January 1985 and October 2007 estimating the relationship between echocardiography, CT or cardiac biomarkers and the risk of death in patients with haemodynamically stable PE. Twelve of 722 potentially relevant studies met inclusion criteria.