- Email: [email protected]
Moving Palliative Care From Research to Practice: Commentary on Uitdehaag et al.
Vol. 47 No. 3 March 2014
Journal of Pain and Symptom Management
515
Promoting Evidence in Practice Series Editor: Sydney M. Dy, MD, MS
Moving Palliative Care From Research to Practice: Commentary on Uitdehaag et al. Charles W. Given, PhD Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan; and Walther Cancer Foundation, Inc., Indianapolis, Indiana, USA
Research that seeks to enhance the practice of palliative cancer care continues to face challenges. The work by Uitdehaag and colleagues is a valuable article in several regards.1 The authors describe in great detail the challenges they encountered in the design and testing of their nurse-led intervention for upper gastrointestinal cancers. I commend the authors for the careful detail they present surrounding the problems in implementing the intervention and the outcome measures.2 It is unfortunate that the authors did not present more information on the symptoms experienced by patients in each arm and if nurses were better able to manage symptoms at the end of life. Patients in the nursing arm were more costly, and patients in each arm experienced a roughly equal number of hospital readmissions and primary care contacts. Those in the nurse arm reported a nonsignificant reduction in depression, but this did not extend to their health-related quality of life. Perhaps, nurse home visits are important for support and relieving isolation, but given patients’ nearness to death, the dose of the intervention could
not improve perceived health. One might suppose that a more intense dose of the nurse intervention might have produced greater differences between the two groups. These issues highlight the complexity of research on endof-life care and targeting interventions that can impact patients’ needs, deliver appropriate treatment, and contain the costs of endof-life care. Aligning these dimensions within an intervention is complex, and although not fully achieving them, this research offers insights and details to guide future work.
Address correspondence to: Charles W. Given, PhD, Department of Family Medicine, College of Human Medicine, Michigan State University, B108 Clinical
Center, East Lansing, MI 48824, USA. E-mail: [email protected] Accepted for publication: September 4, 2013.
Ó 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
References 1. Uitdehaag MJ, van Putten PG, van Eijck CHJ, et al. Nurse-led follow-up at home vs. conventional medical outpatient clinic follow-up in patients with incurable upper gastrointestinal cancer: a randomized study. J Pain Symptom Manage 2013;47: 518e530. 2. Building momentum: The science of end-of-life and palliative care. A review of research trends and funding, 1997-2010. Bethesda, MD: National Institutes of Health, National Institute of Nursing Research, 2013.
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2013.10.003
Journal of Pain and Symptom Management
515
Promoting Evidence in Practice Series Editor: Sydney M. Dy, MD, MS
Moving Palliative Care From Research to Practice: Commentary on Uitdehaag et al. Charles W. Given, PhD Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan; and Walther Cancer Foundation, Inc., Indianapolis, Indiana, USA
Research that seeks to enhance the practice of palliative cancer care continues to face challenges. The work by Uitdehaag and colleagues is a valuable article in several regards.1 The authors describe in great detail the challenges they encountered in the design and testing of their nurse-led intervention for upper gastrointestinal cancers. I commend the authors for the careful detail they present surrounding the problems in implementing the intervention and the outcome measures.2 It is unfortunate that the authors did not present more information on the symptoms experienced by patients in each arm and if nurses were better able to manage symptoms at the end of life. Patients in the nursing arm were more costly, and patients in each arm experienced a roughly equal number of hospital readmissions and primary care contacts. Those in the nurse arm reported a nonsignificant reduction in depression, but this did not extend to their health-related quality of life. Perhaps, nurse home visits are important for support and relieving isolation, but given patients’ nearness to death, the dose of the intervention could
not improve perceived health. One might suppose that a more intense dose of the nurse intervention might have produced greater differences between the two groups. These issues highlight the complexity of research on endof-life care and targeting interventions that can impact patients’ needs, deliver appropriate treatment, and contain the costs of endof-life care. Aligning these dimensions within an intervention is complex, and although not fully achieving them, this research offers insights and details to guide future work.
Address correspondence to: Charles W. Given, PhD, Department of Family Medicine, College of Human Medicine, Michigan State University, B108 Clinical
Center, East Lansing, MI 48824, USA. E-mail: [email protected] Accepted for publication: September 4, 2013.
Ó 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
References 1. Uitdehaag MJ, van Putten PG, van Eijck CHJ, et al. Nurse-led follow-up at home vs. conventional medical outpatient clinic follow-up in patients with incurable upper gastrointestinal cancer: a randomized study. J Pain Symptom Manage 2013;47: 518e530. 2. Building momentum: The science of end-of-life and palliative care. A review of research trends and funding, 1997-2010. Bethesda, MD: National Institutes of Health, National Institute of Nursing Research, 2013.
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2013.10.003