Need for additional professional psychosocial and spiritual support in patients with advanced diseases in the course of specialist palliative care - a longitudinal observational study

Anneke Ullrich; Holger Schulz; Sven Goldbach; Wiebke Hollburg; Annette Rommel; Marten Müller; Denise Kirsch; Katrin Kopplin-Förtsch; Julia Messerer; Louise König; Frank Schulz-Kindermann; Carsten Bokemeyer; Karin Oechsle

doi:10.1186/s12904-021-00880-6

Need for additional professional psychosocial and spiritual support in patients with advanced diseases in the course of specialist palliative care - a longitudinal observational study

BMC Palliat Care. 2021 Nov 25;20(1):182. doi: 10.1186/s12904-021-00880-6.

Affiliations

¹ Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
² Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany.
³ Specialist Outpatient Palliative Care Team "PalliativPartner Hamburg GbR", Hamburg, Germany.
⁴ Specialist Outpatient Palliative Care Team "Das Palliativteam", Hamburg, Germany.
⁵ Palliative Care Ward, Asklepios Hospital Rissen, Hamburg, Germany.
⁶ Specialist Outpatient Palliative Care Team "PCT Hamburg-West", Hamburg, Germany.
⁷ Palliative Care Ward, Agaplesion Diakonie-Hospital, Hamburg, Germany.
⁸ Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. kaoechsl@uke.de.

Abstract

Background: We investigated the need for additional professional support and associated factors in patients (pts) at initiation and in the course of in- and outpatient specialist palliative care (I-SPC/O-SPC).

Methods: Pts entering an urban SPC network consecutively completed questionnaires on psychosocial/spiritual problems and support needs within 72 h (T0) as well as within the first 6 weeks (T1) of SPC. Hierarchical linear regression analysis was used to investigate the impact of sociodemographic / disease-related variables, psychological / physical burden, social support, and SPC setting on the extent of support needs.

Results: Four hundred twenty-five pts (70 years, 48% female, 91% cancer, 67% O-SPC) answered at T0, and 167 at T1. At T0, main problems related to transportation, usual activities, and dependency (83-89%). At T1, most prevalent problems also related to transportation and usual activities and additionally to light housework (82-86%). At T0, support needs were highest for transportation, light housework, and usual activities (35-41%). Cross-sectional comparisons of SPC settings revealed higher problem scores in O-SPC compared to I-SPC at T0 (p = .039), but not at T1. Support need scores were higher in O-SPC at T0 (p < .001), but lower at T1 (p = .039). Longitudinal analyses showed a decrease of support need scores over time, independent from the SPC setting. At T0, higher distress (p = .047), anxiety/depression (p < .001), physical symptom burden (p < .001) and I-SPC (p < .001) were associated with higher support need scores (at T1: only higher distress, p = .037).

Conclusion: Need for additional professional psychosocial/spiritual support was identified in up to 40% of pts. with higher need at the beginning of O-SPC than of I-SPC. During SPC, this need decreased in both settings, but got lower in O-SPC than in I-SPC over time. Support need scores were not only associated with psychological, but also physical burden.

Keywords: Palliative care; Psychosocial needs; Specialist palliative care; Spiritual needs; Support needs.

Publication types

Observational Study

MeSH terms

Cross-Sectional Studies
Female
Humans
Longitudinal Studies
Male
Neoplasms*
Palliative Care*
Surveys and Questionnaires