Timing and Outcome of Referral to the First Stand-Alone Palliative Care Center in the Eastern Mediterranean Region,the Palliative Care Center of Kuwait

Abstract

Background:

Compared to other regions of the world, palliative care (PC) in the Eastern Mediterranean region is at an earlier stage of development. The Palliative Care Center of Kuwait (PCC-K) was established a few years ago as the first stand-alone PC center in the region. This study was conducted to investigate the timing of referral to the PCC-K and its outcome.

Methods:

Retrospective review of referrals to the PCC-K during its first 3 years of action. Late referral was defined as referral during the last 30 days of life.

Results:

During the 3-year period, 498 patients with cancer were referred to the PCC-K of whom 467 were eligible for analysis. Referral was considered late in 58% of patients. Nononcology facilities were more likely to refer patients late when compared to oncology facilities (P = .033). The palliative performance scale (PPS) was ≤30 in 59% of late referrals and 21% in earlier referrals (P < .001). Among 467 referred patients, 342 (73%) were eligible for transfer to the PCC-K, 102 (22%) were ineligible, and 23 (5%) died before assessment by the PCC-K consultation team. From the 342 eligible patients, the family caregivers refused the transfer of 64 (19%) patients to the PCC-K.

Conclusion:

Patients are frequently referred late to the PCC-K. Further research to identify barriers to PC and its early integration in Kuwait is required. The PPS may be useful in identifying late referrals.

Keywords

palliative care cancer eastern mediterranean region kuwait referral timing palliative performance scale

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References

Connor

Bermedeo

MCS

, eds. Global Atlas of Palliative Care at the End-of-Life. London: Worldwide Palliative Care Alliance, 2014. Web site. http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care. Accessed January 4, 2016.

Gray

Ezzat

Volker

. Developing palliative care services for terminally ill patients in Saudi Arabia. Ann Saudi Med. 1995;15(4):370–377.

Heedman

Starkhammar

. Patterns of referral to a palliative care unit: an indicator of different attitudes toward the dying patient? J Palliat Med. 2002;5(1):101–106.

World Health Organization. National Cancer Control Programmes: Policies and Managerial Guidelines. 2nd ed. Geneva, Switzerland: World Health Organization; 2002.

Davis

Temel

Balboni

Glare

. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med. 2015;4(3):99–121.

Baek

Shin

Choi

. Late referral to palliative care services in Korea. J Pain Symptom Manage. 2011;41(4):692–699.

Poulose

Neo

. Association between referral-to-death interval and location of death of patients referred to a hospital-based specialist palliative care service. J Pain Symptom Manage. 2013;46(2):173–181.

Hui

Kim

Roquemore

Dev

Chisholm

Bruera

. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer. 2014;120(11):1743–1749.

Ferlay

Soerjomataram

Ervik

. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Web site. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. Accessed January 4, 2016.

10.

El-Basmy

Al-Mohannadi

Al-Awadi

. Some epidemiological measures of cancer in Kuwait: national cancer registry data from 2000-2009. Asian Pac J Cancer Prev. 2012;13(7):3113–3118.

11.

Anderson

Downing

Hill

Casorso

Lerch

. Palliative performance scale (PPS): a new tool. J Palliat Care. 1996;12(1):5–11.

12.

Victoria Hospice Society. Palliative Performance Scale, version 2 (PPSv2). Victoria (BC), Canada: Victoria Hospice Society; 2001. Web site. http://www.victoriahospice.org/health-professionals/clinical-tools. Accessed January 4, 2016.

13.

Alsirafy

El Mesidy

Abou-Elela

. Where do Egyptian palliative care patients with cancer die? Am J Hosp Palliat Care. 2010;27(5):313–315.

14.

Stjernswärd

Ferris

Khleif

. Jordan palliative care initiative: a WHO Demonstration Project. J Pain Symptom Manage. 2007;33(5):628–633.

15.

Alsirafy

Abou-Alia

Ghanem

. Palliative care consultation versus palliative care unit: which is associated with shorter terminal hospitalization length of stay among patients with cancer? Am J Hosp Palliat Care. 2015;32(3):275–279.

16.

Al-Sayer

. Paediatric palliative care in Kuwait. Med Princ Pract. 2007;16(suppl 1):53.

17.

Lamont

Christakis

. Physician factors in the timing of cancer patient referral to hospice palliative care. Cancer. 2002;94(10):2733–2737.

18.

Baek

Shin

Choi

. Late referral to palliative care services in Korea. J Pain Symptom Manage. 2011;41(4):692–699.

19.

Kim

Hwang

. Association between the emotional status of family caregivers and length of stay in a palliative care unit: a retrospective study. Palliat Support Care. 2015;13(6):1695–1700.

20.

Alshemmari

Elbasmi

Alsirafy

. The place of death of patients with cancer in Kuwait. BMJ Support Palliat Care. 2015;5(5):510–512.

21.

Lau

Maida

Downing

Lesperance

Karlson

Kuziemsky

. Use of the Palliative Performance Scale (PPS) for end-of-life prognostication in a palliative medicine consultation service. J Pain Symptom Manage. 2009;37(6):965–972.

22.

Alshemmari

Ezzat

Samir

Sajnani

Alsirafy

. Symptom burden in hospitalized patients with cancer in kuwait and the need for palliative care. Am J Hosp Palliat Care. 2010;27(7):446–449.