The Orkdal Model

Background

Palliative care early in the cancer disease trajectory improves health related quality of life (HRQOL) for patients and family members. Collaboration between community and specialist care and professions is paramount to achieve optimal cancer care.

Aim

The overall aim of the study is to improve care for cancer patients with metastatic and/or loco-regional disease in need of palliative care and their families in 13 municipalities belonging to a local hospital (Orkdal) addressing, among others, the following research questions: to what extent will the implementation of an integrated palliative care programme contribute to an increase in the time patients spend at home, and to an improvement of family members' self-reported HRQOL?

Methods

The intervention consists of three main parts: 1. A standardised care pathway for the palliative care cancer patient, 2. an educational program for health care personnel involved with care of cancer palliative patients in specialist and community care, and 3. information about cancer and palliative care to patients, family members, general public and health care providers.

The Orkdal Model will be evaluated as a prospective controlled pre-post study with the following outcomes: Primary: Patients' time spent at home, family members' HRQOL. Secondary: Number of home deaths, use of tumor- directed treatment the last three months of life and improvement of HCPs' knowledge and skills. Tertiary: Patient reported HRQOL, did the patients die where they preferred to die, extent of implementation of the care pathway, distribution of health care services use between specialist and community care, total cost per patient and share of costs between specialist and community. Comparisons: between data in the pre and post intervention phase from the region of Orkdal, and with data from a local hospital where the intervention is not implemented.

Status by September 2017

A standardised care pathway for all cancer palliative care patients has been developed and is revised every year. The pathway is bridging specialist and community care. The care pathway focuses on the availability of palliative care services, exchange of information between health care providers and symptom assessment.

The educational program consists of two parts: one to inform about the project and the care pathway, and one to increase knowledge and skills in cancer and palliative care. Information to the public, patients, and family carers regarding anti-cancer treatment, assessment and available treatment of symptoms, end-of-life care and available resources locally will be offered in written materials, electronically, during consultations and at public meetings.

A patient pre-study was completed in 2014 (n=119).

Three qualitative studies have been conducted within the frame of the Orkdal Model Study:

  • Marte Nilssen Neverdal and Kristina Rystad: “The establishment of a standardized care pathway across specialist and primary care”. Master Thesis in Strategic Change Management, Department of Industrial Economics and Technology Management, Faculty of Social Sciences and Technology Management, NTNU, 2014.
  • Tone Inga Braseth: “Patient held record and individual plan: do they support care for patients receiving palliative care?” Master thesis in Clinical Health Science, Department of Circulation and Medical Imaging, Medical Faculty, NTNU, 2016.
  • Marianne Johnsen: “Implementation of a standardized care pathway in palliative cancer care- health care professionals’ experiences”. Master thesis in Clinical Health Science, Department of Circulation and Medical Imaging, Medical Faculty, NTNU, 2016.

By November 2017, about 200 patients, 90 family members and 500 health care providers are included in the main study. Inclusion will be closed in December 2017, and follow-up will be closed in December 2019. 

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Publications Orkdal Model

Articles

Røen I et al: Resilience for family carers of advanced cancer patients-how can health care providers contribute? A qualitative interview study with carers. Palliat Med 2018 May 1 

 

Abstracts

Brenne AT et al: The Orkdal model: Development, implementation, and evaluation of collaboration between specialist and community care within cancer palliative care. Abstract accepted for poster at Palliative Care in Oncology Symposium, Boston, USA, 24-25 October 2014. Journal of Clinical Oncology. 2014.

Lau KP et al: The Orkdal Model: Establishment of an integrated oncology and palliative care outpatient clinic to improve collaboration and care – who are the patients? Abstract accepted for poster at 14th World Congress of the European Association for Palliative Care, Copenhagen, Denmark, 8-10 May 2015.

Knudsen AK et al: Orkdalsmodellen – fremtidens kreftomsorg. Utvikling, implementering og evaluering av et samhandlingsprosjekt innen kreftomsorg. Abstract for Regional forskningskonferanse 2015, Stjørdal, Norway, 9-10 June 2015.

Røen I et al: Pårørende til livstruende syke kreftpasienters erfaringer med og ønske om støtte fra helsepersonell. Abstract accepted for oral presentation at Den 4. Nettverkssamling for PårørendeForskning, Stavanger, Norway, 8-9 June 2016.

Knudsen AK et al: Evaluation of health care providers’ education during implementation of an integrated oncology and palliative programme in a rural district in Norway. Abstract accepted for poster at 9th World Research Congress of the European Association of Palliative Care, Dublin, Ireland, 9-11 June 2016.

Braseth TI et al: Pasientens perm og individuell plan, nyttig for kreftpasienter i palliativ fase? Abstract accepted for oral presentation at 4. Landskonferanse i palliasjon, Stavanger, Norway, 14-16 September 2016.

Johnsen M et al: Implementering av standardisert pasientforløp for den palliative kreftpasienten- helsepersonells erfaringer. Abstract accepted for oral presentation at 4. Landskonferanse i palliasjon, Stavanger, Norway, 14-16 September 2016.

Skjelvan L et al: Kompetanseheving for helsepersonell som ledd i utvikling av integrert kurativ og palliativ kreftomsorg i Orkdalsregionen. Abstract accepted for oral presentation at 4. Landskonferanse i palliasjon, Stavanger, Norway, 14-16 September 2016.

Skjelvan L et al: Bedre kreftomsorg gjennom bedre oppgavedeling i Orkdalsregionen. Abstract accepted for oral presentation at 4. Landskonferanse i palliasjon, Stavanger, Norway, 14-16 September 2016.

Røen I et al: Pårørende til livstruende syke kreftpasienters erfaringer med og ønske om støtte fra helsepersonell. Abstract accepted for oral presentation at Nordisk konferanse i religionspsykologi, Honne, Norway, 17- 18 October 2016.

Røen I et al: Pårørende til palliative kreftpasienter – hvilken støtte ønsker de? Abstract accepted for oral presentation at Nettverksmøte for Tro og Helse, Honne, Norway, 18- 19 October 2016.

Røen I et al: Pårørende til palliative kreftpasienters erfaringer med og ønske om støtte fra helsepersonell  Abstract accepted for oral presentation at Fagdager for prester i helsesektoren, Honne, Norway, 1 November 2016.

Brenne AT et al: Use of standardized care pathway in palliative care for cancer patients. Abstract accepted for oral presentation at 6th International Seminar of the PRC and EAPC- RN, Banff, Canada, 1-3 December 2016.

Røen I et al: Translation and pilot-testing of the Norwegian translation of the Carer Support Needs Assessment Tool (CSNAT). Abstract accepted for poster at EAPC 2017, 15th World Congress of the European Association for Palliative Care, Madrid, Spain, 18-20 May 2017.

Røen I et al: Family carers of advanced cancer patients – experiences, needs, and suggestions for improvement of care. Abstract accepted for poster at EAPC 2017, 15th World Congress of the European Association for Palliative Care, Madrid, Spain, 18-20 May 2017 Madrid.

Røen I et al: Family carers of advanced cancer patients – experiences with chaplaincy’s spiritual care. Abstract accepted for oral presentation at International Association for the Psychology of Religion (IAPR) conference, Hamar, Norway, 21-24 August 2017

Lau KP et al: Preferred place of death and its associated factors among patients with advanced cancer in Norway. Abstract accepted for poster at 10th World Congress of the European Association for Palliative Care, Bern, Switzerland, 24-16 May 2018

Karlsen L, et al: Where would you prefer to die? Answers from general public and advanced cancer patients in Mid-Norway. 10th World Congress of the European Association for Palliative Care, Bern, Switzerland, 24-16 May 2018

Invited lectures

Knudsen AK et al: Orkdalsmodellen – fremtidens kreftomsorg. Utvikling, implementering og evaluering av et samhandlingsprosjekt innen kreftomsorg. Abstract for 13. Landskonferanse i palliasjon, Trondheim, Norway, 17-19 September 2014.

Brenne AT: Standardized care pathways: Is the concept valid for palliative care internationally? 4th International Seminar of the PRC and EAPC- RN, Amsterdam, Netherlands, 16-17 October 2014.

Knudsen AK, Ysland IM, Lomundal B: Orkdalsmodellen- samhandling for en bedre kreftomsorg. Sykehuskonferansen 2015, Hell, Norway, 3-4 March 2015.