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Chair ICO/UVIC-UCC of palliative care at the University of Vic - Central University of Catalonia: An innovative multidisciplinary model of education, research and knowledge transfer
Abstract
Objectives
Generation and dissemination of knowledge is a relevant challenge of palliative care (PC). The Chair Catalan Institute of Oncology (ICO)/University of Vic (UVIC) of Palliative Care (CPC) was founded in 2012, as a joint project of the ICO and the University of Vic/Central of Catalonia to promote the development of PC with public health and community-oriented vision and academic perspectives. The initiative brought together professionals from a wide range of disciplines (PC, geriatrics, oncology, primary care and policy) and became the first chair of PC in Spain. We describe the experience of the CPC at its fifth year of implementation.
Methods
Data collection from annual reports, publications, training and research activities.
Results
Results for period 2012–2017 are classified into three main blocks: (1) Programme: (a) The advanced chronic care model (Palliative needs (NECPAL)); (b) the psychosocial and spiritual domains of care (Psychosocial needs (PSICPAL)); (c) advance care planning and shared decision making (Advance care planning (PDAPAL)); and (d) the compassive communities projects (Society involvement (SOCPAL)). (2) Education and training activities: (a) The master of PC, 13 editions and 550 professionals trained; (b) postgraduate course on psychosocial care, 4 editions and 140 professionals trained; and (c) workshops on specific topics, pregraduate training and online activities with a remarkable impact on the Spanish-speaking community. (3) Knowledge-transfer activities and research projects: (a) Development of 20 PhDs projects; and (b) 59 articles and 6 books published.
Conclusion
Being the first initiative of chair in PC in Spain, the CPC has provided a framework of multidisciplinary areas that have generated innovative experiences and projects in PC.
... 1 In this context, it is essential that healthcare professionals (HCPs) received proper training to ensure the provision of quality healthcare based on integrative, collaborative models of EOL care. 8 Unfortunately, although educational and training programmes have started to focus more on issues related to this type of care, most academic training programmes provide only limited content on EOL care. 9 There is a growing awareness of the need to implement changes in undergraduate and postgraduate education to expand knowledge of palliative care (PC) and EOL care. 1 10 11 In this regard, Catalonia (Spain) has been a pioneer, through the implementation of public programmes that are aligned with international recommendations for PC. 12 At present, there is by copyright. ...
... This MsPC was first offered in 1997 by the UB and later transferred to the University of Vic (UVic). 8 The main objective of the MsPC is to provide HCPs with advanced training in the following areas: symptom management, comprehensive care, biopsychosocial and spiritual assessment, communication and bioethics. The programme emphasises on the multidimensional, interdisciplinary approach, and the curriculum is primarily based on recommendations from the European Association of Palliative Care 10 and WHO. 13 In recent years, the MsPC has evolved a series of changes, the most important being those that were implemented in 2012-the eighth edition. ...
Objective:
To assess the impact after 20 years of a Master's degree in palliative care (MsPC) on the participants' educational outcomes in terms of educational needs satisfaction, motivation, applicability and professional development (PD) in the palliative care (PC) field.
Methods:
A cross-sectional study was conducted between October 2016 and February 2017. Participants were students of the MsPC from 13 editions. An ad hoc survey comprising closed-end questions was provided. Variables such as sociodemographic and learning outcomes, based on Kirkpatrick's model, were included.
Results:
Respondents were 76.6% women, and 60% were between 30 and 50 years of age. Over half of participants were physicians (57.4%), with >15 years of experience (52%). 77% (n=152) reported previous work experience (PWE) in PC, and 23% (n=45) had no PWE. After completing the MsPC, 49% of those without PWE were hired to work in a PC unit, while 84,2% with PWE continued work in a PC-related position. 51.6% professionals with PWE were currently working in other PC areas, such as training or research. High scores were observed on expectations, training needs, motivation in professional practice, PD, applicability and satisfaction, in both groups. Data have shown statistically significant differences on the perceived value of the MsPC to obtain work in the PC field (p=0.006).
Conclusions:
This MsPC training programme improves educational outcomes, and promotes PD, regardless of PWE in PC. Interdisciplinary training for all professionals who care for PC individuals is required. To ensure the quality of education in PC programmes, a systematic process of continuous evaluation is needed.
... Three different clusters have been identified based on research interests among the authors within this field. The first cluster is the red color coded cluster which includes collaboration among significant author like Gomez-Batiste et al. (2019). The research focus of this red cluster includes paper entitled like "Chair ICO/UVIC-UCC of palliative care at the University of Vic -Central University of Catalonia: an innovative multidisciplinary model of education, research and knowledge transfer". ...
Based on the citation records, this study for the first time
examines the bibliometric characteristics of integration of
knowledge in education literature from the year 1985 to June
2020. This study reviews total 102 documents published in the
Web of Science index journals. For the visualization and
analysis, VOSviewer software was applied. The bibliometric
results identified the most productive and impactful authors and
journals in this literature. After the science mapping of
bibliometric data, this paper identifies the major underlying
research themes integration of knowledge in education. The key
themes in this literature include the knowledge transfer, higher
education, university, innovation and management. Among
these keywords, knowledge transfer, higher education and
model show the strongest correlation, followed by innovation,
commercialization; performance and management; multiple
intelligence and information. However, there is no significant
correlation among keywords like knowledge transfer,
knowledge integration, healthcare, and multiple intelligence.
Therefore, future research can be directed focusing on these
keywords to expand the existing knowledge in this literature.
... PC is expanding in the developed world, despite the myths and misunderstanding about its nature and purpose, but it is just beginning to be available in the developing world, where it is most needed. [3][4][5][6][7][8] Another concept to overcome is the patient who is "out of therapeutic possibilities". There is always a therapy to be recommended for a patient. ...
... As one of top four pillar industries in Shenzhen, logistics industry plays a significant role in the economic structure of Shenzhen. The international development of Shenzhen calls for innovative and versatile talents with high quality and skills and international visions, who are proficient in foreign languages and familiar with international rules [2]. ...
Background:
A program of Compassionate City or Community (CC) has been designed and developed in the City of Vic (43,964 habitants, Barcelona, Spain), based on The Compassionate City Charter and other public health literature and experiments, with the joint leadership of the City Council and the Chair of Palliative Care at the University of Vic, and as an expansion of a comprehensive and integrated system of palliative care.
Methods:
The program started with an assessment of needs of the city as identified by 48 social organizations with a foundational workshop and a semi-structured survey. After this assessment, the mission, vision, values and aims were agreed. The main aims consisted in promoting changes in social and cultural attitudes toward the end of life (EoL) and providing integrated care for people with advanced chronic conditions and social needs such as loneliness, poverty, low access to services at home, or conflict. The selected slogan was "Living with meaning, dignity, and support the end of life".
Results:
The program for the first year has included 19 activities (cultural, training, informative, and mixed) and followed by 1,260 attendants, and the training activities were followed by 147 people. Local and regional sponsors are funding the initiative. After a year, a quantitative and qualitative evaluation was performed, showing high participation and satisfaction of the attendants and organizations. In the second year, the care for particular vulnerable people defined as targets (EoL and social factors described before) will start with volunteers with more organizations to join the project.
Conclusions:
The key identified factors for the initial success are: the strong joint leadership between social department of the Council and the University; clear aims and targets; high participation rates; the limited size of the geographical context; which allowed high participation and recognition; and the commitment to evaluate results.
A comprehensive guide to help in building integrated palliative care programs and services with a public health perspective, written by most of the members of the Technical Advisory Group ant the WHO HQ.
In 2015, the World Health Organization (WHO) Demonstration Project on Palliative Care in Catalonia (Spain) celebrated its 25th anniversary. The present report describes the achievements and progress made through this project. Numerous innovations have been made with regard to the palliative care model, organization, and policy. As the concept of palliative care has expanded to include individuals with advanced chronic conditions, new needs in diverse domains have been identified. The WHO Resolution on "Strengthening of palliative care as a component of comprehensive care throughout the life course," together with other related WHO initiatives, support the development of a person-centered integrated care palliative care model with universal coverage. The Catalan Department of Health, together with key institutions, developed a new program in the year 2011 to promote comprehensive and integrated palliative care approach strategies for individuals with advanced chronic conditions. The program included epidemiological research to describe the population with progressive and life-limiting illnesses. One key outcome was the development of a specific tool (NECPAL CCOMS-ICO©) to identify individuals in the community in need of palliative care. Other innovations to emerge from this project to improve palliative care provision include the development of the essential needs approach and integrated models across care settings. Several educational and research programs have been undertaken to complement the process. These results illustrate how a palliative care program can respond and adapt to emerging needs and demands. The success of the palliative care approach described here supports more widespread adoption by other key care programs, particularly chronic care programs.
Objective
The goal of this study is to describe the development of a new tool, the Psychosocial and Spiritual Needs Evaluation scale Instrumento de Evaluación de Necesidades Psicosociales y Espirituales del Enfermo al Final de Vida (ENP-E), designed to assess the psychosocial needs of end-of-life (EOL) patients. And, secondarily, to describe the face validity and psychometric properties of this instrument in the Spanish-speaking context.
Method
The scale was developed through a seven-stage process: (1) literature review; (2) expert panel establishment; (3) discussion and agreement on the most relevant dimensions of psychosocial care; (4) description of key indicators and consensus-based questions to evaluate such dimensions; (5) assessment of the scale by external palliative care (PC) professionals; (6) evaluation by patients; and (7) analysis of scale's psychometrics properties. To assess content validity, 30 PC professionals and 20 patients evaluated the questionnaire. To determine psychometric properties, 150 participants completed these scales: the ENP-E; the Hospital Anxiety and Depression Scale; item 15 from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative; and the Distress Thermometer.
Result
All respondents evaluated the tool as “excellent.” In terms of construct validity, the internal consistency (Cronbach's alpha = 0.74) and temporal stability (test-retest r = 0.74, p < 0.1) were both adequate. On the factorial analysis, four factors (emotional-wellbeing, social support, spiritual, and information) explained 58.4% of the variance. This scale has a sensitivity of 76.3%, specificity of 78.9%, and the cutoff is 28.
Significance of results
To provide quality PC to EOL patients, it is essential to determine the psychosocial factors that influence well-being. This requires the use of reliable and specific instruments. The ENP-E is a novel tool that provides a systematic, holistic assessment of the psychosocial needs of EOL patients. Its routine use would allow clinicians to monitor such needs over time. This would, in turn, permit comprehensive, highly individualized interventions to improve effective PC approach.
Objective
Implementation of an advance care planning (ACP) program for people with advanced chronic conditions is a complex process. The aims of this paper are to describe (1) the development of the ACP program in Catalonia, Spain, for patients with advanced chronic conditions and complex needs and (2) the preliminary results of the implementation of this program in health and social services.
Method
The ACP program was developed and implemented in a four-stage process as follows: (1) design and organization of the project; (2) selection of the professionals to carry out the project; (3) creation of four working groups to develop the conceptual model, guidelines, training program, and perform a qualitative evaluation; and (4) project implementation.
Result
The following deliverables were completed: (1) conceptual framework document; (2) practical guidelines for the application of the ACP; (3) online training course (3,763 healthcare professionals completed the online course, with an overall satisfaction rating of 8.4 on a 10-point scale); and (4) additional training activities (conferences, short courses, and seminars) in between 2015 and 2017.
Significance of results
This project was led by the Catalan Ministry of Health. The strengths of the project development include the contribution of a wide range of professionals from the entire region, approval by the Catalan Bioethics Committee and the Social Services Ethics Committee, and the ongoing validation by members of the community. A standardized online training course was offered to all primary care professionals and included as a quality indicator for continuing education for those professionals in the period 2016–2020. The main outcome of this project is the establishment of a pragmatic ACP throughout the region and training of the health and social care professionals involved in the care of advanced chronic patients.
Palliative care must be early applied to all types of advanced chronic and life limited prognosis patients, present in all health and social services. Patients' early identification and registry allows introducing palliative care gradually concomitant with other measures. Patients undergo a systematic and integrated care process, meant to improve their life quality, which includes multidimensional assessment of their needs, recognition of their values and preferences for advance care planning purposes, treatments review, family care, and case management.
Leaded by the National Department of Health, a program for the early identification of these patients has been implemented in Catalonia (Spain). Although the overall benefits expected, the program has raised some ethical issues. In order to address these challenges, diverse institutions, including bioethics and ethics committees, have elaborated a proposal for the program's advantages. This paper describes the process of evaluation, elaboration of recommendations, and actions done in Catalonia.
Background:
Between 69% and 82% of patients with advanced chronic illness require palliative care (PC). The NECPAL CCOMS-ICO© tool can identify these individuals. Tools to estimate survival are available, but have limited predictive ability, and therefore we sought to assess if NECPAL could improve survival prediction.
Objective:
To describe hospital mortality, survival rates, and related variables in a sample of inpatients identified with the NECPAL tool.
Design:
Cross-sectional study with longitudinal cohort follow-up. Sociodemographic and clinical data were analyzed. A predictive model (Cox regression analysis) was performed to assess survival.
Setting/subjects:
Patients admitted to a tertiary hospital. Included patients were considered to be especially affected by their chronic condition and NECPAL+ patients (surprise question [SQ]+ plus ≥1 of the tool's other three criteria). Patients were classified into three subgroups: non-NECPAL (either SQ- or not meeting any additional NECPAL criteria); NECPAL I-II (SQ+ with one to two additional criteria); and NECPAL III (SQ+ with all three additional criteria).
Results:
Of the 602 inpatients, 236 (39.2%) were included. Of these, 49 (20.3%) died during hospitalization: 14 (13.3%) were NECPAL I-II; 34 (35.1%) were NECPAL III; and none were non-NECPAL (p < 0.001). At two years, 146 deaths (61.9%) were observed: 9 (26.5%) non-NECPAL; 57 (54.3%) NECPAL I-II; and 80 (82.5%) NECPAL III (p < 0.001). Median survival was 9.1 months. Variables associated with higher mortality were NECPAL III classification (hazard ratio [HR]: 1.75 [1.19-2.57]); in need of PC (HR: 2 [1.27-3.13]); dysphagia (HR: 1.7 [1.12-2.58] 6); cancer (HR: 3.21 [2.19-4.71]); and age >85 years (HR: 2.52 [1.46-4.35]). At six months, the NECPAL had an area under the curve (AUC) of 0.7 (95% confidence interval [CI]: 0.632-0.765), and at 24 months, the NECPAL AUC was 0.717 (95% CI: 0.650-0.785).
Conclusions:
The NECPAL CCOMS-ICO© tool can improve the prediction of mortality. The presence of all three NECPAL criteria (NECPAL III) increases the tool's predictive ability.
Objective: To determine whether specific psychosocial interventions can ease discomfort in palliative care (PC) patients, particularly in those with high levels of pain or emotional distress.
Methods: Changes in the psychological parameters of 8,333 patients were assessed in a quasi-experimental, prospective, multi-center, single group, pre-test/post-test study. Psychosocial care was delivered by 29 psychosocial care teams (PST; 137 professionals). Pre- and post-intervention changes in these variables were assessed: mood, anxiety, emotional distress. Patients were classified as complex, when presented high levels of anxiety, mood, suffering (or perception of time as slow) and distress (or unease, or discomfort), or non-complex. These groups were compared to assess changes in suffering-related parameters from baseline.
Results: Psychosocial interventions reduced patients’ suffering. These interventions were more effective in complex patients.
Conclusions: After successive psychosocial interventions, the level of suffering in complex patients decreased until close to parity with non-complex patients, suggesting that patients with major complexity could benefit most from specific psychosocial treatment. These findings support the importance of assessing and treating patients’ psychosocial needs.
Key words: psychosocial intervention, effectiveness, palliative care, distress, suffering, prospective studies.
Objective
We aimed to describe the overall quantitative and qualitative results of a “La Caixa” Foundation and World Health Organization Collaborating Center Program entitled “Comprehensive Care for Patients with Advanced Illnesses and their Families” after four years of experience.
Method
Qualitative and quantitative methods were employed to assess the program. Quasiexperimental, prospective, multicenter, single-group, and pretest/posttest methods were utilized to assess the quantitative data. The effectiveness of psychosocial interventions was assessed at baseline (visit 1) and after four follow-up visits. The following dimensions were assessed: mood state, discomfort, anxiety, degree of adjustment or adaptation to disease, and suffering. We also assessed the four dimensions of the spiritual pain scale: faith or spiritual beliefs, valuable faith or spiritual beliefs, meaning in life, and peace of mind/forgiveness. Qualitative analyses were performed via surveys to evaluate stakeholder satisfaction.
Results
We built 29 psychosocial support teams involving 133 professionals—mainly psychologists and social workers. During the study period, 8,964 patients and 11,810 family members attended. Significant improvements were observed in the psychosocial and spiritual dimensions assessed. Patients, family members, and stakeholders all showed high levels of satisfaction.
Significance of Results
This model of psychosocial care could serve as an example for other countries that wish to improve psychosocial and spiritual support. Our results confirm that specific psychosocial interventions delivered by well-trained experts can help to ease suffering and discomfort in end-of-life and palliative care patients, particularly those with high levels of pain or emotional distress.
Background:
The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO(©) (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown.
Aim:
To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality.
Design:
Longitudinal, prospective and observational cohort study.
Setting/participants:
Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months.
Results:
Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) (p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL.
Conclusion:
SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.