Improving the processes and times of referring cancer patients to palliative care is the objective of a consensus document of the Spanish Association Against Cancer, the Spanish Society of Medical oncology (SEOM) and the Spanish Society of Palliative Care (SECPAL) which identifies barriers and proposes fourteen elements for improvement.
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Image of one of the rooms of the Clinical Hospital of valencia. EFE/Kai Försterling
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Image of one of the rooms of the Clinical hospital of Valencia. EFE/Kai Försterling
The lack of healthcare resources and professionals with specific training, both in primary care and in hospitals, delays the hospitalization times of cancer patients who require palliative care, is one of the conclusions of the document.“Processes and times for sending cancer patients to palliative care. Search for elements of improvement”.
According to these patient and doctor organizations, in Spain there are almost 130,000 patients with complex palliative needs, but 80,000 do not receive quality palliative care due to inequalities in access and quality associated with geographical, socioeconomic factors and the different training of healthcare professionals.
Palliative care is an essential part of healthcare systems in general and cancer care in particular. According to the World Health Association (WHO), they improve the quality of life of patients, whether adults or children, and their families, when they are faced with problems related to untreatable diseases.
What barriers do palliative care in cancer have?
The experts who wrote this document have identified the main barriers or deficits of palliative care in relation to cancer.
- 1) Screening and identification of palliative care needs: healthcare providers sometimes have difficulty identifying patients who require palliative care, resulting in delays in referral. This is partly due to “feeling like an immortal patient”where there is resistance to accepting the need for palliative care.
- 2) Activation of bypass systems: The existence of a primary caregiver and effective communication with the family are necessary for adequate referral, as occurs, for exmaple, in rural areas with aging populations, and for information on the provision of palliative care.
- 4) Lack of human resources in primary and hospital care. There is a very low
- 5) Training of healthcare workers: The lack of healthcare personnel trained in palliative care, both medical and nursing, and the lack of accredited units for extensive palliative care limits the ability of professionals to identify and correctly refer patients who require this care.
- 6) Consultation time: It is not sufficient for the correct identification, referral and treatment of cancer patients who require palliative care. the pressure of care prevents healthcare professionals from dedicating the time necessary for complete and adequate care in consultation.
- 7) Hay different models of care which vary between different autonomous communities and even between hospitals within the same community, implying inequalities in access and quality of palliative care.
- 8) Coordination: deficiencies in the necessary fluid communication and close collaboration between oncology and palliative care professionals are observed, which negatively impact the continuity and quality of care received by patients.
- 1) Promotion of advance directives: Carry out communication campaigns to encourage advance care planning and signing of advance directive documents.
- 2) Creation of multidisciplinary working groups work on developing agreed baselines, an immediate action that can be taken forward with existing resources and staff, improving coordination and overall patient care.
- 3) Common clinical sessions: Establish joint clinical sessions between oncology and palliative care, an action that can be initiated and adapted locally and does not require large investments.
- 4) Continuous training on palliative care for oncologists, palliative care professionals and general practitioners. And facilitate rotations between oncologists and palliative care teams.
- 5) Social awareness through campaigns, educational and community activities.
- 6) increased functionality: priority to establish hospital palliative care support teams in all centres.
- 9) Development of protocols and common standards of care across oncology, palliative care and primary care. It does not require large investments, but requires a large coordination effort.
- 10) Implementation of self-reliant functional units in hospitals where patients can receive care from multiple specialists in a single visit. The organization of each hospital center and the need for self-financing make this proposal difficult to implement and generalize in the short term.
- 12) Standardization of attention and follow-up timesalthough the variability in resources and structure of health services in different regions complicates the implementation of uniform standards.
- 13) Creation of organic palliative care services. The scientific societies participating in this consensus believe that, to this end, it would be convenient to create the MIR specialty of palliative care.
- 14) Achievement of continuity of care 24/7, specific for people with palliative needs, since it requires investment, it is necessary to motivate, raise awareness and influence for administrations to implement it.
SEOM and SECPAL propose:
What are the main barriers to accessing palliative care for cancer patients in Spain?
Interview: Improving Palliative Care for Cancer Patients in Spain
Editor: Welcome to Time.news. Today, we have the pleasure of speaking with Dr.Ana Martínez, a leading expert in palliative care and one of the authors of the recent consensus document addressing the referral processes for cancer patients to palliative care in Spain. Thank you for joining us, Dr. Martínez.
Dr. Martínez: Thank you for having me.It’s an critically important topic that needs more awareness and discussion.
Editor: Absolutely. The consensus document highlights several barriers in the current system for referring cancer patients to palliative care. Could you elaborate on what the key obstacles are?
Dr. Martínez: Certainly. one of the major barriers is the screening and identification of palliative care needs. Frequently enough, healthcare providers struggle to recognize when a patient requires palliative care. This can lead to critically important delays in referrals. The perception among some patients and even providers can be that seeking palliative care is equivalent to giving up hope, which we know isn’t the case.
Editor: That’s an intriguing point—this idea of feeling like an “immortal patient.” How can healthcare professionals change this mindset among their patients?
Dr. Martínez: It starts with education and interaction. We need to build a narrative around palliative care that emphasizes its role in enhancing quality of life rather than as a last resort. Training healthcare professionals to recognize the signs of palliative care needs is essential. It’s also about fostering an environment where patients feel comfortable discussing their worries and needs throughout their treatment journey.
Editor: Another barrier mentioned in the document is the activation of bypass systems. How does this impact patients, particularly in rural areas?
Dr. Martínez: In rural areas, patients often rely on primary caregivers for support, and effective communication is key. However, if primary caregivers are not adequately trained or equipped with details about palliative care, patients may miss out on essential services.this lack of support can exacerbate feelings of isolation and lead to disparities in care quality, often exacerbated by geographical and socioeconomic factors.
Editor: Speaking of education, the document also cites a shortage of trained professionals in both primary and hospital care settings. What steps can be taken to address this issue?
Dr.Martínez: Increasing the number of trained healthcare professionals in palliative care is crucial. This can be pursued thru specialized training programs and curricula in medical schools focusing on palliative care. Additionally, ongoing professional growth and workshops can help existing staff enhance their skills.Partnerships between hospitals and palliative care organizations can also create mentorship opportunities.
Editor: It sounds like a extensive approach is needed. With nearly 130,000 cancer patients in Spain having complex palliative needs yet many lacking quality care, what are the fourteen elements proposed for betterment in the document?
Dr. Martínez: The fourteen elements encompass various strategies, including better training, enhanced communication frameworks, standardized referral protocols, and improved public awareness about palliative care. We need to work collaboratively as a healthcare system to reduce inequalities and ensure that every patient has access to the care they need.
Editor: It seems like public awareness is critical.How can we encourage families and patients to engage more with palliative care services?
Dr. martínez: Public awareness campaigns can play a vital role. By sharing stories, improving understanding, and dispelling myths about palliative care, we can help families feel more empowered to seek help.Additionally, healthcare providers should have the resources to provide clear information about the benefits of palliative care as part of the cancer treatment process.
Editor: Thank you, Dr. Martínez, for your valuable insights. It is evident that improving palliative care for cancer patients in Spain requires a multi-faceted approach involving education, resources, and awareness. We hope this consensus document sparks the necessary discussions and actions for real change.
Dr. Martínez: Thank you for highlighting these issues. The more we talk about palliative care, the closer we get to making a meaningful difference in patients’ lives.
