None listed
Conditions
Brief summary
This study will evaluate a new model of care which aims to improve the introduction process for new patients coming into the palliaitve care service. Palliative care is based on a philosphy that acknowledges the physical, social, psychological, spiritual and cultural elements which make up the total patient. By introducing a comprehensive multidisciplinary assessment process it is hoped that patients will feel that they have been understood and that their presenting illness is understood within a context of their own value and belief base. As a result of this multidisciplinary assessment clinic the care plan will reflect the domains of care that contribute to 'good palliative care'and that patients and their families will have a solid understanding of what they can expect from a referral to a specialist palliative care service.
Interventions
The intervention is attendance at an interdisciplinary team
The intervention is an invitation to attend an interdisicplinary clinic by way of early intoroduction to the palliative care service. Participants are asked to allow 90 minutes in which time they will spend 30 minutes with each health care provider.The intervention includes assessment of both the patient and caregiver by the nurse practitioner for physical assessment, the social worker for assistance with finances, housing and advance
The intervention is attendance at an interdisciplinary team The intervention is an invitation to attend an interdisicplinary clinic by way of early intoroduction to the palliative care service. Participants are asked to allow 90 minutes in which time they will spend 30 minutes with each health care provider.The intervention includes assessment of both the patient and caregiver by the nurse practitioner for physical assessment, the social worker for assistance with finances, housing and advanced care documents. The patient and caregiver are then separated from each other and the patient is seen by the psycho-oncology nurse who conducts a mental health screen for coping and adjustment to illness and the caregiver is assessed by the Caregiver Network Facilitator who focuses on the role of carer and identifies supports within the family network and those from agencies. The outcome measure is to determine the value of separating patient and caregiver for assessment of coping and managing with the illness and the role of caregiving. At completion of the clinic an assessment is made to determine the involvement from the palliative care service. In some cases the patient may have no pressing needs and this will be communicated back to the referrer who will resume management of the patient. Some patients will enage in a shared care arrangement where palliative care provides support for a defined period with the referrer reamaining responsible for their ongoing management. In this situation the patient will be referred to the medical assessment clinic which is the current usual care utilised for ongoing follow up. Those patients that are assessed to require the full support of the specialist palliative care team wil be followed up in an ongoing manner either through the medical assessment clinic or via the home visiting program. The frequency of follow up will depend on the assessed level of need and this will be communicated back to the referrer.
Sponsors
Kate Swetenham
Study design
Allocation
Non-randomised trial
Primary purpose
Educational / counselling / training
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient is triaged on referral as well enough to attend an outpatient clinic appointment.
Exclusion criteria
If the patient does not wish to attend the clinic this will be the exclusion criteria.
Outcome results
None listed