Palliative Care and Multi-Agent Systems: A Necessary Paradigm Shift
2. Chronic Disease and Contributing Factors
3. Multi-Agent Systems and Palliative Care
4. Clinical Considerations
4.2. Comparative Studies and Efficacy
4.4. Multi-Agent System
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Author (Year)||Groups Studied/Intervention||Results/Findings||Conclusions|
|Study 1: Baumann AJ et al. The benefit of Early Palliative Care Intervention in End-Stage Liver Disease Patients Awaiting Liver Transplantation ||A 2015 improvement report looked at patients with end-stage liver disease (ESLD). The patients were provided an early palliative care intervention and subsequently assessed to see if clinical improvement occurred in addition to positive changes in mood.||Pre-palliative care: 23 of 30 (76.6%) of patients reported moderate-to-severe symptoms of pruritis, well-being, anxiety, appetite, and fatigue.|
Pre-palliative care: 13 of 30 patients reported depressive symptoms.
Post-palliative care: 50% of the moderate-to-severe symptoms significantly improved, with fatigue and well-being having less statistically significant reduction.
Post-palliative depressive symptoms were reduced by 27.8%.
|Study 1 provides objective data showing symptom improvement in those provided the palliative care intervention. This efficacy is significant for providers to keep in mind for all trajectories of illness. Knowing the efficacy of this palliative care intervention, the healthcare system must deal with the best method to cope with the increase in demand for services if it becomes widely used.|
|Study 2: Yardley I, et al. Patient safety in palliative care: A mixed-methods study of reports to a national database of serious incidents ||A 2018 study looked at the national database of the National Health Service in England to find reports of serious incidents requiring investigation. These reports were targeted at patients receiving palliative care.||475 reports identified. Reports classified as follows: |
266 reports of pressure ulcers, 91 reports of medication errors, 18 of disturbed dying,
8 of transfer incidents,
6 of suicides,
|The study concluded that these incidents could mostly be attributed to lack of coordination, staff and providers without proper palliative care experience, and under-resourcing.|
|Study 3: Sullivan D, et al. Association of Early Palliative Care Use With Survival and Place of Death Among Patients With Advanced Lung Cancer Receiving Care in the Veterans Health Administration ||A 2019 study looked at 23,154 patients with Stage IIIb or Stage IV lung cancer from the Veterans Affairs healthcare system. The study assessed enhanced survivability in early palliative care; 57% received palliative care.||Palliative care, after diagnosis, from 0–30 days = decreased survivability. Palliative care from 31–365 days, after diagnosis, =greater survivability. Palliative care received after 365 days = no significance.||Palliative care is associated with greater survivability and reduced risk of death in acute care settings. Palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.|
|Author (Year)||Groups Studied and Intervention||Results and Findings||Conclusions|
|Study 1: O’Leary N et al. A comparative study of the palliative care needs of heart failure and cancer patients ||A 2009 cross-sectional comparative cohort study looked to assess whether the palliative care needs of those with heart failure were similar to the needs of those with cancer. The study used both quantitative and qualitative measures in the study.||The two groups reported comparable levels of overall need for palliative care. Differences in specific needs did exist between the two groups. For example, the group with heart failure had a completely different symptom burden than the group with cancer.||A tailored approach must be considered with palliative care. It can benefit patients of all illness trajectories. However, each illness requires different needs to increase the comfort of the patient.|
|Study 2: Siouta N. et al., Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease ||Fourteen studies including 7 for chronic disease, 4 for oncology, 2 for chronic disease and cancer, and 2 for end-of-life pathways. Evaluation of integrated palliative care in disease treatment throughout Europe.||Better symptom control, less caregiver burden, improvement in continuity and coordination of care, fewer admissions, lower costs, and patients passing in their preferred location.||A generic framework for PC in cancer and chronic disease is needed—one that includes aspects of treatment, consulting, and training.|
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Brondeel, K.C.; Duncan, S.A.; Luther, P.M.; Anderson, A.; Bhargava, P.; Mosieri, C.; Ahmadzadeh, S.; Shekoohi, S.; Cornett, E.M.; Fox, C.J.; et al. Palliative Care and Multi-Agent Systems: A Necessary Paradigm Shift. Clin. Pract. 2023, 13, 505-514. https://doi.org/10.3390/clinpract13020046
Brondeel KC, Duncan SA, Luther PM, Anderson A, Bhargava P, Mosieri C, Ahmadzadeh S, Shekoohi S, Cornett EM, Fox CJ, et al. Palliative Care and Multi-Agent Systems: A Necessary Paradigm Shift. Clinics and Practice. 2023; 13(2):505-514. https://doi.org/10.3390/clinpract13020046Chicago/Turabian Style
Brondeel, Kimberley C., Sheina A. Duncan, Patrick M. Luther, Alexandra Anderson, Pranav Bhargava, Chizoba Mosieri, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Charles J. Fox, and et al. 2023. "Palliative Care and Multi-Agent Systems: A Necessary Paradigm Shift" Clinics and Practice 13, no. 2: 505-514. https://doi.org/10.3390/clinpract13020046