The European Association for Palliative Care (EAPC) has started today its 17th World Congress Online. Under the motto 'Exploring new dimensions', this congress will last three days in which research teams and projects from all around the world will present their latest studies and data regarding palliative care. The iLIVE Project is also present in the Congress with three different posters and presentations scheduled for this days.
“All of us are experiencing growing demand, changing practice, and increasing challenges to the delivery of palliative care”, explains the chair for the scientific committee of the congress, Fliss Murtagh. This space provides of an interesting platform to reflect on the progress made in palliative care all around the world and is also a place to share ideas and to continue in the path toward universal health coverage for 2030, as stated by the UN. That is why it is important to be present in the congress.
WP2: Recommendations for Deprescribing Medication in the Last Phase of Life: An International Consensus
WP2 will be presenting this poster aimed to find consensus on recommendations about deprescribing medications for adult patients with a life expectancy ⩽6months.
Background: Several tools for deprescribing medication have been published. However, most have been developed for specific patient groups and do not define the clinical situation or other prompts for which deprescribing may be considered.
Methods: Experts in the field of palliative care were invited to participate in an international Delphi study. Existing tools were integrated in a list of 42 recommendations regarding the deprescription of specific types of medication. Experts were asked to rate their agreement with each recommendation on a Likert-scale from 1 to 5 (strongly agree – strongly disagree), starting for patients with a life expectancy ⩽6 months and, in case of no agreement, asked for patients with shorter life expectancies. Consensus was reached in case ⩾70% of experts agreed with a recommendation, the IQR was ⩽1 and ⩽10% strongly disagreed.
Results: 47 experts from 11 countries participated (response rate 53%). For patients with a life expectancy ⩽6 months, consensus was reached for 32 (86%) recommendations. 11 considered the deprescription of cardiovascular medication given for mild-moderate hypertension and/or the prevention of cardiovascular events. Experts also agreed on 11 recommendations which considered deprescribing antiplatelet therapy, anticoagulants and blood glucose lowering drugs in case of complica- tions or if prescribed for prevention of future events. For the 5 recom- mendations without consensus for a life expectancy ⩽6 months, consensus was reached for 1 recommendation in case of a life expectancy ⩽1 month, namely deprescription of proton pump inhibitors pre- scribed for uncomplicated gastric/oesophageal disease.
Conclusion: A high level of consensus was reached on recommendations for deprescribing medications in patients with a life expectancy of ⩽6 months.
WP3: iLIVE Project Volunteer Study: Delivery of a Novel Training Programme for Volunteer Coordinators, to Underpin Development and Implementation of Hospital Palliative Care Volunteer Services
WP3 presented this poster that aims to describe a novel training programme developed for volunteer coordinatorBackground: iLIVE is an EU-H2020 funded study to assess end of life care in 13 countries. The iLIVE Volunteer Study (WP3) will evaluate the devel- opment, training and implementation of new Hospital Palliative Care Volunteer (HPCV) services for patients in the last month of life, in 5 coun- tries. A European Core Curriculum (ECC) will guide HPCV service devel- opment, devised from the results of a recent WP3 Delphi study that identified 54 essential elements for service implementation and training.
Design, methods and approach: An educational psychologist with inter- national experience in training volunteers developed the training pro- gramme, based in Experiential Learning Theory (ELT). The programme covered the two sections of the ECC:
1. ECC-A: 10-Step Model for development and implementation of HPCV services into a highly structured context (hospital)
2. ECC-B: training curriculum for HPCV’s, including example train- ing sessions and materials
Training included plenaries, small group work, guided reflections and participant presentations. Programme evaluation was gained through participant feedback.
Results: 10 participants from 5 countries attended the 3 day training programme. Feedback received was positive and highlighted the follow- ing themes:
The programme provided valuable opportunity for shared learning
Ongoing reflection via ELT facilitated understanding of the ECC
A focus on training methodology (including sample training materials) highlighted as valuable
Conclusions: The programme provided a structured, theory-based approach, which facilitated understanding of the ECC, empowering VC’s to develop their own HPCV services, and train volunteers to support patients at the end of life. Recent challenges with COVID-19 will impact design and delivery of these services. iLIVE WP3 will evaluate these HPCV services in 5 countries.s (VC’s) in use of the ECC prior to developing their own HPCV services.
WP4: Methodological Aspects of Economic Evaluations Conducted in the Pal- liative and End-of-Life-care Settings: A Systematic Review
This study is part of iLIVE, a EU funded research that aims, amongst other, to identify and summarize relevant information on the methodological aspects for conducting economic evaluations in the palliative or end-of-life care settings. This information is of high rele- vance as the generation of valid and useful evidence and decision base for service development requires that research methods applied in the palliative care or end-of-life care fields consider the specific conditions of these settings in their methodology. However, common research guid- ance is lacking, especially regarding the methods applied in economic evaluations.
Design, methods: A systematic review has been conducted following the methodology described in a published research protocol. Pre-designed forms have been used for data extraction, followed by narrative synthe- sis and critical appraisal.
Results: Our search strategy yield 5030 references, of these 121 refer- ences were included after abstract and title and full-text screening. We identified information on methodological challenges, potential solutions and recommendations for conducting economic evaluations in the pal- liative and end-of-life care settings, with regards to research and trials in general (8%), the target population (4%), the study perspective (8%), the setting and location (6%), measuring outcomes (including adaptions of QALYs, capabilities, alternative self-reported outcome measures) (32%), valuation (13%), assessing costs (e.g. inventory of costing frameworks) (23%) and other factors (5%).
Conclusion: The findings of this systematic review should help to clarify current methodological questions, prioritize future methodological research studies and standardize the methodology and execution of future economic evaluations, which should increase their comparability and overall transparency.
Acknowledgements: The research presented in this abstract is funded by the EU’s Horizon 2020 programme under GA ID: 825731.
Colive Study: End-of-Life Care, Dying and Bereavement during the COVID-19 Pan- demic from Latin American Perspective
We are also present with the colive Study, that aims to explore the characteristics of EoL care practices as provided during the pandemic in 7 Latin American countries (Argentina, Brasil, Chile, Colombia, El Salvador, Perú, Uruguay) and the experiences from relatives and healthcare providers.
The COVID-19 pandemic is a serious threat to public health. Latin American structural conditions are a propitious place for the spread of COVID-19. Argentina, Brazil, Chile, Colombia, Mexico and Peru are the countries with the most deaths on the continent.
Methods: Observational study of a convenience sample of people who have recently experienced the death of either a relative or a patient died or not from COVID-19 using 2 rounds of questionnaire surveys, with additional deep-interviews. Social Determinants of Health, working con- ditions, and QoL were assesed. Primary outcome: a descriptive assess- ment of the characteristics of EoL care during the pandemic, from the experience of relatives and HCP.
Preliminary Results:1430 questionnaires completed until now (726 rela- tives/704 HCP) In-depth interviews analysis in progress. Most of the rela- tives perceived their loved ones were treated with respect and dignity during the last days of life by doctors 85% and nurses 81 % most of time. HCP rated their QoL average 5 (1 Very poor, 7 Excellent).
Conclusion: Provision of best person-centred care for dying patients requires understanding of cross-cultural experiences of dying and bereavement. We provided international and multidimensional perspec- tives of the impact of this unprecedented pandemic from 7 Latin American countries.