Are specialist-provided end-of-life scenarios key to initiation of advance care planning in primary care? A mixed-methods study.

OBJECTIVES: Specialist-provided end-of-life scenarios (SP-EOLS) may improve advance care planning (ACP) implementation in primary care by helping overcome barriers such as uncertain prognosis and poor interprofessional collaboration. We aimed to explore the current use and potential impact of SP-EOLS on ACP in Dutch primary care. METHODS: We performed a mixed-methods study. From patients discussed in a hospital-based academic palliative care multidisciplinary team meeting between 2016 and 2019 and died, we collected primary care electronic medical records data on SP-EOLS, actual EOLS, and ACP initiation and applied descriptive and comparative analyses. Subsequently, we interviewed general practitioners (GPs) and thematically analyzed the transcripts. RESULTS: In 69.7% of 66 reviewed patient files, SP-EOLS were found. In patients whose GP had received SP-EOLS, ACP conversations were more often reported (92.0 vs. 61.0%, p = 0.006). From 11 GP interviews, we identified 4 themes: (1) SP-EOLS guide GPs, patients, and relatives when dealing with an uncertain future perspective; (2) SP-EOLS provide continuity of care between primary and secondary/tertiary care; (3) SP-EOLS should be tailored to the individual patient; and (4) SP-EOLS need to be personalized and uniformly transferred to GPs. SIGNIFICANCE OF RESULTS: SP-EOLS may facilitate ACP conversations by GPs. They have the potential to help overcome existing barriers to ACP implementation by providing guidance and supporting interprofessional collaboration. Future research should focus on improving SP-EOLS and tailor them to the needs of all end users, focusing on improving their effect on ACP conversations.

[Oncology at a glance]. / Oncologie in vogelvlucht.

The prevalence of cancer is rising, on the one hand because of increasing cancer incidence as a consequence of lifestyle changes, aging and screening and on the other hand because of increasing survival rates thanks to increasingly successful therapeutic possibilities. Since virtually all caregivers are confronted with cancer patients or survivors, a basic knowledge of oncology is required. In this article we present a brief update on the current situation in the field of oncology. We pay attention to diagnostics, treatment and palliative care for patients with cancer.

[Measuring pain is useful and every doctor can do it: 7 tips]. / Pijn meten is nuttig en iedere arts kan het: 7 tips.

Pain is one of the main factors influencing quality of life; its incidence is higher than is generally assumed. Pain is not spontaneously reported in all cases; it should be asked about more often. Not measuring pain is one of the main reasons for inadequate pain treatment. Pain should be assessed and recorded more routinely in both primary and secondary healthcare. This can be done in simple and quick ways. Self-reporting using a visual-analogue scale or numeric rating scale is the preferred method. This can be done even by patients with a mild cognitive disorder. Several simple and reliable observational scales exist for patients who cannot report well, e.g. elderly patients with a cognitive disorder or young children. For chronic pain, the low-threshold use of a multi-dimensional scale will increase the likelihood of successful treatment.

Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study.

OBJECTIVE: scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and monitoring, (iv) roles and responsibilities of involved health care professionals, (v) communication and coordination of care between hospital and community health care professionals, (vi) quality indicators for malnutrition management. DESIGN: a modified Delphi study. METHODS: eleven geriatricians with special interest in malnutrition participated. In four rounds the experts rated the relevance of 204 statements, which were based on a literature review, on a five-point Likert scale. From the responses, means and 95% CIs were calculated. Consensus was defined as a lower 95% confidence limit ≥4.0. RESULTS: the panel reached consensus that malnutrition should be considered a geriatric syndrome. The nutritional status should be assessed using the Mini Nutritional Assessment combined with comprehensive geriatric assessment. Nutritional interventions should be combined with interventions targeting underlying factors. Specific goals for nutritional therapy and ways to achieve them were agreed upon. According to the experts, malnutrition is best managed by a multidisciplinary team for whom roles and responsibilities were specified. At discharge written information about the nutritional problem, treatment plan and goals should be provided to the patient, caregiver and community health care professionals. CONCLUSION: this study shows that a qualitative study based on a modified Delphi technique can result in national consensus on essential ingredients for a practical malnutrition guideline for geriatric patients.

[Indications for palliative sedation]. / Indicatiestelling voor palliatieve sedatie.

Two male patients, aged 75 and 47 years, suffered from dyspnoea in the terminal phase of their disease, COPD and lung cancer, respectively. Both were given palliative sedation. The palliative consultation team was consulted when problems occurred. Although the Royal Dutch Medical Association issued a guideline on palliative sedation, the practice of administering palliative sedation is still complicated. Determining whether a symptom is 'refractory' and estimating the life expectancy is especially complex. A symptom is refractory when it causes unbearable suffering and conventional modes of treatment are not effective or timely. Knowledge of this guideline, early anticipation of possible scenarios and communication with the patient and his family contribute to good care. The palliative consultation team can help physicians with these decisions, preferably by starting at an early stage.