Blog

In today’s rapidly evolving healthcare environment, the PAL-CYCLES project is at the forefront of enhancing transitional palliative care for patients with advanced cancer. This project is focused on developing, adapting, implementing, and evaluating a comprehensive palliative care program that ensures a seamless transition from hospital care to community-based care. The project recognizes the complex nature of patient care transitions, involving the coordinated and continuous movement of patients across different care settings, providers, and levels of care as their medical conditions and needs evolve. According to Coleman et al. (2003), this process is vital for maintaining the continuity of patient care and ensuring the best outcomes. 

The concept of “transition” in palliative care is not just about changing care settings but also about a shift in the patient’s care goals. While the initial focus may be on curing or managing a chronic illness, the transition to palliative care emphasizes maximizing the patient’s quality of life. This approach is particularly important for patients with advanced cancer, where the focus shifts from curative treatments to supportive care aimed at enhancing comfort and well-being. As Gott et al. (2011) have highlighted, this transition is essential for improving the overall patient experience and outcomes in palliative care settings. 

The Pal-Cycles consortium was delighted to be able to attend the inaugural lecture of Professor Jeroen Hasselaar, held on 9^th November 2023 at Radboud University, Nijmegen, the Netherlands.

In his enlightening lecture, Professor Jeroen Hasselaar, who leads the Pal-Cycles project, shed light on the profound meaning of palliative care. He emphasised that it goes beyond the technical aspects of medicine and encompasses the social context of care and the provision of support. Care is not just a one-way delivery; it is a profound connection between individuals. Palliative care is not solely focused on death, but also on embracing the meaningful aspects of life. It is about living fully and being an active part of a vibrant and dynamic environment that includes work, school, community, religious activities, and more.

Many of the aspects of palliative care highlighted in the lecture are reflected in the Pal-Cycles project. Rather than focusing solely on improving medical care, the Pal-Cycles project aims to improve communication and collaboration in palliative care and to improve the transition of patients with palliative care needs to the environment in which they prefer to live out the rest of their lives. In this sense, Professor Hasselaar emphasised the concept of “social empowerment” and encouraged a broader social perspective on this issue, stressing that issues of life and death go beyond the medical sphere and shape the way individuals face these challenges in their social context, as well as the way society responds.

The 2017 Quality Framework for Palliative Care emphasises the significance of considering the wishes, values, and needs of patients and their families across various dimensions: physical, psychological, social, and spiritual. This framework serves as a guide for caregivers, providing insights on how to address the patient’s social context, including family dynamics, financial considerations, available support systems, and the re-establishment of connections. Ultimately, it aims to enhance the overall wellbeing of patients in a comprehensive sense.

This lecture concluded with a powerful message, stressing the importance of further exploring and emphasising the social dimension of palliative care through research and awareness. These aspirations are encompassed within the Pal-Cycles project

In January 2023 I started as a PHD candidate on the Pal-Cycles project. With an educational background focusing on international policy making and healthcare organization and management, I developed a fascination for solving problems through policies or interventions, and what makes them effective or not. More specifically I am interested in what can be done from an organizational point of view to improve people’s quality of life.

Observed from an organizational point of view, a rocky road is often experienced by patients with advanced cancer moving from curative care to palliative care. Ineffective communication between the afore mentioned settings induces misunderstandings regarding for example the treatment goals or responsibilities. These misunderstandings often cause patients to experience adverse events and preventable hospital admissions, which have a negative impact on their quality of life.

In the Pal-Cycles research project we aim to develop a programme to improve the transition from curative care to palliative care for cancer patients, applicable in seven different European countries (The Netherlands, Germany, United Kingdom, Poland, Hungary, Romania, and Portugal).

The research team is developing the Pal-Cycles programme, based on the following five cornerstones.

1. Identification of a patient with palliative and supportive care needs in collaboration with their oncologist and the hospital palliative care team.
2. Compassionate communication towards the patient and their family.
3. A collaborative multidimensional care plan and follow-up in the home care setting.
4. Timely evaluation of the care plan with patients and relatives.
5. Identification of the terminal phase (if reached) based on periodic evaluations, with appropriate intensification of care and end-of-life talks depending on local possibilities and habits, including consultation with patients and families about ethically and legally sensitive issues.

The Pal-Cycles programme will be tested for effectiveness using a stepped wedge clinical trial.  Patients will participate in the trial for five months. In addition to the effectiveness being tested, the implementation process and the ethics of the Pal-Cycles will also be evaluated. By doing this, we hope that in five years, we will be able to share whether the systemic changes made through the programme were effective in reducing unplanned admissions at the end of life and improving quality of life of patients and relatives.