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Integration of medical oncology and palliative care procedures in various institutional and economical settings: Development of tailored interventions based on patient needs and testing of its preliminary efficacy on patient reported outcomes, tumour

Applicant Strasser Florian
Number 142226
Funding scheme Romanian-Swiss Research Programme (RSRP)
Research institution Onkologische Palliativmedizin Palliativzentrum Kantonsspital St. Gallen
Institution of higher education Cantonal hospital of St.Gallen - KSPSG
Main discipline Clinical Cancer Research
Start/End 01.01.2013 - 31.12.2015
Approved amount 373'320.00
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Keywords (1)

Chemotherapy

Lay Summary (German)

Lead
Integration von onkologischen und palliativmedizinischen Massnahmen in verschiedenen institutionellen und wirtschaftlichen Rahmenbedingungen: Entwicklung von massgeschneiderten, auf Patientenbedürfnissen basierenden klinischen Praxis-Instrumenten und Abschätzung ihrer möglichen Wirksamkeit für die Lebensqualität von Patienten, die Tumorkontrolle und Kosten.
Lay summary
Für die Betreuung von Patienten mit unheilbarer Krebskrankheit spielen Krebsspezialisten-Teams eine zentrale Rolle. Allerdings ist die Integration von palliativmedizinischen Massnahmen in die klinische Routine eine Herausforderung, insbesondere bei limitierten ökonomischen Ressourcen. Klinische Praxis- Instrumente können sowohl die Patientenbedürfnisse sichtbarer machen wie auch spezifische palliativmedizinische Massnahmen in die onkologische Praxis integrieren. Für diese Massnahmen ist eine Abschätzung ihrer Wirksamkeit auf patientenbezogene Endpunkte, Tumorkontrolle, chemotherapiebezogene Nebenwirkungen sowie Gesundheitskosten wichtig.

Das gemeinschaftliche Forschungsprogramm zwischen Rumänien und der Schweiz fokussiert sich auf 5 onkologische Einrichtungen in Rumänien und eine in der Schweiz. Die Forschungshypothese ist, dass die Bereitstellung von massgeschneiderter Hilfestellung in der klinischen Praxis, basierend auf vorher erhobenen epidemiologischen Daten in jedem Institut, die Ergebnisse verbessern kann. Zuerst werden Patientendaten mit validierten Instrumenten zu Symptomen sog. palliativen Schlüsselinterventionen gesammelt. Daraufhin werden die Daten gemeinsam an einem Workshop, und unter Beizug von intl. Experten, analysiert. Anschliessend werden spezifische Interventionen (Schulungen von Krebsspezialistenteams, Einsatz von Patienten-Erfassungsinstrumenten in die Routine, Monitoring von palliativen Interventionen) in jeder der 5 Institutionen eingesetzt und ihre mögliche Wirksamkeit in einer Pilotstudie abgeschätzt. Ein abschliessender Workshop fasst die Resultate zusammen für die Weiterentwicklung in Rumänien.

Unsere Arbeit hat einerseits zum Ziel, die onkologisch palliativmedizinische Versorgung in Rumänien zu optimieren. Andererseits werden die erhobenen Daten für die Planung zukünftiger Studien im Bereich der onkologischen Palliativmedizin in Ländern mit limitierten ökonomischen Ressourcen hilfreich sein.

Direct link to Lay Summary Last update: 15.01.2013

Responsible applicant and co-applicants

Employees

Collaboration

Group / person Country
Types of collaboration
Institute of Oncology Bucharest Romania (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
End of Life Research Group Belgium (Europe)
- Exchange of personnel
Institutul Oncologic Cluj Romania (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
SAKK Statistic Group Switzerland (Europe)
- Exchange of personnel
Regional Oncologic Institute Iasi Romania (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Spitalul Judetean de Urgenta Alba Iulia Romania (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Hospice Casa Sperantei Romania (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
The 9th World Research Congress of the EAPC Poster Unmet Needs for Key Interventions Palliative Cancer Care in Patients with Advanced Cancer: Comparison of Romanian and Swiss Results 09.06.2016 Dublin, Ireland Strasser Florian;
National Conference of the Romanian Society for Medical Oncology SNOMR IOB 2015 Talk given at a conference Palliative and Supportive Care in Advancerd Lung Cancer 08.10.2015 Poiana Brașov, Romania Strasser Florian;
The 14th World Congress of the EAPC Poster The patient´s view: 268 advanced cancer patients´ self-reported prioritized symptoms and which hcp took care of them 08.05.2015 Copenhagen, Denmark Strasser Florian;
The 14th World Congress of the EAPC Poster Quality of Death and Dying – 75 Advanced Cancer Patients’ Dying. Experience from the View of their Family Members 08.05.2015 Copenhagen, Denmark Strasser Florian;
The 14th World Congress of the EAPC Poster Advanced Cancer Patients’ Worries Related to End-of-Life and Perceived Communication with Health Care Professionals 08.05.2015 Copenhagen, Denmark Strasser Florian;
The 14th World Congress of the EAPC Poster Exploring of factors affecting recruitment in a longitudinal, multicentre, observational study of key interventions palliative cancer care (KIPCC) 08.05.2015 Copenhagen, Denmark Strasser Florian;
The Conferences of the Regional Institute of Oncology Iasi, Romania (CONFER 2014) Talk given at a conference Impact of palliative care interventions on cancer outcomes 29.11.2014 Iasi, Romania Strasser Florian;
Palliative Care Congress Biel (Switzerland) Poster Key Interventions of Palliative Cancer Care- Gaps between need and delivery:A longitudinal multicenter study 26.11.2014 Biel, Switzerland Strasser Florian; Magaya-Kalbermatten Natalie;
SAKK Semi-Annual Meeting Talk given at a conference Invited presentation in the working group the network of outcome research on Mapping patient perceived need for palliative care interventions and perceived delivery of them by health care professionals. 20.11.2014 Bern, Switzerland Strasser Florian;
ESMO Congress Poster Key Interventions of Palliative Cancer Care (KI-PCC) - patient perceived need and remembered delivery by health-care professionales (HCP): A prospective, longitudinal, multicenter study 26.09.2014 Madrid, Spain Strasser Florian;
Oncology Days-Oncology Institute “Prof Dr I. Chiricuta" Poster Integration of medical oncology and palliative care procedures in various institutional and economical settings 12.06.2014 Cluj, Romania Achimas Patrick;
National Research Conference on Palliative Care (SAMW) Poster Romanian-Swiss Research Program IZERZO: Protocol development of the “Reality Map of Integrated Oncology and Palliative Care (PC) in Romanian Cancer Centres” 26.11.2013 Bern, Switzerland Strasser Florian; Magaya-Kalbermatten Natalie;
SAKK Semi-Annual Meeting Talk given at a conference Invited presentation in the working group the ntework of outcome research on quality indicators exemplifying this project. 20.11.2013 Basel, Switzerland Strasser Florian;
Palliative Care National Conference Talk given at a conference Early integration of oncology and palliative care on the example of cancer cachexia 24.10.2013 Sibiu, Romania Strasser Florian;


Self-organised

Title Date Place
3. Implementation IZERZO Project at St Luke Hospital 16.01.2016 Bukarest, Romania
2. Presentation IZERZO Project Results at St Luke Hospital 16.11.2015 St Luke Hospital, Bucharest, Romania
1. Presentation IZERZO Project at St Luke Hospital 16.09.2015 St Luke Hospital, Bucharest, Romania
Research Seminar Palliative Care, Kantonsspital St. Gallen (Switzerland) 28.05.2014 Kantonsspital St Gallen, Switzerland

Knowledge transfer events



Self-organised

Title Date Place
Implementation of Checklists in clinical practice of medical oncologists 20.11.2015 Bucharest, Romania

Communication with the public

Communication Title Media Place Year
Talks/events/exhibitions Communicating the diagnosis and the prognosis- an actual problem International 2015
Talks/events/exhibitions Practical Guidelines Elaborated During the Romanian Swiss Partnership IZERZO- Integration of medica International 2015
Talks/events/exhibitions Research in Medical Oncology and Palliative Care International 2015
Talks/events/exhibitions Ïllness and Prognosis Understanding in Routine Care International 2014
Talks/events/exhibitions Integration of medical oncology and palliative care procedures in various institutional and economic International 2014
Talks/events/exhibitions Mid-term meeting International 2014
Talks/events/exhibitions National Congress of Romanian Society of Anaesthesia and Critical Care International 2014

Awards

Title Year
Second Prize for Poster "Key Interventions of Palliative Cancer Care- Gaps between need and delivery:A longitudinal multicenter study" at Palliative Care Congress Biel (Switzerland), palliative.ch, 26th November 2014. 2014

Abstract

Background: In the care of advanced incurable cancer patients medical oncologists play a sentinel role in not only providing tumour directed treatment, but also in identifying and treating palliative care needs. In busy oncological clinics and more pronounced in resource restricted settings, the integration of palliative care procedures in daily practise however is challenging. Models of integrated oncology and palliative care are developing, one important is the ESMO designated centers incentive program providing 13 criteria’s. However this is linked to substantial institutional commitments, which might not be rapidly feasible on the necessary time. Therefore the provision of clinical practise tools to integrate specific palliative care procedures into daily practise of medical oncologists and testing their effects on patient reported outcomes, tumour control including anticancer treatment toxicities and also health services costs seems timely and appropriate. These interventions can be summarized under promoting of illness understanding, multidimensional symptom assessment and management, indication criteria of chemotherapy in palliative intention, care plans to promote continuity of care in support networks and proactive end of life preparation including family members. Aim: The joint research program between Romania and Switzerland focuses on 4 institutions in Romania and one institution in Switzerland. The research hypothesis is that the provision of tailored clinic practice tools, based on prior epidemiological data in each institution, can improve outcomes. Methods: The research plan includes collection of real-practice patient-based data, development of tailored educational & clinical practice tools interventions based on these results, and testing for feasibility and collection of information about preliminary efficacy on the levels patient reported outcomes, tumor control, and costs.First a workshop for protocol finalization will be conducted in Romania including the 4 institutions and the principle investigators, this to ensure development of research capacities. The second phase will include for 6 months in all 4 institutions collection of patient needs with validated tools for symptoms, but also the other for key interventions, collected by a research nurse locally spending 30 minutes per patient, who are selected randomly. Parallel the palliative outcome scale will be validated according to standard procedures and formal translation. In the third phase, data will be analyzed and a second workshop of two days conducted in Romania, including all participant research personal and selected European leaders of medical oncology in palliative care. Decisions will be made about which tailored interventions are provided in each institution. In the fourth phase these interventions will be implemented as pilot projects, mainly focusing on feasibility, led by the local institutions, supported by experts in palliative care education and in medical oncology, utilizing also the international network of educators in oncological palliative medicine (ESMO palliative care working group and international association of hospice and palliative care). Examples of interventions are the use of pain intensity, presence of depression, and weight loss (%) in every patient seen by medical oncologists. Another example includes the documentation of the goals of anticancer treatment including pre-chemotherapy evaluation of cancer-related symptoms and patient-rated importance of expected toxicities. Another example may encompass the provision of a care plan coordinating also home care services and continuity of care with the oncologist. The educational effects will be tested by knowledge tests to assure effectivity. In a fifth phase information about preliminary efficacy will be collected based on patient reported outcomes, tumour control and chemotherapy toxicities and also health services used to extrapolate costs. In the final phase this data will be also analyzed and discussed in a third workshop, where it will be decided on potential intervention trials for exploring effectiveness of new clinical practice tools and palliative care procedures webbed in medical oncology care. Expected impact: It is foreseen to publish several manuscripts based on this research, guided by investigators from Romania. The results will provide the basis for further implementation research of tailored interventions of palliative care procedures provided by medical oncologists.
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