{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:03:05Z","timestamp":1785416585374,"version":"3.56.0"},"reference-count":39,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2023,3,5]],"date-time":"2023-03-05T00:00:00Z","timestamp":1677974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","award":["R261-A15091"],"award-info":[{"award-number":["R261-A15091"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Knowledge about the process and the results of the implementation of clinical guidelines to improve palliative care is limited. A national project aimed at improving the quality of life of advanced cancer patients admitted to specialized palliative care services in Denmark by implementing clinical guidelines for the treatment of pain, dyspnea, constipation, and depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To investigate the degree of clinical guideline implementation by evaluating the proportion of patients treated according to guidelines among those who qualified (i.e. reported severe symptom level) before and after the 44 palliative care services implemented the guidelines, and how often different types of interventions were provided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This is a national register-based study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/participants:<\/jats:title>\n                    <jats:p>Data from the improvement project were stored in and later obtained from the Danish Palliative Care Database. Adult patients with advanced cancer admitted to palliative care between September 2017 and June 2019 who answered the EORTC QLQ-C15-PAL questionnaire were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In total 11,330 patients answered the EORTC QLQ-C15-PAL. The proportions of services that implemented the four guidelines ranged 73%\u201393%. Among services that had implemented guidelines, the proportion of patients receiving interventions was roughly constant over time reaching between 54% and 86% (lowest for depression). Pain and constipation were frequently treated pharmacologically (66%\u201372%), whereas dyspnea and depression were frequently treated non-pharmacologically (61% each).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Implementing clinical guidelines was more successful for physical symptoms than for depression. The project generated national data on interventions provided when guidelines were followed, which may be used to understand differences in care and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163231155977","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T00:35:28Z","timestamp":1678062928000},"page":"749-759","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Implementation of clinical guidelines in specialized palliative care\u2014results from a national improvement project: A national register-based study"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6814-7426","authenticated-orcid":false,"given":"Leslye","family":"Rojas-Concha","sequence":"first","affiliation":[{"name":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9611-8131","authenticated-orcid":false,"given":"Maiken Bang","family":"Hansen","sequence":"additional","affiliation":[{"name":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6260-8896","authenticated-orcid":false,"given":"Mathilde","family":"Adsersen","sequence":"additional","affiliation":[{"name":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten Aagaard","family":"Petersen","sequence":"additional","affiliation":[{"name":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mogens","family":"Groenvold","sequence":"additional","affiliation":[{"name":"Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, and Frederiksberg Hospital, University of Copenhagen, Denmark"},{"name":"Department of Public Health, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,3,5]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-8-38"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2021.100225"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-014-0130-z"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2018.0345"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-015-0089-9"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0319-7"},{"key":"e_1_3_2_8_2","unstructured":"National Coalition for Hospice and Palliative Care. Clinical practice guidelines for quality palliative care 4th edition. 2018 pp.1\u2013190."},{"key":"e_1_3_2_9_2","first-page":"1","article-title":"Palliative care in the global setting: ASCO resource-stratified practice guideline","volume":"4","author":"Osman H","year":"2018","unstructured":"Osman H, Shrestha S, Temin S, et al. Palliative care in the global setting: ASCO resource-stratified practice guideline. J Glob Oncol 2018; 4: 1\u201324.","journal-title":"J Glob Oncol"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216309107024"},{"key":"e_1_3_2_11_2","first-page":"1","volume-title":"Extended S3 guideline palliative care for patients with an incurable cancer","author":"German Society for Palliative Medicine","year":"2021","unstructured":"German Society for Palliative Medicine. Extended S3 guideline palliative care for patients with an incurable cancer [Erweiterte S3-Leitlinie Palliativmedizin f\u00fcr Patienten mit einer nicht heilbaren Krebserkrankung]. The AWMF (Working Group of Scientific Medical Societies), 2021, pp.1\u2013216."},{"key":"e_1_3_2_12_2","first-page":"110","volume-title":"National clinical practice guidelines for palliative care 2012\u20132014","author":"Regional Cancer Center Stockholm Gotland","year":"2012","unstructured":"Regional Cancer Center Stockholm Gotland. National clinical practice guidelines for palliative care 2012\u20132014 [Nationellt V\u00e5rdprogram f\u00f6r Palliativ V\u00e5rd 2012-2014]. Regional Cancer Center in Cooperation, Sweden, 2012, pp.60\u2013110."},{"key":"e_1_3_2_13_2","first-page":"1","volume-title":"Management of constipation in adult patients receiving palliative care","author":"The Irish Health Service Executive","year":"2015","unstructured":"The Irish Health Service Executive. Management of constipation in adult patients receiving palliative care. National clinical guideline No. 10, 2015, pp.1\u201394."},{"key":"e_1_3_2_14_2","unstructured":"Greater Manchester Medicine Management Group (GMMMG). Palliative care: Pain and symptom control guidelines for adults 2019 pp.1\u2013128."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0699-0"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2017.09.011"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-020-00565-6"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-017-0187-y"},{"key":"e_1_3_2_19_2","unstructured":"Danish Regions. Learning and quality teams-LKT in specialized palliative care: project description [L\u00e6rings og kvalitetsteam p\u00e5 det specialiserede palliative omr\u00e5de: projekt beskrivelse] 2016 pp.1\u201327."},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2005.06.022"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S99468"},{"key":"e_1_3_2_22_2","first-page":"1","volume-title":"EAPC atlas of palliative care in Europe","author":"Centeno C","year":"2007","unstructured":"Centeno C, Clark D, Lynch T, et al. EAPC atlas of palliative care in Europe. International Association for Hospice and Palliative Care, 2007, pp.1\u2013410."},{"key":"e_1_3_2_23_2","unstructured":"Danish Health Authority. Recommendations for Palliative Care [Anbefalinger for Den Palliativ Indsats] 2017 p. 1-54."},{"key":"e_1_3_2_24_2","unstructured":"Hansen MB Adsersen M Groenvold M. Report from the Danish Palliative Database 2019 [\u00c5rsrapport for Dansk Palliativ Database 2019] 2020 pp. 1-71."},{"key":"e_1_3_2_25_2","volume-title":"The improvement guide: a practical approach to enhancing organizational performance","author":"Langley G","year":"2009","unstructured":"Langley G, Moen R, Nolan K, et al. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco, CA: Jossey-Bass Publishers, 2009.","edition":"2"},{"key":"e_1_3_2_26_2","unstructured":"Danish Health Authority. Danish Regions: The national quality program [Danske Regioner: Det nationale kvalitetsprogram] https:\/\/www.regioner.dk\/sundhed\/kvalitet-og-styring\/det-nationale-kvalitetsprogram (2016 accessed 15 May 2022)."},{"key":"e_1_3_2_27_2","unstructured":"Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Approved clinical guidelines [Godkendte retningslinjer] http:\/\/www.dmcgpal.dk\/661\/godkendteretningslinjer (2013 accessed 12 April 2022)."},{"key":"e_1_3_2_28_2","unstructured":"Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for pain treatment with strong opioids [Klinisk retningslinje for smertebehandling med st\u00e6rke opioider] http:\/\/www.dmcgpal.dk\/files\/opioider_221020.pdf (2015 accessed 30 July 2022)."},{"key":"e_1_3_2_29_2","unstructured":"Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Pharmacological interventions to relieve refractory dyspnea in adult cancer patients in terminal palliative phase [Farmakologiske interventioner til lindring af refrakt\u00e6r dyspn\u00f8 hos voksne kr\u00e6ftpatienter i sen eller terminal palliativ fase] http:\/\/www.dmcgpal.dk\/files\/kliniske-retningslinjer\/dyspnoe\/farma_dyspn__til_publikation-1.pdf (2019 accessed 20 July 2022)."},{"key":"e_1_3_2_30_2","unstructured":"Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for the pharmacological treatment of constipation [Klinisk retningslinje om farmakologisk behandling af obstipation] http:\/\/www.dmcgpal.dk\/files\/obstipation_farma_221020.pdf (2017 accessed 30 July 2022)."},{"key":"e_1_3_2_31_2","unstructured":"Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for the treatment of clinical depression in cancer patients \u2a7e18 years [Klinisk retningslinje for behandling af klinisk depression hos kr\u00e6ftpatienter \u2a7e18 \u00e5r] http:\/\/www.dmcgpal.dk\/files\/depression_voksne_221020.pdf (2017 accessed 31 July 2022)."},{"key":"e_1_3_2_32_2","unstructured":"Danish Multidisciplinary Cancer Group for Palliative Care (DMCG-PAL). Clinical guideline for interventions that support adult relatives of cancer patients in palliative care [Klinisk retningslinje om interventioner der st\u00f8tter voksne p\u00e5r\u00f8rende til kr\u00e6ftpatienter i palliativt forl\u00f8b] http:\/\/www.dmcgpal.dk\/files\/kliniske-retningslinjer\/paaroeende\/dmcgpal_voksne-parorende_adm_godk_260819.pdf (2013 accessed 31 July 2022)."},{"key":"e_1_3_2_33_2","first-page":"149","article-title":"Symptom distress: Implementation of palliative care guidelines to improve pain, fatigue, and anxiety in patients with advanced cancer","volume":"23","author":"Koesel N","year":"2019","unstructured":"Koesel N, Tocchi C, Burke L, et al. Symptom distress: Implementation of palliative care guidelines to improve pain, fatigue, and anxiety in patients with advanced cancer. 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