INTEGRATION OF PALLIATIVE MEDICINE AND ONCOLOGY IN END-OF-LIFE CARE

Abstract

 The combination of palliative medicine and oncology is being discussed to create comprehensive end-of-life (EOL) care models where quality of life of the patient, symptom management, and psychosocial well-being are valued most highly.  The study is a retrospective regional city-based study that used a mixed-methods approach in classifying 180 patients with advanced-stage malignancies either to early or late transfer to integrated palliative-oncology units.  Quantitative analysis inferred significant improvements in patient-reported outcomes due to early referrals, i.e., less intense pain, better quality of life, and chances of dying at home as assessed by the latter.  Better EOL outcomes were highly significant when very early integration of palliative care was indicated, and as confirmed, by the multiple linear regression analysis.  There was also a significant interaction effect of type of the intervention and the date of referral on the quality of the dying experience as computed in a two-way ANOVA.  Excruciating issues such as the state of emotional preparation, dying with dignity, and ameliorating caregiver burden was uncovered based on the complementary qualitative interviews with patients, caregivers and doctors.  These qualitative results emphasized the advantage of immediate transdisciplinary cooperation and communication.  The findings underline the necessity to institutionalize integrated care pathways in the practice of oncology in terms of both medical performance and the creation of both moral and emotional support systems.  The research made possible a repeatable and tested paradigm of considering linkages of palliative and oncologic concepts in an evidence-based approach that will streamline end-of-life care.