Nevenka Krcevski Skvarc

Background: Interprofessional collaboration is an important part of palliative care. Effective communication and information exchange is essential for a high quality of care. The aim of this study was to test the effectiveness of a new tool for exchanging information between professionals in palliative care on primary healthcare level. Methods: With suggestions from the experts regarding palliative care needs in an interprofessional team from the Delphi study and community nurses from the field, we developed a paper version of the tool. The paper version was tested in a pilot phase, and subsequently, we conducted ten semi-structured interviews with the users of the new tool to test its feasibility and usability. The data were analyzed using qualitative content analysis, leading to improvement and development of the digital version of the new tool. Results: After completing the pilot phase of the research, we identified the following four categories: a systematic tool for more consistent treatment and better communication during the patient’s visit; training and empowerment; quality, safety and digitalization; these categories were later included in the final version of the digital communication tool. Conclusion: Effective palliative care requires a good exchange of information and communication between all care professionals who work with the patient. Effective communication contributes to making patients and their relatives feel safe in their home environment and allows patients to stay in their homes even as their disease progresses. The systematical new tool was assessed as useful to improve interdisciplinary cooperation and prepared in a digital version. Further research after the long-term use of the developed digital tool in everyday work might confirm its sustaining importance.

SUMMARY A 3-month routine clinical practice evaluation of buprenorphine transdermal patch use in Slovenia. A prospective, noninterventional, postmarketing study performed by 68 investigators in 42 clinical practice settings. Buprenorphine transdermal patches 35, 52.5 or 70 µg/h were prescribed to patients with chronic moderate-to-severe cancer pain, or chronic severe noncancer pain insufficiently controlled by nonopioid analgesics or weak opioids. At physician discretion, additional analgesia and adjuvant/supportive treatment was allowed. Data were evaluated for 374 patients (56% female, mean age 69 [range 35-100] years), with cancer-related (53%) or noncancer (46%) pain. Reasons for switching to transdermal buprenorphine included intense pain (insufficient pain relief), good prior patient experience with transdermal buprenorphine, adverse reaction or development of tolerance to previous pain therapy, and the beneficial safety profile of transdermal buprenorphine. Mean pain intensity (baseline: 7.4; 0-10 numerical rating scale) was reduced at final assessment (2.3). Pain relief was rated 'very good' or 'good' in 82% of patients at final assessment. Dose stability was good throughout the study; overall, more patients received supportive antiemetics/laxatives during the study than prior to starting transdermal buprenorphine. One hundred and seventy seven nonserious adverse drug reactions (mainly local skin reactions) occurred in 100 (27%) patients. Treatment was discontinued due to unsatisfactory pain relief (4.6%) or adverse drug reactions (7%). In routine Slovenian clinical practice, transdermal buprenorphine provided efficient analgesia and was well-tolerated in patients with chronic moderate-to-severe cancer pain or chronic severe noncancer pain insufficiently controlled by nonopioids and, as the study results indicate, also in chronic severe noncancer pain insufficiently controlled by weak opioids.