1. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams Albert Tuca, MD, PhD Palliative Care Hospital Support Team ICMHO Hospital Clínic Universitari Barcelona, Spain

2. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Definition of Palliative Care Hospital Support Teams “Multidisciplinary specialist palliative care team which functions in an advisory and supportive capacity within a general hospital. The patients’ care remains the primary responsibility of the physician or surgeon but they are supported and advised by specialist palliative care personnel.” Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organisation of palliative care. Committee of Ministers on 12 November 2003 European Council.

3. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Main characteristics of a Palliative Care Hospital Support Team Specialist multidisciplinary Palliative Care team Function: Consultant team Setting: General Hospital (acute hospitals) Accessibility to any clinical service of hospital No own hospital beds Intervention based on shared care Intensity of Intervention according to specific complexity of every case (intervention levels)

4. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Professionals (usual structure) Doctors: 1-2 / team Nurses: 1-2 / team Social Worker:1 or part time Psychologist:1 or part time

5. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Objectives of a Palliative Care Hospital Support Team Assess the patient from a multidimensional approach Physical symptoms Psychological symptoms Family and Social needs Spiritual needs To agree the level of shared care with referral service according to clinical complexity Establish a therapeutic comprehensive plan Patient follow up during episode of hospital admission and control of response to palliative measures (pharmacological and non-pharmacological) Establish the liaison with community palliative resources at hospital discharge (case management)

6. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams Clinical complexityIntervention level Low complexity I: Advice to other professionals (clinical session) II: Evaluation and proposal but no follow up Medium complexity III: Shared care with intermittent or periodical interventions (+/-72 hours) High complexity IV: Shared care with regular interventions (48 hours) V: Intensive shared care with daily interventions or full responsibility of case

7. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Usually, Palliative Care Hospital Support Teams are the first specialized palliative unit in a general hospital  The natural development of Palliative Care in a general hospital is to create first a consultant team, after an out-patients clinic, and finally a Palliative Care Unit (Palliative Care Service) Palliative Care Support Team Out-patients clinic Palliative Care Unit

8. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Strong Points Intervention centred in patient’s needs Flexibility and accessibility (intervention according palliative complexity) Effectiveness in clinical outcomes High capacity of influence in clinical services  Weaknesses Small teams Usually, part-time psychosocial professionals Brief intervention No possibility of patients follow up at discharge if the Hospital Support Team has not an out-patients clinic

9. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Characteristics of Palliative Care Hospital Support Teams (PCHST) in Spain N PCHST in Spain:96 50% were based in University Hospitals Mean structure (n/PCHST) 1.6 doctors / team 1.9 nurses / team 0.5 social workers / team 0.7 psychologists / team Mean length of experience: 6.8 years (range: 1-20) Global workload (mean): 275 patients / year Diagnosis:90 % advanced cancer FISESH 2010 Study

10. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Characteristics of patients attended by PCHST in Spain GenderMen64% Women 36% Age (mean)69 years Patients ≤ 65 years36% FISESH 2010 Study. N= 364 Age (%)

11. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Characteristics of patients Etiologic treatment during episode of PCHST intervention or last 4 weeks 44% Cancer Chemotherapy 30% Performance Status (PPS) PPS ≤ 40%72% PPS 50-60%15% PPS ≥ 70%13% FISESH 2010 Study. N= 364

12. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams FISESH 2010 Study. N= 364

13. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Effectiveness Comparing the intensity of symptoms (VAS) from the baseline visit with the control at 72 hours after the intervention of PCHST: Differences statistically significant (p<0.001) for all symptoms except: - Asthenia - Anorexia FISESH 2010 Study. N= 364

14. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Mean stay from admission to discharge: 13 days (DST: 9.3)  Mean time between admission and first PCHST consultation 6.9 days (DST: 7.8)  Mean time between PCHST consultation and discharge 6.5 days (DST: 7.1) FISESH 2010 Study. N= 364 Admission Discharge

15. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Clinical complexity Low 85 (23,5%) Medium159 (44%) High117 (32,4%)  PCHST level of intervention Basic advice - Level 1 or 2: 74 (20,6%) Shared care - Level 3: 136 (37,9%) Intensive shared care – Level 4 or 5: 149 (41,5%) FISESH 2010 Study. N= 364

16. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Palliative Care Hospital Support Teams  Hospital discharge Exitus36 % Long or medium stay Palliative Care Unit29 % Home discharge35 % PC out-patients clinic11 % Home Support Team14 % FISESH 2010 Study. N= 364

17. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Conclusions  PCHST are hospital consultant teams in Palliative Care without own beds for admission  Intervention in any clinical service of a general hospital  Intervention based on shared care  Intensity of shared care is based on specific complexity of every case and needs of referent services (agreement of shared care)  High accessibility, flexibility and clinical effectiveness  Brief intervention and difficulties in the follow up if the team does not have an outpatients clinic  Important role in liaison of palliative resources available in their health area.

18. WHO Collaborating Centre for Public Health Palliative Care Programmes. BARCELONA. III/2011 Institut Clínic Malalties Hematològiques i Oncològiques Equip de Suport Hospitalari i Cures Pal·liatives Servei Oncologia Mèdica ICMHO Hospital Clínic Universitari de Barcelona