ABSTRACT
OBJECTIVES: Following three years of a terminal care support team (TCST) activity: (a) to describe current management of terminally ill patients from the care providers' viewpoint, (b) to compare the views of head nurses and physicians about this management, and (c) to identify ways of further improving palliative care. METHODS: A questionnaire was sent to all head nurses and physicians of the hospital. RESULTS: Care-providers consider that the TCST provides therapeutic counselling, training, and psychological help to patients, staff, and families. Few care providers were reluctant to request advice in the management of their patients. Most were satisfied with the partnership with the TCST and deemed it effective. Further improvements suggested for terminally ill patient care included greater assistance from the TCST, especially for nurses, and expanding TCST activities to outpatient management and home care programs. CONCLUSION: Health care providers consider the implementation of the TCST to have been successful.
Subject(s)
Outcome Assessment, Health Care , Patient Care Team/organization & administration , Terminal Care/organization & administration , Attitude of Health Personnel , Hospitals, University , Humans , Interprofessional Relations , Needs Assessment , Paris , Professional-Patient Relations , WorkloadABSTRACT
Three long-term intravenous infusion strategies were compared, namely an implantable port (IP), a tunneled central catheter (TCC), and repeated peripheral catheterization (RPC). A decision analysis model was used in which the sequence of decisions and their possible consequences was described as a decision tree for each of the three strategies. The likelihood of each event occurring was determined based on a literature review. Each event was assigned a cost and a utility. Direct medical costs for the society include the cost of the material, the cost of implantation and removal of the device in the operating room, and the cost of treating complications directly ascribable to the strategy used. Utility is a combination of efficacy (as evaluated based on the likelihood of use of the strategy for one year) and quality of life (as evaluated by experts). In the basic analysis, RPC was the most cost-saving method but had an adverse effect on quality of life (0.82). The cost of using IC or TCC for one year was higher, with the main contributors to the excess cost being the insertion procedure and the management of complications (primarily deep vein thrombosis and infection). Quality of life was better with IC (0.98) than with TCC (0.93). IC also had a higher cost-utility ratio (11,738 French francs [FF]) versus 17,393 FF). A one-way sensitivity comparison of IC and TCC showed that the only realistic change capable of reversing the order between these two methods was a decrease by one-third in the risk of infection with TCCs. This model, used here for the first time, establishes that IC is superior over TCC.
