DINAMO - CSI Project Information

DINAMO aims to enhance advanced training and research to optimise home palliative care in Portugal. This five-year project is led by Dr. Barbara Gomes and comprises two work streams: 1. Building research capacity by supporting postgraduate training scholarships and a research fellowship; 2. Developing research and evidence on home palliative care.

Research objectives: 

To review the evidence on practice and research of home palliative care;

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To estimate current and future needs for home palliative care;

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To elicit preferences of terminally ill patients and families in Portugal for aspects of home palliative care;

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To develop and pilot a new model of home palliative in Portugal and the methods to evaluate it;

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To evaluate the effectiveness and cost-effectiveness of the proposed model of home palliative care in Portugal.

PAGE 2/4 Main publications in peer-review journals Home palliative care works: but how? A meta-ethnography of the experiences of patients and family caregivers Vera P Sarmento, Marjolein Gysels, Irene J Higginson and Barbara Gomes “Home palliative care teams improve patients and caregivers experience of security when facing life-limiting illnesses at home, by providing competent care and being present. These teams should therefore be widely available and empowered with the resources to be present and provide competent care. “ BMJ Support Palliat Care. 2017 Feb 23.

Effectiveness of emergency department based palliative care for adults with advanced disease: a systematic review Duarte da Silva Soares, Cristina Moura Nunes and Barbara Gomes “There is yet no evidence that Emergency Department (ED) based palliative pare (PC) affects patient outcomes except for indication from one study of no association with 90 -day hospital readmission but a possible reduction in length of stay if integrated PC is introduced early at ED rather than after hospital admission. There is an urgent need for trials to confirm these findings alongside other potential benefits and survival effects.“ J Palliat Med. 2016 Jun;19(6):601-9.

Past trends and projections of hospital deaths to inform the integration of palliative care in one of the most ageing countries in the world.

Vera P Sarmento, Irene J Higginson, Pedro L Ferreira, Barbara Gomes “In one of the most ageing countries in the world, there is a long standing trend towards hospitalised dying, more pronounced among the oldest old. To meet people’s preferences for dying at home, the development of integrated specialist home palliative care teams is needed.“ Palliat Med. 2016 Apr;30(4):363-73.

PAGE 3/4 Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers Barbara Gomes, Natalia Calanzani, Vito Curiale, Paul McCrone, Irene J Higginson “The results provide clear and reliable evidence that home palliative care increases the chance of dying at home and reduces symptom burden in particular for patients with cancer, without impacting on caregiver grief. This justifies providing home palliative care for patients who wish to die at home. More work is needed to study costeffectiveness especially for people with non-malignant conditions, assessing place of death and appropriate outcomes that are sensitive to change and valid in these populations, and to compare different models of home palliative care, in powered studies.“ Cochrane Database Syst Rev. 2013 Jun 6;(6):CD007760.

Epidemiological study of place of death in Portugal in 2010 and comparison with the preferences of the Portuguese population Barbara Gomes, Vera P Sarmento, Pedro L Ferreira and Irene J Higginson “There is a substantial gap between the reality and population preferences for place of death in Portugal. To better meet these preferences, it is a national priority to develop home palliative care services that prevent the rise of hospital deaths and that support death at home, with quality and whenever wished.”

Acta Med Port. 2013 Jul-Aug;26(4):327-34.

Regional Profiles of Palliative Care Needs in Portugal The application aims to present population-based indicators of palliative care needs: number of people who die per year, distribution by age and underlying cause of death, distribution by place of death, and georeferencing the palliative care teams. This work has been developed by a working group of the Portuguese Observatory of Palliative Care.

PAGE 4/4 Building research capacity - MSc in Palliative Care - Martins-Branco D. Relationship between palliative care availability and aggressivness of care at the end of life for adult cancer patients dying in public hospitals: A national retrospective cohort study.

King's College London, 2017.

- de Brito M. The landscape of home-based palliative care: Secondary analysis of qualitative data on family carers' experiences. King's College London, 2017.

- Ribeiro C. Feasibility of home vs. hospital-based resistance training for advanced cancer patients: A phase II trial. King's College London, 2017.

- Soares D. Systematic review on the effectiveness of emergency department-based palliative care for adults with palliative care needs. King’s College London, 2015.

- Canario R. “Complex is whatever I cannot solve on my own” - Perspectives of oncologists in Portugal about complex palliative care needs in cancer: A qualitative study. King’s College London, 2015.

- Lacerda A. Cause and Place of Death of Children and Adolescents in Portugal (1987-2011): an Epidemiological Study. King’s College London, 2014.

- Sarmento VP. Key Components of Home Palliative Care according to the Experiences of Patients and Family Caregivers: a Meta-ethnography. King’s College London, 2014.

- Aguiar H. HOME-PT study: Impact of a Home Palliative Care Team (HPCT) on place of death, chemotherapy and NHS resources use and costs for terminal cancer patients in a Portuguese metropolitan area – a retrospective cohort study. King’s College London, 2013.

Project team Dr Barbara Gomes Principal Investigator

Professor Irene J. Higginson - Scientific Director Professor Pedro L. Ferreira (Director of CEISUC) Maja de Brito (Research assistant)

Dr Helder Aguiar (MSc student, 2011-2012) Dr Ana Lacerda (MSc student, 2012-2013) Dr Vera P. Sarmento (MSc student, 2012-2013) Dr Duarte Soares (MSc student, 2013-2014) Dr Rita Canario (MSc student, 2013-2014) Dr Catarina Ribeiro (MSc student, 2015-2016) Dr Diogo M. Branco (MSc student, 2015-2016)

Contacts Email: maja.furlan_de_brito@kcl.ac.uk Correspondence address: Cicely Saunders Institute, Bessemer Road, London SE5 9PJ

For further information or if you are interested in collaborate in future studies, please contact us Funding: Calouste Gulbenkian Foundation