C5 Afaf Girgis.pdf

Afaf Girgis, Amy Waller & David Currow on behalf of the Palliative Care Research Team

Centre for Health Research & Psycho-oncology (CHeRP)Cancer Council NSW, University of Newcastle

and Hunter Medical Research Institute

T he si tuation of M ount L ofty was found

f rom he nce and f rom some other cr oss

bearings, to be 34 59' south and 138 42'

east . No land was visible so far to the

north as whe re the tr ees appeare d above

the horizon, which showed the c oast t o

be ve ry low, and our soundings we re

fas t de cre asing.

From noon to six o'cloc k we r an thirty

miles to the nor thward, skirt ing a sandy

shore at the distance of f ive , and thence

to eight mi le s; the depth was the n 5

fathoms, and we droppe d the anchor upon

a bottom of sand, mixe d with pie ces of

de ad coral.

Flinders University

Systematic assessment of palliative care needs: Efficacy, time, resource implications &

future directions

Centre for Health Research & Psycho-oncology (CHeRP)


National Program Team Prof Afaf Girgis, Centre for Health Research & Psycho-oncology (CHeRP), Cancer

Council NSW, University of Newcastle & Hunter Medical Research Institute

Amy Waller, Dr Claire Johnson, Emma Gorton, Christophe Lecathelanais, CHeRP

Prof David Currow, Department of Palliative and Supportive Services, Flinders University

Professor Patsy Yates, Centre for Palliative Care Research and Education, Queensland University of Technology

A/Professor Geoff Mitchell, Discipline of General Practice, University of Queensland

Professor Linda Kristjanson & Professor Patricia Davidson, Curtin University of Technology

Professor Brian Kelly & Associate Professor David Sibbritt, University of Newcastle

Professor Martin Tattersall, Discipline of Medicine, University of Sydney


Funding: Australian Government Department of Health &

Ageing Cancer Council NSW University of Newcastle & NHMRC PhD scholarship

for A Waller

Development and production of DVD: Pam McLean Cancer Communication Centre, The

University of Sydney and Royal North Shore Hospital, Sydney

Acknowledgements


Overview of Palliative Care Program (2003-2009)COMPLETED WORK (2003-2008) Phase 1: National qualitative study - perceptions of palliative care, issues

surrounding referral in the Australian health care system. [PhD - Johnson] Phase 2: National survey of doctors - current referral practices, predictors of

referral, prevalence of triggers precipitating referral for SPC. [PhD-Johnson]

Phase 3: Development of national Palliative Care Needs Assessment Guidelines and a Needs Assessment Tool, to facilitate needs-based care and enhance SPC resource utilisation.

Phase 4: Evaluation of the impact of the guidelines and tool on patient & caregiver outcomes. [PhD - Waller]

WORK UNDERWAY IN 2009 Phase 5: Development of national dissemination plan and training packages

for referrers and palliative care services Phase 6: Generalising the resources to non-cancer palliative populations (HF)


Overview of the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C)


NAT: PD-C

Operationalises the Guidelines

Aims to facilitate care based on types and complexity of needs: no problems and no need for services; minor problems (ie, low need), which may be met

by their primary health professional; medium to high needs and potentially require a

referral for full assessment by specialist services

Designed for ongoing use in both generalist and specialist care settings


Reliability & Validity of the NAT: PD-C

[POSTER 252 WALLER]


Setting & participants 50 people with advanced cancer recruited from

a specialist palliative care service (SPCS) Charles Gairdner [Wendy Scott]

Procedure SPCS staff member completed a NAT on

patient admission Second staff member completed:

Second NAT on same patient on same day Other validated measures as part of standard

practice (PCOC)

Validation in specialist PC service


Validation - analysisInter-rater reliability Did staff members respond in the same way to each

item in the NAT? [Kappa]

Validity Did staff respond in the same way to items in the PC-

NAT and Problem Severity Scale (PCPSS) items that assessed similar areas of concern? [Kappa]

Does the NAT changes in functional status item correlate with scores from: Resource utilisation groups Activities of Daily Living

(RUG-ADL)? Australian Karnofsky Performance Scale (AKPS)?


Results: HPs rated most NAT items similarly

Item N Severity of concern %

agreed PABAK

Patient wellbeing Physical 50 54% 0.31 Daily living 50 72% 0.58 Psychological 48 67% 0.51 Information 48 52% 0.28 Spiritual 48 88% 0.76 Financial 49 73% 0.60 Social 50 68% 0.52

Ability of caregiver/family to care for the patient Distress 44 48% 0.22 Physical care 45 60% 0.40 Coping 45 67% 0.51 Financial 44 77% 0.54 Information 44 68% 0.49 Relationships and functioning 42 72% 0.57 Caregiver wellbeing Physical & psychosocial Wellbeing

41 59% 0.39

Bereavement 40 58% 0.37

Kappa agreement range:0-0.2 = poor0.2-0.4 = fair0.4-0.6 = moderate0.6-0.8 = substantial 0.8-1.0 = almost perfect


Results: Comparable to validated measures

Measures NAT vs Problem Severity Score

N % agreed

PABAK

NAT Physical symptoms & PCPSS Pain 48 65% 0.48 (moderate)NAT Physical symptoms & PCPSS Other symptoms

47 49% 0.24 (fair)

NAT Psychological and PCPSS Psychological 48 63% 0.45 (moderate)

NAT Caregiver wellbeing and PCPSS Family 41 61% 0.42 (moderate)

PC-NAT level of concern

RUG-ADL (r = 0.74)

AKPS(r = - 0.84)

N Mean SD N Mean SDNone 22 4.18 0.85 21 72.86 11.02Some 22 7.59 4.10 21 55.71 11.64

Significant 5 9.80 4.38 5 42 21.68


Completion rates, impact on referrals, patient

outcomes & length of consultation

[POSTER 251 WALLER]


Evaluation study methods Setting & participants

195 patients with advanced cancer and 103 of their caregivers from 3 cancer centres (haematology, medical, radiation & gynae oncology)

Data collection: Bi-monthly CATIs for up to 15 months Audio-taped some consultations

Intervention: Health professionals trained in the Guidelines and use

of the NAT: PD-C, 5-9 months after start of recruitment NAT: PD-C completed for all participating patients

approx monthly, by oncologist, nurse, GP, PC service


NAT: PD-C completion rates 83% completion rate in oncology clinics 1+ unmet need recorded on 80% of NATs Majority of concerns addressed within the current

care systems; referrals in


Length of consultation (min) when NAT: PD-C completed vs not

Without NAT (n=15)

With NAT (n=33)

Mean (minutes) 19.7 17.4 Median 17.5 17.4 Range 9.2 - 53.5 3.5 40.0


Conclusions The NAT: PD-C:

Can be reliably completed by any HCP in specialist and generalist settings

Can assist in identifying issues of concern, particularly in areas that are not routinely well addressed in the consultation (eg psychological, caregiver issues)

Use does not lengthen consultations Has acceptable levels of reliability and validity Can facilitate communication between HCPs in

different care settings, eg as discharge planning tool Name changed to encourage use with ALL

patients with advanced cancer


National disseminationduring 2009


Dissemination of resources

Summary Guidelines and a pad of 50 NAT:PD-Cs mailed to 1000+ health services throughout Australia- 37% Community services (nursing care)- 30% Cancer treatment centres- 22% Community services providing PC nursing- 11% Palliative care services

PCOC, PEPA, COGs local support


Can Meet Needs Skills training workshopsDates so far .

Location of workshop Date of workshop WA - Perth 29th September 2009

1st October 20092nd October 2009

NSW - AlburyNSW - Sydney

22nd October 20095th November 2009

VIC - Melbourne 28th October 2009

QLD - Brisbane 4th November 20095th November 2009

TAS - LauncestonTAS - Hobart

26th November 200927th November 2009

SA - Adelaide 3rd December 2009


Dissemination online Electronic resources

GUIDELINES - http://www.newcastle.edu.au/ research-centre/cherp/professional resources/ needs-assessment.html

NAT: PD-C - http://www.newcastle.edu.au/ research-centre/cherp/professional-resources/ natpdc.html

Can Meet Needs online program (to come) http://www.newcastle.edu.au/research-

centre/cherp/CanMeetNeeds

Cancer Learning; Caresearch Medical Director ????


Watch this space .

Battery of Needs Assessment Tools: Needs Assessment Tool: Progressive

Disease Heart Failure (NAT: PD-HF) Needs Assessment Tool: Patients & Families

(NAT-P&F) (consumer version in testing phase)

Needs Assessment Tool: Caregivers (NAT-C) (caregiver version for GP intervention in testing phase)

Slide Number 1National Program Team AcknowledgementsOverview of Palliative Care Program (2003-2009)Slide Number 5NAT: PD-CSlide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Validation in specialist PC serviceValidation - analysisResults: HPs rated most NAT items similarlyResults: Comparable to validated measuresSlide Number 16Evaluation study methodsImpact on patient outcomesLength of consultation (min) when NAT: PD-C completed vs notConclusionsSlide Number 21Dissemination of resources Can Meet Needs Skills training workshopsDissemination online Watch this space .

C5 Afaf Girgis.pdf

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