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Cross SH, Kavalieratos D. Public Health and Palliative Care. Clin Geriatr Med 2023; 39:395-406. [PMID: 37385691 PMCID: PMC10571066 DOI: 10.1016/j.cger.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Meeting the needs of people at the end of life (EOL) is a public health (PH) concern, yet a PH approach has not been widely applied to EOL care. The design of hospice in the United States, with its focus on cost containment, has resulted in disparities in EOL care use and quality. Individuals with non-cancer diagnoses, minoritized individuals, individuals of lower socioeconomic status, and those who do not yet qualify for hospice are particularly disadvantaged by the existing hospice policy. New models of palliative care (both hospice and non-hospice) are needed to equitably address the burden of suffering from a serious illness.
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Affiliation(s)
- Sarah H Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30322, USA
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Hussaini SMQ, Blackford AL, Gupta A, Sedhom R, Cross SH, Warraich HJ, LeBlanc TW. Rural-urban disparities in place of death in hematologic malignancies in the United States, 2003 to 2019. Blood Adv 2022; 6:4731-4734. [PMID: 35703573 PMCID: PMC9631667 DOI: 10.1182/bloodadvances.2022007276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- S. M. Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Amanda L. Blackford
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Ramy Sedhom
- Division of Hematology and Oncology, Perelman School of Medicine, and
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Sarah H. Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Haider J. Warraich
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, West Roxbury, MA
| | - Thomas W. LeBlanc
- Duke Cancer Institute, Durham, NC; and
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
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Shenker RF, Elizabeth McLaughlin M, Chino F, Chino J. Disparities in place of death for patients with primary brain tumors and brain metastases in the USA. Support Care Cancer 2022; 30:6795-6805. [PMID: 35527286 DOI: 10.1007/s00520-022-07120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients with primary or metastatic brain tumors often require intensive end-of-life care, for which place of death may serve as a quality metric. Death at home or hospice is considered a more "ideal" location. Comprehensive information on place of death of people with brain tumors is lacking. METHODS Using CDC Wonder Database data, those who died in the USA from a solid cancer from 2003 to 2016 were included and place of death for those with primary brain, brain metastases, and solid non-brain tumors were compared. Multivariate logistic regression tested for disparities in place of death. RESULTS By 2016, 51.1% of patients with primary brain tumors and 45.2% with brain metastases died at home. 15.9% of patients with primary brain tumors and 23.6% with brain metastases died in the hospital. Black patients were least likely to die at home or hospice. For patients with primary brain tumors, being married (OR = 2.25 (95%CI 2.16-2.34), p < 0.01) and having an advanced degree (OR = 1.204 (95%CI 1.15-1.26), p < 0.01) increased odds of home/hospice death; older age (OR = 0.50 (95%CI 0.46-0.54), p < 0.01) decreased odds for home/hospice death. For patients with brain metastases, being married (OR = 2.19 (95%CI 2.11-2.26), p < 0.01) increased odds of home/hospice death and male sex (OR = 0.87 (095%CI .85-0.89), p < 0.01) and older age (OR = 0.59 (95%CI 0.47-0.75), p < 0.01) decreased odds of home/hospice death. CONCLUSION Disparities exist in place of death in the brain tumor population. Focused interventions are indicated to increase the utilization of hospice in those with metastatic cancer, under-represented minority groups, and the elderly population.
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Affiliation(s)
- Rachel F Shenker
- Department of Radiation Oncology, Duke University School of Medicine, 20 Duke Medicine Cir, Durham, NC, 27710, USA.
| | - Mary Elizabeth McLaughlin
- Department of Interventional Radiology, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junzo Chino
- Department of Radiation Oncology, Duke University School of Medicine, 20 Duke Medicine Cir, Durham, NC, 27710, USA
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Tsuchida T, Onishi H, Ono Y, Machino A, Inoue F, Kamegai M. Factors associated with preferred place of death among older adults: a qualitative interview study in Tama City, Tokyo, Japan. BMJ Open 2022; 12:e059421. [PMID: 35613762 PMCID: PMC9174769 DOI: 10.1136/bmjopen-2021-059421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To analyse the cognitive processes involved in the decision-making of older adults who are not in the end-of-life stage regarding the selection of a preferred place of death. DESIGN A qualitative cross-sectional study based on semistructured in-depth interviews. The interview scripts were sectioned by context, then summarised, conceptualised and categorised. Post-categorisation, the relationships between the conceptual factors were examined. SETTING Tama City, Tokyo, Japan, from November 2015 to March 2016. PARTICIPANTS 20 long-term care users and their families or care providers were interviewed about their preferred places of death and the factors behind their decisions. RESULTS Three categories based on the preferred place of end-of-life care and death were extracted from the interview transcripts: (A) discouraging the decision of a preferred place of death, (B) enhancing the desire for home death and (C) enhancing the desire for a hospital/long-term care facility death. Category A consists of concerns about the caregiver's health, anxiety about solitary death, and constraints of and concerns about the household budget. Both categories B and C consist of subcategories of reinforcing and inhibiting factors of whether to desire a home death or a hospital/long-term care facility death. If their previous experiences with care at home, a hospital or a care facility were positive, they preferred the death in the same setting. If those experiences were negative, they tend to avoid the death in the same setting. CONCLUSIONS One's mindset and decision regarding a preferred place of death include the consideration of economic factors, concerns for caregivers, and experiences of care at home or in a hospital/long-term care facility. Furthermore, health professionals need to be aware of the ambivalence of senior citizens to support their end-of-life decisions.
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Affiliation(s)
- Tomoya Tsuchida
- Division of General Internal Medicine, Department of Internal Medicine, Sei Marianna Ika Daigaku, Kawasaki, Japan
| | - Hitotaka Onishi
- International Cooperation for Medical Education, University of Tokyo, Tokyo, Japan
| | - Yoshifumi Ono
- Internal Medicine, Tama-Nambu Chiiki Hospital, Tokyo, Japan
| | | | - Fumiko Inoue
- Nursing, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
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Loh KP, Seplaki CL, Sanapala C, Yousefi-Nooraie R, Lund JL, Epstein RM, Duberstein PR, Flannery M, Culakova E, Xu H, McHugh C, Klepin HD, Lin PJ, Watson E, Grossman VA, Liu JJ, Geer J, O’Rourke MA, Mustian K, Mohile SG. Association of Prognostic Understanding With Health Care Use Among Older Adults With Advanced Cancer: A Secondary Analysis of a Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220018. [PMID: 35179585 PMCID: PMC8857680 DOI: 10.1001/jamanetworkopen.2022.0018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE A poor prognostic understanding regarding curability is associated with lower odds of hospice use among patients with cancer. However, the association between poor prognostic understanding or prognostic discordance and health care use among older adults with advanced incurable cancers is not well characterized. OBJECTIVE To evaluate the association of poor prognostic understanding and patient-oncologist prognostic discordance with hospitalization and hospice use among older adults with advanced cancers. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc secondary analysis of a cluster randomized clinical trial that recruited patients from October 29, 2014, to April 28, 2017. Data were collected from community oncology practices affiliated with the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program. The parent trial enrolled 541 patients who were aged 70 years or older and were receiving or considering any line of cancer treatment for incurable solid tumors or lymphomas; the patients' oncologists and caregivers (if available) were also enrolled. Patients were followed up for at least 1 year. Data were analyzed from January 3 to 16, 2021. MAIN OUTCOMES AND MEASURES At enrollment, patients and oncologists were asked about their beliefs regarding cancer curability (100%, >50%, 50%, <50%, and 0%; answers other than 0% reflected poor prognostic understanding) and life expectancy (≤6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; answers of >5 years reflected poor prognostic understanding). Any difference between oncologist and patient in response options was considered discordant. Outcomes were any hospitalization and hospice use at 6 months captured by the clinical research associates. RESULTS Among the 541 patients, the mean (SD) age was 76.6 (5.2) years, 264 of 540 (49%) were female, and 486 of 540 (90%) were White. Poor prognostic understanding regarding curability was reported for 59% (206 of 348) of patients, and poor prognostic understanding regarding life expectancy estimates was reported for 41% (205 of 496) of patients. Approximately 60% (202 of 336) of patient-oncologist dyads were discordant regarding curability, and 72% (356 of 492) of patient-oncologist dyads were discordant regarding life expectancy estimates. Poor prognostic understanding regarding life expectancy estimates was associated with lower odds of hospice use (adjusted odds ratio, 0.30; 95% CI, 0.16-0.59). Discordance regarding life expectancy estimates was associated with greater odds of hospitalization (adjusted odds ratio, 1.64; 95% CI, 1.01-2.66). CONCLUSIONS AND RELEVANCE This study highlights different constructs of prognostic understanding and the need to better understand the association between prognostic understanding and health care use among older adult patients with advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02107443.
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Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christopher L. Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Chandrika Sanapala
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jennifer L. Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Ronald M. Epstein
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul R. Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Marie Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eva Culakova
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Huiwen Xu
- Department of Preventive Medicine and Population Health, School of Medicine, Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Colin McHugh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Po-Ju Lin
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | - Jane Jijun Liu
- Heartland National Cancer Institute Community Oncology Research Program (NCORP), Decatur, Illinois
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, St Louis Park
| | - Mark A. O’Rourke
- NCORP of the Carolinas (Greenville Health System NCORP), Greenville, South Carolina
| | - Karen Mustian
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya G. Mohile
- James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester, New York
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Noh H, Lee HY, Lee LH, Luo Y. Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework. Am J Hosp Palliat Care 2021; 39:822-830. [PMID: 34856830 DOI: 10.1177/10499091211057847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Despite the need for hospice care as our society ages, adults in the U.S.'s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama's Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama's Black Belt region (N = 179, age = 18-91). Participants' awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care (OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care (OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama's Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.
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Affiliation(s)
- Hyunjin Noh
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Hee Y Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Lewis H Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Yan Luo
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
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Predictors of the final place of care of patients with advanced cancer receiving integrated home-based palliative care: a retrospective cohort study. BMC Palliat Care 2021; 20:164. [PMID: 34663303 PMCID: PMC8522009 DOI: 10.1186/s12904-021-00865-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Meeting patients’ preferences for place of care at the end-of-life is an indicator of quality palliative care. Understanding the key elements required for terminal care within an integrated model may inform policy and practice, and consequently increase the likelihood of meeting patients’ preferences. Hence, this study aimed to identify factors associated with the final place of care in patients with advanced cancer receiving integrated, home-based palliative care. Methods This retrospective cohort study included deceased adult patients with advanced cancer who were enrolled in the home-based palliative care service between January 2016 and December 2018. Patients with < 2 weeks’ enrollment in the home-based service, or ≤ 1-week duration at the final place of care, were excluded. The following information were retrieved from patients’ electronic medical records: patients’ and their families’ characteristics, care preferences, healthcare utilization, functional status (measured by the Palliative Performance Scale (PPSv2)), and symptom severity (measured by the Edmonton Symptom Assessment System). Multivariate logistic regression was employed to identify independent predictors of the final place of care. Kappa value was calculated to estimate the concordance between actual and preferred place of death. Results A total of 359 patients were included in the study. Home was the most common (58.2%) final place of care, followed by inpatient hospice (23.7%), and hospital (16.7%). Patients who were single or divorced (OR: 5.5; 95% CI: 1.1–27.8), or had older family caregivers (OR: 3.1; 95% CI: 1.1–8.8), PPSv2 score ≥ 40% (OR: 9.1; 95% CI: 3.3–24.8), pain score ≥ 2 (OR: 3.6; 95% CI: 1.3–9.8), and non-home death preference (OR: 23.8; 95% CI: 5.4–105.1), were more likely to receive terminal care in the inpatient hospice. Patients who were male (OR: 3.2; 95% CI: 1.0–9.9), or had PPSv2 score ≥ 40% (OR: 8.6; 95% CI: 2.9–26.0), pain score ≥ 2 (OR: 3.5; 95% CI: 1.2–10.3), and non-home death preference (OR: 9.8; 95% CI: 2.1–46.3), were more likely to be hospitalized. Goal-concordance was fair (72.6%, kappa = 0.39). Conclusions Higher functional status, greater pain intensity, and non-home death preference predicted institutionalization as the final place of care. Additionally, single or divorced patients with older family caregivers were more likely to receive terminal care in the inpatient hospice, while males were more likely to be hospitalized. Despite being part of an integrated care model, goal-concordance was sub-optimal. More comprehensive community networks and resources, enhanced pain control, and personalized care planning discussions, are recommended to better meet patients’ preferences for their final place of care. Future research could similarly examine factors associated with the final place of care in patients with advanced non-cancer conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00865-5.
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Hamano J, Masukawa K, Tsuneto S, Shima Y, Morita T, Kizawa Y, Miyashita M. Are family relationships associated with family conflict in advanced cancer patients? Psychooncology 2021; 31:260-270. [PMID: 34453463 DOI: 10.1002/pon.5801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Family conflict during end-of-life care is an important issue for advanced cancer patients and their families, although studies are lacking. We investigated the association between family relationships and family conflict in advanced cancer patients. METHODS This study was a secondary analysis of a nationwide multicenter questionnaire survey targeting the bereaved family members of cancer patients who died in palliative care units, general wards, or at home to evaluate the quality of end-of-life care in Japan. RESULTS A total of 1084 questionnaires (63.0%) were returned and we analyzed a total of 908 responses. In total, 38.0% of family members reported at least one family conflict during end-of-life care, and the most frequent family conflict was "about certain family members not pulling their weight" (23.5%). Multivariate linear analysis revealed family members who asserted their opinions (p < 0.001), family assessment device score (p < 0.001), worries about family finances during cancer treatment (p < 0.001), family members contacted after illness were helpful (p = 0.003), female patients (p = 0.03), and family with family relationship index ≤7 (p = 0.04) were positively associated with the outcome-family conflict (OFC) score. Proxy decision maker was selected by the patient (p = 0.003), people listened to families' worries or problems (p = 0.003), physician gave sufficient explanation (p = 0.003), living will before their illness (p = 0.038) and female bereaved family members (p = 0.046) were negatively associated with the OFC score. CONCLUSIONS It may be important for health care providers to actively assess the possibility of family conflicts according to family relationships, such as a proxy decision maker having been selected by the patient.
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Affiliation(s)
- Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Osaka, Japan
| | | | - Tatsuya Morita
- Palliative Care Team, Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamtsu, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Bucy T, Carder P, Tunalilar O. Dying in Place: Factors Associated with Hospice Use in Assisted Living and Residential Care Communities in Oregon. JOURNAL OF AGING AND ENVIRONMENT 2021. [DOI: 10.1080/26892618.2021.1942382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Taylor Bucy
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula Carder
- Institute on Aging, Portland State University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Ozcan Tunalilar
- Institute on Aging, Portland State University, Portland, Oregon, USA
- Portland State University, Nohad A. Toulan School of Urban Studies and Planning, Portland, Oregon, USA
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On Board: Interdisciplinary Team Member Perspectives of How Patients With Heart Failure and Their Families Navigate Hospice Care. J Hosp Palliat Nurs 2021; 22:351-358. [PMID: 32658391 DOI: 10.1097/njh.0000000000000673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hospice agencies serve an expanding population of patients with varying disease conditions and sociodemographic characteristics. Patients with heart failure represent a growing share of hospice deaths in the United States. However, limited research has explored the perspectives of hospice interdisciplinary team members regarding how patients with heart failure and their families navigate hospice care. We sought to address this research gap by conducting qualitative interviews with hospice interdisciplinary team members at a large, not-for-profit hospice agency in New York City (N = 32). Five overarching themes from these interviews were identified regarding components that members of the hospice interdisciplinary team perceived as helping patients with heart failure and their families navigate hospice care. These themes included (1) "looking out: caregiving support in hospice care," (2) "what it really means: patient knowledge and understanding of hospice," (3) "on board: acceptance of death and alignment with hospice goals," (4) "on the same page: communication with the hospice team," and (5) "like a good student: symptom management and risk reduction practices." Interdisciplinary team members delineated several components that influence how patients with heart failure and their families navigate hospice services and communicate with care providers. Hospice agencies should consider policies for augmenting services among patients with heart failure to improve their understanding of hospice, supplement available caregiving supports for patients without them, and remove communication barriers.
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Ikeda T, Tsuboya T. Place of Death and Density of Homecare Resources: A Nationwide Study in Japan. Ann Geriatr Med Res 2021; 25:25-32. [PMID: 33794586 PMCID: PMC8024167 DOI: 10.4235/agmr.21.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 11/06/2022] Open
Abstract
Background Although more than half of the population of Japan wants to spend their last days at home, approximately only 10% are able to do so. This study examined the associations between death at home and healthcare facility density by municipality based on the analysis of nationwide observed data in Japan. Methods We used data on deaths at home and healthcare resources in municipalities across Japan for the fiscal years 2014 and 2017. The proportions of deaths at home by municipality were used as the dependent variable, while healthcare resources (e.g., hospital density) divided by the population of older people in each municipality and municipality-level income were used as independent variables. We applied a fixed-effects regression analysis to examine the association of healthcare resources and municipality-level income with death at home. Results Clinics providing home medical care and facilities providing visiting nursing services were positively associated with death at home, with coefficients (95% confidence intervals) of 2.14 (1.12 to 3.15) and 2.19 (0.99 to 3.39), respectively. Stratified analysis showed that these associations were observed in higher income-level municipalities but not in lower income-level municipalities. Conclusion Municipalities with a higher density of home care services had higher rates of death at home, whereas municipalities with a higher density of hospitals had lower rates. We recommend the development of policy that allows hospitals to be converted into home care providers so that more people can spend time in peace at home at the end of their lives.
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Affiliation(s)
- Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Department of Community Health, Public Health Institute, Shiwa, Japan
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Kapoor AK, Bhatnagar S, Mutneja R. Clinical and Socio-demographic Profile of Hospice Admissions: Experience from New Delhi. Indian J Palliat Care 2021; 27:68-75. [PMID: 34035620 PMCID: PMC8121229 DOI: 10.4103/ijpc.ijpc_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/01/2020] [Accepted: 10/02/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Our hospice caters to referrals from the wide areas in the northern Indian territory. A descriptive analysis of hospice admissions can bring to light, the status of palliative care in the region overall. Aim: The aim was to assess the clinical and demographic profile of hospice admissions in New Delhi during the time period 2016–2017. Methods: Hospice admission records from the calendar year 2016 were digitized from paper charts, and statistical analysis was carried out using SPSS v21. Patient and caregiver demographic profile and dominant referral and utilization patterns were retrospectively assessed. Results: One hundred and fifty-four admissions (mean age 51.8 ± 15 years; 60% females) were recorded. Up to one-third of the patients (48, 31%) were single at the time of admission. Majority of the patients had below 10th grade literacy level (116, 75.3%) and belonged to low socioeconomic status. Two large tertiary care centers were the most common referrers (54.6%). The top three diagnoses were head-and-neck cancers (56, 36.4%), gastrointestinal cancers (27, 17.5%), and metastatic breast cancer (23, 14.9%). Major patient-reported debilities were pain (73%), dysphagia (51%), and incontinence (45%). The mean duration from diagnosis to hospice referral was 2.7 ± 0.7 years. Majority of the patients (76%) reported to have undergone some form of oncologic treatment. Up to two-thirds of the patients received opioids with or without additional supportive care. Conclusion: Pain, dysphagia, and incontinence were the most common reasons for hospice referral, with incontinence being significantly correlated with the divorced status. There were no differences in the prevalence of other symptoms with relation to the marital status. Data on hospice utilization patterns in India are limited to pilot experiences. More data are needed to drive national-level policies.
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Affiliation(s)
- Astha Koolwal Kapoor
- Department of Onco-anaesthesia and Palliative Medicine, DR.B.R.A.I.R.C.H, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-anaesthesia and Palliative Medicine, DR.B.R.A.I.R.C.H, All India Institute of Medical Sciences, New Delhi, India
| | - Rajni Mutneja
- Medical Officer, Shanti-Avedna Saan (Hospice), New Delhi, India
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Osakwe ZT, Arora BK, Peterson ML, Obioha CU, Fleur-Calixte RS. Factors Associated With Home-Hospice Utilization. Home Healthc Now 2021; 39:39-47. [PMID: 33417361 DOI: 10.1097/nhh.0000000000000937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Utilization of hospice for end-of-life care is known to be lower among racial and ethnic minority groups than among White populations when controlling for other socioeconomic factors. Certain patient, provider, and community characteristics may influence home-hospice use. We sought to identify patient, provider, and community factors associated with home-hospice use. Our final analytic sample included 1,208,700 hospice patients who received home-hospice from 2,148 Medicare-certified hospice providers in 2016. We found that an increase in the proportion of hospice patients with a primary diagnosis of dementia decreased the odds that home-hospice was provided (OR = 1.42, 95% CI = 1.36-1.48). Patients who received hospice care from a provider with a higher proportion of dually enrolled patients were less likely to receive home-hospice (OR = 1.42, 95% CI = 1.36-1.48) and hospices located in ZIP-codes with higher proportion of Hispanic resident were less likely to provide home-hospice (OR = 1.00, 95% CI = 0.99-0.99). Additional research is needed to clarify the mechanisms underlying these associations.
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Tedesco A, Shanks L, Dosani N. The Good Wishes Project: An End-of-Life Intervention for Individuals Experiencing Homelessness. Palliat Med Rep 2020; 1:264-269. [PMID: 34223486 PMCID: PMC8241317 DOI: 10.1089/pmr.2020.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Individuals experiencing homelessness face marginalization, dehumanization, and barriers to accessing quality palliative care. Inspired by the 3 Wishes Project, the Good Wishes Project (GWP) facilitates granting wishes to individuals experiencing homelessness and receiving palliative care with a goal of enhancing comfort and personalizing the end-of-life experience. Objective: The main objective of this study was to elicit provider perspectives on the utility of the GWP in the delivery of end-of-life care to a population of homeless and vulnerably housed individuals. Design: For this qualitative study, GWP client information and wish data were collected anonymously and analyzed quantitatively and descriptively. Semistructured interviews were conducted with health and social service professionals who cared for GWP clients. Interviews were recorded, transcribed, and analyzed through qualitative content analysis. Results: At the time of evaluation, there were a total of 27 clients in the GWP. At 14 months after the project's launch, 40 wishes had been made, 24 of which had been granted. Wishes were classified into five categories: basic necessities, end-of-life preparations, personal connections, paying-it-forward, and leisure. From the provider perspective (n = 7), the project was found to have utility in three main domains: establishing and enhancing connection, satisfying basic needs, and promoting person-centered care. Conclusions: The GWP is a promising psychosocial intervention in providing quality palliative care to individuals experiencing homelessness, whose lives have largely been burdened with hardship and marginalization.
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Affiliation(s)
| | - Leslie Shanks
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Naheed Dosani
- Inner City Health Associates, Toronto, Ontario, Canada
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15
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Sedhom R, Kuo PL, Gupta A, Smith TJ, Chino F, Carducci MA, Bandeen-Roche K. Changes in the place of death for older adults with cancer: Reason to celebrate or a risk for unintended disparities? J Geriatr Oncol 2020; 12:361-367. [PMID: 33121909 DOI: 10.1016/j.jgo.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/28/2020] [Accepted: 10/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Place of death is important to patients and caregivers, and often a surrogate measure of health care disparities. While recent trends in place of death suggest an increased frequency of dying at home, data is largely unknown for older adults with cancer. METHODS Deidentified death certificate data were obtained via the National Center for Health Statistics. All lung, colon, prostate, breast, and pancreas cancer deaths for older adults (defined as >65 years of age) from 2003 to 2017 were included. Multinomial logistic regression was used to test for differences in place of death associated with sociodemographic variables. RESULTS From 2003 through 2017, a total of 3,182,707 older adults died from lung, colon, breast, prostate and pancreas cancer. During this time, hospital and nursing home deaths decreased, and the rate of home and hospice facility deaths increased (all p < 0.001). In multivariable regression, all assessed variables were found to be associated with place of death. Overall, older age was associated with increased risk of nursing facility death versus home death. Black patients were more likely to experience hospital death (OR 1.7) and Hispanic ethnicity had lower odds of death in a nursing facility (OR 0.55). Since 2003, deaths in hospice facilities rapidly increased by 15%. CONCLUSION Hospital and nursing facility cancer deaths among older adults with cancer decreased since 2003, while deaths at home and hospice facilities increased. Differences in place of death were noted for non-white patients and older adults of advanced age.
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Affiliation(s)
- Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins, Baltimore, MD, United States of America.
| | - Pei-Lun Kuo
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins, Baltimore, MD, United States of America
| | - Thomas J Smith
- Department of Palliative Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Michael A Carducci
- Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins, Baltimore, MD, United States of America
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, United States of America
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16
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17
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Zhuang Q, Lau ZY, Ong WS, Yang GM, Tan KB, Ong MEH, Wong TH. Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study. PLoS One 2020; 15:e0232219. [PMID: 32324837 PMCID: PMC7179880 DOI: 10.1371/journal.pone.0232219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Factors associated with place of death inform policies with respect to allocating end-of-life care resources and tailoring supportive measures. OBJECTIVE To determine factors associated with non-hospital deaths among cancer patients. DESIGN Retrospective cohort study of cancer decedents, examining factors associated with non-hospital deaths using multinomial logistic regression with hospital deaths as the reference category. SETTING/SUBJECTS Cancer patients (n = 15254) in Singapore who died during the study period from January 1, 2012 till December 31, 2105 at home, acute hospital, long-term care (LTC) or hospice were included. RESULTS Increasing age (categories ≥65 years: RRR 1.25-2.61), female (RRR 1.40; 95% CI 1.28-1.52), Malays (RRR 1.67; 95% CI 1.47-1.89), Brain malignancy (RRR 1.92; 95% CI 1.15-3.23), metastatic disease (RRR 1.33-2.01) and home palliative care (RRR 2.11; 95% CI 1.95-2.29) were associated with higher risk of home deaths. Patients with low socioeconomic status were more likely to have hospice or LTC deaths: those living in smaller housing types had higher risk of dying in hospice (1-4 rooms apartment: RRR 1.13-3.17) or LTC (1-5 rooms apartment: RRR 1.36-4.11); and those with Medifund usage had higher risk of dying in LTC (RRR 1.74; 95% CI 1.36-2.21). Patients with haematological malignancies had increased risk of dying in hospital (categories of haematological subtypes: RRR 0.06-0.87). CONCLUSIONS We found key sociodemographic and clinical factors associated with non-hospital deaths in cancer patients. More can be done to enable patients to die in the community and with dignity rather than in a hospital.
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Affiliation(s)
- Qingyuan Zhuang
- Department of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- * E-mail:
| | - Zheng Yi Lau
- Policy Research and Evaluation Division, Ministry of Health, Singapore, Singapore
| | - Whee Sze Ong
- National Cancer Centre Singapore, Singapore, Singapore
| | - Grace Meijuan Yang
- Department of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Kelvin Bryan Tan
- Policy Research and Evaluation Division, Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Ting Hway Wong
- Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
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18
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Stephens SJ, Chino F, Williamson H, Niedzwiecki D, Chino J, Mowery YM. Evaluating for disparities in place of death for head and neck cancer patients in the United States utilizing the CDC WONDER database. Oral Oncol 2020; 102:104555. [PMID: 32006782 DOI: 10.1016/j.oraloncology.2019.104555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate trends in place of death for patients with head and neck cancers (HNC) in the U.S. from 1999 to 2017 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. MATERIALS/METHODS Using patient-level data from 2015 and aggregate data from 1999 to 2017, multivariable logistic regression analyses (MLR) were performed to evaluate for disparities in place of death. RESULTS We obtained aggregate data for 101,963 people who died of HNC between 1999 and 2017 (25.9% oral cavity, 24.6% oropharynx/pharynx, 0.4% nasopharynx, and 49.1% larynx/hypopharynx). Most were Caucasian (92.7%) and male (87.0%). Deaths at home or hospice increased over the study period (R2 = 0.96, p < 0.05) from 29.2% in 1999 to 61.2% in 2017. On MLR of patient-level data from 2015, those who were single (ref), ages 85+ (OR 0.78; 95% CI: 0.68, 0.90), African American (OR 0.73; 95% CI: 0.65, 0.82), or Asian/Pacific Islanders (OR 0.66; 95% CI: 0.54, 0.81) were less likely to die at home or hospice. On MLR of the aggregate data (1999-2017), those who were female (OR 0.87; 95% CI: 0.83, 0.91) or ages 75-84 (OR 0.79; 95% CI: 0.76, 0.82) were also less likely to die at home or hospice. In both analyses, those who died from larynx/hypopharynx cancers were less likely to die at home or hospice. CONCLUSIONS HNC-related deaths at home or hospice increased between 1999 and 2017. Those who were single, female, African American, Asian/Pacific Islander, older (ages 75+), or those with larynx/hypopharynx cancers were less likely to die at home or hospice.
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Affiliation(s)
- Sarah J Stephens
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Hannah Williamson
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Donna Niedzwiecki
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Junzo Chino
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
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19
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Iqbal J, Sutradhar R, Zhao H, Howell D, O'Brien MA, Seow H, Dudgeon D, Atzema C, Earle CC, DeAngelis C, Sussman J, Barbera L. Operationalizing Outpatient Palliative Care Referral Criteria in Lung Cancer Patients: A Population-Based Cohort Study Using Health Administrative Data. J Palliat Med 2020; 23:670-677. [PMID: 31944866 DOI: 10.1089/jpm.2019.0515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Early referral of cancer patients for palliative care significantly improves the quality of life. It is not clear which patients can benefit from an early referral, and when the referral should occur. A Delphi Panel study proposed 11 major criteria for an outpatient palliative care referral. Objective: To operationalize major Delphi criteria in a cohort of lung cancer patients, using a prospective approach, by linking health administrative data. Design: Population-based observational cohort study. Setting/Subjects: The study population comprised 38,851 cases of lung cancer in the Ontario Cancer Registry, diagnosed from January 1, 2012, to December 31, 2016. Measurements: We operationalized 6 of the 11 major criteria (4 diagnosis or prognosis based and 2 symptom based). Patients were considered eligible (index event) for palliative care if they qualified for any criterion. Among eligible patients, we identified those who received palliative care. Results: Twenty-eight thousand one hundred sixty-four patients were eligible for palliative care by qualifying for either the diagnosis- or prognosis-based criteria (n = 21,036, 76.5%), or for symptom-based criteria (n = 7128, 23.5%). A total of 23,199 (82.4%) patients received palliative care. The median time from palliative care eligibility to the receipt of first palliative care or death or maximum study follow-up was 56 days (range = 17-348). Conclusions: We operationalized six major criteria that identified the majority of lung cancer patients who were eligible for palliative care. Most eligible patients received the palliative care before death. Future research is warranted to test these criteria in other cancer populations.
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Affiliation(s)
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Doris Howell
- Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Deborah Dudgeon
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Clare Atzema
- ICES, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- ICES, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carlo DeAngelis
- Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Barbera
- Division of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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20
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Roeland EJ, Lindley LC, Gilbertson-White S, Saeidzadeh S, Currie ER, Friedman S, Bakitas M, Mack JW. End-of-life care among adolescent and young adult patients with cancer living in poverty. Cancer 2019; 126:886-893. [PMID: 31724747 DOI: 10.1002/cncr.32609] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/05/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND To the authors' knowledge, end-of-life (EOL) care outcomes among adolescents and young adults (AYAs) with cancer who are living in poverty remain poorly understood. The primary aim of the current study was to examine the effect of poverty on EOL care for AYA patients with cancer. METHODS The authors conducted a multisite, retrospective study of AYA patients with cancer aged 15 to 39 years who died between January 2013 and December 2016 at 3 academic sites. Medical record-based EOL care outcomes included hospice referral, palliative care (PC) consultation, cancer treatment within the last month of life, and location of death. Two measures of poverty were applied: 1) zip code with a median income ≤200% of the federal poverty level; and 2) public insurance or lack of insurance. Logistic regression analyses were conducted. RESULTS A total of 252 AYA cancer decedents were identified. Approximately 41% lived in a high-poverty zip code and 48% had public insurance or lacked insurance; approximately 70% had at least 1 poverty indicator. Nearly 40% had a hospice referral, 60% had a PC consultation (76% on an inpatient basis), 38% received EOL cancer treatment, and 39% died in the hospital. In bivariable analyses, AYA patients living in low-income zip codes were found to be less likely to enroll in hospice (P ≤ .01), have an early PC referral (P ≤ .01), or receive EOL cancer treatment (P = .03), although only EOL cancer treatment met statistical significance in multivariable models. No differences with regard to location of death (P = .99) were observed. CONCLUSIONS AYA patients with cancer experience low rates of hospice referral and high rates of in-hospital death regardless of socioeconomic status. Future studies should evaluate early inpatient PC referrals as a possible method for improving EOL care.
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Affiliation(s)
- Eric J Roeland
- Department of Oncology and Palliative Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa C Lindley
- College of Nursing, University of Tennessee at Knoxville, Knoxville, Tennessee
| | | | | | - Erin R Currie
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah Friedman
- University of California at San Diego, San Diego, California
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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21
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Puechl AM, Chino F, Havrilesky LJ, Davidson BA, Chino JP. Place of death by region and urbanization among gynecologic cancer patients: 2006-2016. Gynecol Oncol 2019; 155:98-104. [PMID: 31378375 DOI: 10.1016/j.ygyno.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate associations between US region of residence and urbanization and the place of death among women with gynecologic malignancies in the United States. METHODS A retrospective cross-sectional study was performed using publicly available death certificate data from the National Center for Health Statistics. All gynecologic cancer deaths were included from 2006 to 2016. Comparisons among categories were performed with a two-tailed chi-square test, with p-values <0.05 considered significant. RESULTS From 2006 to 2016, 328,026 women died from gynecologic malignancies in the US. Of these deaths, 40.1% (n = 134,333) occurred in the patient's home, 24.9%(n = 81,823) in the hospital, and 11.3% (37,188) in an inpatient hospice facility. Place of death varied by geographic region. The Northeast had the largest percentage of gynecologic cancer patients (31.3%) die as a hospital inpatient. The West had the highest percentage of deaths (49.3%) at home. Deaths in a hospice facility were the highest (14.1%) in the South. Place of death varied by urbanization; patients residing in large central metro or rural counties were the most likely to die during hospital admission (28.7% and 27.1%, respectively). Patients living in medium-sized metro areas were the least likely to die in hospitals (21.8%) and most likely to die in a hospice facility (14.3%). All comparisons were significant by study definition. CONCLUSION The place of death for patients with gynecologic malignancies varies by US region and urbanization. These disparities are multifactorial in nature, likely influenced by both sociodemographic factors and regional resource availability. In this study, however, rural and central metro areas are identified as regions that may benefit from further hospice development and advocacy.
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Affiliation(s)
- Allison M Puechl
- Duke University Division of Gynecologic Oncology, Department of Radiation Oncology, Durham, NC, United States of America.
| | - Fumiko Chino
- Duke Cancer Institute, Department of Radiation Oncology, Durham, NC, United States of America
| | - Laura J Havrilesky
- Duke University Division of Gynecologic Oncology, Department of Radiation Oncology, Durham, NC, United States of America
| | - Brittany A Davidson
- Duke University Division of Gynecologic Oncology, Department of Radiation Oncology, Durham, NC, United States of America
| | - Junzo P Chino
- Duke Cancer Institute, Department of Radiation Oncology, Durham, NC, United States of America; Duke University Medical Center, Department of Radiation Oncology, Durham, NC, United States of America
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22
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Hughes MC, Vernon E. Closing the Gap in Hospice Utilization for the Minority Medicare Population. Gerontol Geriatr Med 2019; 5:2333721419855667. [PMID: 31276019 PMCID: PMC6598325 DOI: 10.1177/2333721419855667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures included Medicare racial/ethnic minority hospice utilization, for-profit hospice status, estimated cost savings, and several demographic and socioeconomic variables. Results: The prevalence of for-profit hospices was associated with significantly increased hospice utilization among racial/ethnic minorities. With savings of about $2,105 per Medicare hospice enrollee, closing the gap between the White and racial/ethnic minority populations would result in nearly $270 million in annual cost savings. Discussion: Significant disparities in hospice use related to hospice for-profit status exist among the racial/ethnic minority Medicare population. CMS and state policymakers should consider lower racial/ethnic minority hospice utilization and foster better community outreach at all hospices to decrease patient costs and improve quality of life.
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Affiliation(s)
- M Courtney Hughes
- Northern Illinois University, DeKalb, USA.,Relias Institute, Morrisville, NC, USA
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23
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Wales J, Kalia S, Moineddin R, Husain A. The Impact of Socioeconomic Status on Place of Death Among Patients Receiving Home Palliative Care in Toronto, Canada: A Retrospective Cohort Study. J Palliat Care 2019; 35:167-173. [PMID: 31204570 DOI: 10.1177/0825859719855020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities. AIM Our study examines the association between socioeconomic status and other demographic factors on place of death in a population receiving home palliative care in Toronto, Canada. DESIGN This is a retrospective chart review of patients who died between August 2013 and August 2015 when admitted to a home-based palliative care service. Multivariate multinomial regression examined the relationship between the place of death (home, palliative care unit [PCU], or acute care) with age, gender, primary diagnosis, and income quintile. Bivariate logistic regression was fitted to calculate the odds ratio (OR) and probability of preference for home death. SETTING/PARTICIPANTS Patients receiving home-based palliative care services from the Latner Centre for Palliative Care in Toronto, Canada. RESULTS A total of 2066 patients were included in multivariate analysis. Patients in the lowest income quintile had increased odds of dying in acute care (OR = 2.41, P < .001) or dying in PCU (OR = 1.64, P = .008) than patients in highest income quintile. Patients in the next lowest income quintiles 2 and 3 were also more likely to die in acute care. The rate of preference for home death was significantly lower in the lowest income quintile (OR = 0.47, P = .0047). CONCLUSIONS Patients in lower income quintiles are less likely to die at home, despite receiving home-based palliative care, although they may also be less likely to prefer home death.
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Affiliation(s)
- Joshua Wales
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sumeet Kalia
- University of Toronto Practice Based Research Network, North York General Hospital, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amna Husain
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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24
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Cross SH, Kamal AH, Taylor DH, Warraich HJ. Hospice Use Among Patients with Heart Failure. Card Fail Rev 2019; 5:93-98. [PMID: 31179019 PMCID: PMC6545999 DOI: 10.15420/cfr.2019.2.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022] Open
Abstract
Despite its many benefits, hospice care is underused for patients with heart failure. This paper discusses the factors contributing to this underuse and offers recommendations to optimise use for patients with heart failure and proposes metrics to optimise quality of hospice care for this patient group.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University Durham, NC, US
| | - Arif H Kamal
- Duke Cancer Institute Durham, NC, US.,Duke Fuqua School of Business, Duke University Durham, NC, US
| | - Donald H Taylor
- Sanford School of Public Policy, Duke University Durham, NC, US.,Margolis Center for Health Policy, Duke University Durham, NC, US.,Duke Clinical Research Institute Durham, NC, US
| | - Haider J Warraich
- Department of Medicine, Division of Cardiology, Duke University Medical Center Durham, NC, US
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25
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Davies JM, Sleeman KE, Leniz J, Wilson R, Higginson IJ, Verne J, Maddocks M, Murtagh FEM. Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002782. [PMID: 31013279 PMCID: PMC6478269 DOI: 10.1371/journal.pmed.1002782] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Low socioeconomic position (SEP) is recognized as a risk factor for worse health outcomes. How socioeconomic factors influence end-of-life care, and the magnitude of their effect, is not understood. This review aimed to synthesise and quantify the associations between measures of SEP and use of healthcare in the last year of life. METHODS AND FINDINGS MEDLINE, EMBASE, PsycINFO, CINAHL, and ASSIA databases were searched without language restrictions from inception to 1 February 2019. We included empirical observational studies from high-income countries reporting an association between SEP (e.g., income, education, occupation, private medical insurance status, housing tenure, housing quality, or area-based deprivation) and place of death, plus use of acute care, specialist and nonspecialist end-of-life care, advance care planning, and quality of care in the last year of life. Methodological quality was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). The overall strength and direction of associations was summarised, and where sufficient comparable data were available, adjusted odds ratios (ORs) were pooled and dose-response meta-regression performed. A total of 209 studies were included (mean NOS quality score of 4.8); 112 high- to medium-quality observational studies were used in the meta-synthesis and meta-analysis (53.5% from North America, 31.0% from Europe, 8.5% from Australia, and 7.0% from Asia). Compared to people living in the least deprived neighbourhoods, people living in the most deprived neighbourhoods were more likely to die in hospital versus home (OR 1.30, 95% CI 1.23-1.38, p < 0.001), to receive acute hospital-based care in the last 3 months of life (OR 1.16, 95% CI 1.08-1.25, p < 0.001), and to not receive specialist palliative care (OR 1.13, 95% CI 1.07-1.19, p < 0.001). For every quintile increase in area deprivation, hospital versus home death was more likely (OR 1.07, 95% CI 1.05-1.08, p < 0.001), and not receiving specialist palliative care was more likely (OR 1.03, 95% CI 1.02-1.05, p < 0.001). Compared to the most educated (qualifications or years of education completed), the least educated people were more likely to not receive specialist palliative care (OR 1.26, 95% CI 1.07-1.49, p = 0.005). The observational nature of the studies included and the focus on high-income countries limit the conclusions of this review. CONCLUSIONS In high-income countries, low SEP is a risk factor for hospital death as well as other indicators of potentially poor-quality end-of-life care, with evidence of a dose response indicating that inequality persists across the social stratum. These findings should stimulate widespread efforts to reduce socioeconomic inequality towards the end of life.
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Affiliation(s)
- Joanna M. Davies
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Julia Verne
- Health Intelligence, Public Health England, Bristol, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Fliss E. M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Polt G, Weixler D, Bauer N. [A retrospective study about the influence of an emergency information form on the place of death of palliative care patients]. Wien Med Wochenschr 2019; 169:356-363. [PMID: 30725441 DOI: 10.1007/s10354-019-0681-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/02/2019] [Indexed: 11/27/2022]
Abstract
In palliative medicine planning in advance is important for critical care situations. It is highly significant to make useful and by the patient and his relatives desired decisions. These concern transport in a situation of crisis and the venue of death (either death at home or transfer to a hospital).In this study the effect of a new Emergency Information Form about the place of death was examined. The used Emergency Information Form enabled the patient to express a wish on transfer in the case of crisis in advance and communicate this wish to the Emergency system.A total of 858 patients, taken care of by the mobile palliative-team Hartberg/Weiz/Vorau in the period from 2010 to 2015, were included in the study. The Intervention group-the patients for whom an Emergency Information Form was established-counted 38 patients. Data analysis was retrospective, pseudo anonymized and external.The 4 most important results were:1) The Emergency Information Form increased the probability for the intervention group to die at home (intervention group: 72.2%, controll group 1: 53.0%, controll group 2: 56.6%).2) Important in this change was, that the opinion of the patients was considered. The decision made in the Emergency Information Form correlated with a high significance (p = 0.01) with the actual place of death.3) Furthermore, it came clear that the Emergency Information Form was a useful tool to handle the utilization of special facilities. Within the intervention group young patients (with a lot of symptoms) died in a special facility more often than old patients. These, rather geriatric people, were mostly brought to a general hospital.4) There was no significant relation between the duration of care and the probability that an Emergency Information Form was established (p = 0.63). However, there was a high significance between the number of home visits and the probability that an Emergency Information Form was written (p = 0.02).Due to the fact that there was a small intervention group restricted to only one palliative team further studies could help to make clear advises for palliative teams regarding scope, duration and frequency of home-visits. Thus the term "care continuity" could be concretized in the guidelines.The study brought forward that numerous (and short) contacts with the patient were more convenient than less but long home-visits in order to fulfil the patients wish concerning his place of death.
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Affiliation(s)
- Günter Polt
- LKH Hartberg, Rotkreuzplatz 2, 8230, Hartberg, Österreich.
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Ko W, Miccinesi G, Beccaro M, Moreels S, Donker GA, Onwuteaka-Philipsen B, Alonso TV, Deliens L, Van den Block L. Factors Associated with Fulfilling the Preference for Dying at Home among Cancer Patients: The role of General Practitioners. J Palliat Care 2018. [DOI: 10.1177/082585971403000303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aim: This study aimed to explore clinical and care-related factors associated with fulfilling cancer patients’ preference for home death across four countries: Belgium (BE), the Netherlands (NL), Italy (IT), and Spain (ES). Methods: A mortality follow-back study was undertaken from 2009 to 2011 via representative networks of general practitioners (GPs). The study included all patients aged 18 and over who had died of cancer and whose home death preference and place of death were known by the GP. Factors associated with meeting home death preference were tested using multivariable logistic regressions. Results: Among 2,048 deceased patients, preferred and actual place of death was known in 42.6 percent of cases. Home death preference met ranged from 65.5 to 90.9 percent. Country-specific factors included older age in BE, and decisionmaking capacity and being female in the NL GPs’ provision of palliative care was positively associated with meeting home death preference. Odds ratios (ORs) were: BE: 9.9 (95 percent confidence interval [CI] 3.7–26.6); NL: 9.7 (2.4–39.9); and IT: 2.6 (1.2–5.5). ORs for Spain are not shown because a multivariate model was not performed. Conclusion: Those who develop policy to facilitate home death need to examine available resources for primary end-of-life care. But: Cette étude avait pour objectif d'examiner les facteurs cliniques associés aux demandes des patients désirant mourir à la maison. Cette re-cherche s'étendait sur quatre pays soit la Belgique, les Pays-Bas, l'Italie, et l'Espagne. Méthode: Par l'inter-médaire des réseaux représentatifs d'omnipraticiens, nous avons pu faire un suivi rétrospectif des mortalités survenues durant les années 2009, 2010, et 2011. Cette étude comprenait les patients agés de 18 ans et plus morts du cancer et dont les médecins connaissaient tout autant les volontés de pouvoir mourir à la maison que l'endroit où les patients étaient morts. Les facteurs correspondants aux préférences des patients ont été validés à l'aide de la méthode statistique de regression logistique à variables multiples. Résultats: Parmi les 2 048 personnes décédées on connaissait, chez 42,6 pourcent d'entre elles, la préférence et l'endroit de la mort. Le choix de mourir à domicile variait de 65,5 pourcent à 90,9 pourcent. Les facteurs spécifiques à certains pays étaient l'âge avancé pour la Belgique et, pour les Pays-Bas, la capacité décisionnelle et le fait d'être de sexe feminin. La prestation des soins palliatifs par les omnipraticiens est associée de façon positive au choix de mourir à la maison. Les rapports de probabilités étaient les suivants: Belgique: 9,9 [95 pourcent d'intervalle de fiabilité (3,7–26,6)], Pays-Bas: 9,7 (2,4–39,9) et l'Italie: 2,6 (1,2–5,5). Les facteurs de probabilité pour l'Espagne ne sont pas indiqués car on n'a pas fait d'analyse selon le modèle multivariable. Conclusion: Les professionnels de la santé ayant pour tâche d'établir les politiques pour faciliter la mort à la maison doivent connnaître toutes les resources dont ils disposent dans leur communauté afin de pouvoir offrir les soins de première ligne à domicile.
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Affiliation(s)
- Winne Ko
- End-of-Life Care Research Group, Room 126, Building K, Department of Family Medicine, Vrije Universiteit Brussel Laarbeeklaan 103, 1090 Brussels, Belgium; and Ghent University, Ghent, Belgium
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, ISPO, Florence, Italy
| | - Monica Beccaro
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Sarah Moreels
- Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Gé A. Donker
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Bregje Onwuteaka-Philipsen
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health; and Palliative Care Expertise Centre, VU University Medical Centre, Amsterdam, Netherlands
| | - Tomás V. Alonso
- Public Health Directorate General, Health Department, Valencia, Spain; L Deliens: End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Ghent University, Ghent, Belgium; EMGO Institute for Health and Care Research, Department of Public and Occupational Health; and Palliative Care Expertise Centre, VU University Medical Centre, Amsterdam, Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group and Department of Family Medicine, Vrije Universiteit Brussel, Brussels, Belgium; and Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- Lieve Van den Block, Zeger De Groote, Sarah Brearley, Augusto Caraceni, Joachim Cohen, Massimo Costantini, Anneke Francke, Richard Harding, Irene Higginson, Stein Kaasa, Karen Linden, Guido Miccinesi, Bregje Onwuteaka-Philipsen, Koen Pardon, Roeline Pasman, Sophie Pautex, Sheila Payne, and Luc Deliens
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Raziee H, Saskin R, Barbera L. Determinants of Home Death in Patients With Cancer: A Population-Based Study in Ontario, Canada. J Palliat Care 2018; 32:11-18. [PMID: 28662622 DOI: 10.1177/0825859717708518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine factors associated with home death in patients with cancer in Ontario, particularly to assess the association between death at home and (1) patients' rural/urban residence and (2) neighborhood income in urban areas. MATERIALS AND METHODS We conducted a retrospective cross-sectional study in Ontario (2003-2010) using linked administrative databases. In order to account for clustering phenomenon, multivariable generalized estimating equation model was used to evaluate factors associated with home death. Analysis was performed in both rural and urban areas. For urban areas, neighborhood income was tested as a determinant of the place of death. RESULTS A total of 193 783 deaths were analyzed, 9.1% of which occurred at home. In urban areas, home death was more likely for patients living in richer neighborhoods (odds ratio 1.69 for the highest compared to lowest neighborhood income quintile, 95% confidence interval: 1.54-1.86). The odds of dying at home when living in a rural area were no different from those living in the poorest urban neighborhood. Other variables associated with lower odds of home death were comorbidity index, certain cancers, and year of death. CONCLUSION The likelihood of dying at home significantly increases with living in higher-income urban neighborhoods and decreases with rural residence. Urban neighborhoods with lowest income have odds of home death similar to rural areas. These findings underline the importance of targeting proper populations for public support at the end of life.
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Affiliation(s)
- Hamid Raziee
- 1 Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Refik Saskin
- 2 Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Lisa Barbera
- 1 Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Chino F, Kamal AH, Leblanc TW, Zafar SY, Suneja G, Chino JP. Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities. Cancer 2018; 124:4408-4419. [DOI: 10.1002/cncr.31737] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/18/2018] [Accepted: 08/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Fumiko Chino
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Arif H. Kamal
- Division of Medical Oncology and Palliative Care, Duke Cancer Institute; Durham North Carolina
| | - Thomas W. Leblanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute; Durham North Carolina
| | - S. Yousuf Zafar
- Division of Medical Oncology and Palliative Care, Duke Cancer Institute; Durham North Carolina
| | - Gita Suneja
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Junzo P. Chino
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
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Treece J, Ghouse M, Rashid S, Arikapudi S, Sankhyan P, Kohli V, O’Neill L, Addo-Yobo E, Bhattad V, Baumrucker SJ. The Effect of Hospice on Hospital Admission and Readmission Rates: A Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318761105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptom control may become challenging for terminally ill patients as they near the end of life. Patients often seek hospital admission to address symptoms, such as pain, nausea, vomiting, and restlessness. Alternatively, palliative medicine focuses on the control and mitigation of symptoms, while allowing patients to maintain their quality of life, whether in an outpatient or inpatient setting. Hospice care provides, in addition to inpatient care at a hospice facility or in a hospital, the option for patients to receive symptom management at home. This option for symptom control in the outpatient setting is essential to preventing repeated and expensive hospital readmissions. This article discusses the impact of hospice care on hospital readmission rates.
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Affiliation(s)
| | | | - Saima Rashid
- East Tennessee State University, Johnson City, TN, USA
| | | | | | - Varun Kohli
- East Tennessee State University, Johnson City, TN, USA
| | - Luke O’Neill
- East Tennessee State University, Johnson City, TN, USA
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Wales J, Kurahashi AM, Husain A. The interaction of socioeconomic status with place of death: a qualitative analysis of physician experiences. BMC Palliat Care 2018; 17:87. [PMID: 29925364 PMCID: PMC6011451 DOI: 10.1186/s12904-018-0341-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/12/2018] [Indexed: 11/25/2022] Open
Abstract
Background Home is a preferred place of death for many people; however, access to a home death may not be equitable. The impact of socioeconomic status on one’s ability to die at home has been documented, yet there remains little literature exploring mechanisms that contribute to this disparity. By exploring the experiences and insights of physicians who provide end-of-life care in the home, this study aims to identify the factors perceived to influence patients’ likelihood of home death and describe the mechanisms by which they interact with socioeconomic status. Methods In this exploratory qualitative study, we conducted interviews with 9 physicians who provide home-based care at a specialized palliative care centre. Participants were asked about their experiences caring for patients at the end of life, focusing on factors believed to impact likelihood of home death with an emphasis on socioeconomic status, and opportunities for intervention. We relied on participants’ perceptions of SES, rather than objective measures. We used an inductive content analysis to identify and describe factors that physicians perceive to influence a patient’s likelihood of dying at home. Results Factors identified by physicians were organized into three categories: patient characteristics, physical environment and support network. Patient preference for home death was seen as a necessary factor. If this was established, participants suggested that having a strong support network to supplement professional care was critical to achieving home death. Finally, safe and sustainable housing were also felt to improve likelihood of home death. Higher SES was perceived to increase the likelihood of a desired home death by affording access to more resources within each of the categories. This included better health and health care understanding, a higher capacity for advocacy, a more stable home environment, and more caregiver support. Conclusions SES was not perceived to be an isolated factor impacting likelihood of home death, but rather a means to address shortfalls in the three identified categories. Identifying the factors that influence ability is the first step in ensuring home death is accessible to all patients who desire it, regardless of socioeconomic status.
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Affiliation(s)
- Joshua Wales
- The Temmy Latner Centre for Palliative Care, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T 3L9, Canada.
| | - Allison M Kurahashi
- The Temmy Latner Centre for Palliative Care, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T 3L9, Canada
| | - Amna Husain
- The Temmy Latner Centre for Palliative Care, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T 3L9, Canada
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Dudley N, Ritchie CS, Wallhagen MI, Covinsky KE, Cooper BA, Patel K, Stijacic Cenzer I, Chapman SA. Characteristics of Older Adults in Primary Care Who May Benefit From Primary Palliative Care in the U.S. J Pain Symptom Manage 2018; 55:217-225. [PMID: 28916294 DOI: 10.1016/j.jpainsymman.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Older adults with advanced illness and associated symptoms may benefit from primary palliative care, but limited data exist to identify older adults in U.S. primary care to benefit from this care. OBJECTIVES To describe U.S. primary care visits among adults aged 65 years and older with advanced illness. METHODS Cross-sectional analysis of the National Ambulatory and Hospital Ambulatory Medical Care Surveys (2009-2011) was conducted using Chi-squared tests to compare visits without and with advanced illness with U.S. primary care defined by National Committee for Quality Assurance Palliative and End-of-Life Care Physician Performance Measurement Set International Classification of Diseases, Ninth Revision (ICD-9) codes for end-stage illness. RESULTS Among visits by older adults to primary care, 7.9% visits were related to advanced illness. A higher proportion of advanced illness visits was among men vs. women (8.9% vs. 7.2%; P = 0.03) and adults aged 75 years and older, non-Hispanic whites (8.3%) and blacks (8.2%) vs. Hispanic (6.7%) and non-Hispanic other (2.5%) (P = 0.02), dually eligible for Medicare and Medicaid, and from patient ZIP Codes with lower median household incomes (below $32,793). A higher percentage of visits with advanced illness conditions to primary care was chronic obstructive pulmonary disease, congestive heart failure, dementia, and cancer, and symptoms reported with these visits were mostly pain, depression, anxiety, fatigue, and insomnia. CONCLUSION In the U.S., approximately 8% primary care visits among older adults was related to advanced illness conditions. Advanced illness visits were most common among those most likely to be socioeconomically vulnerable and highlight the need to focus efforts for high-quality palliative care for these populations.
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Affiliation(s)
- Nancy Dudley
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA; San Francisco Veterans' Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, California, USA.
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Margaret I Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Kenneth E Covinsky
- San Francisco Veterans' Affair Medical Center, Geriatrics, Palliative & Extended Care, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- Dean's Office, School of Nursing, University of California, San Francisco, California, USA
| | - Kanan Patel
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Irena Stijacic Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Susan A Chapman
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
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Association of hospice utilization and publicly reported outcomes following hospitalization for pneumonia or heart failure: a retrospective cohort study. BMC Health Serv Res 2018; 18:12. [PMID: 29316924 PMCID: PMC5761109 DOI: 10.1186/s12913-017-2801-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/14/2017] [Indexed: 12/25/2022] Open
Abstract
Background The Center for Medicare and Medicaid Services (CMS) and the Hospital Quality Alliance began collecting and reporting United States hospital performance in the treatment of pneumonia and heart failure in 2008. Whether the utilization of hospice might affect CMS-reported mortality and readmission rates is not known. Methods Hospice utilization (mean days on hospice per decedent) for 2012 from the Dartmouth Atlas (a project of the Dartmouth Institute that reports a variety of public health and policy-related statistics) was merged with hospital-level 30-day mortality and readmission rates for pneumonia and heart failure from CMS. The association between hospice use and outcomes was analyzed with multivariate quantile regression controlling for quality of care metrics, acute care bed availability, regional variability and other measures. Results 2196 hospitals reported data to both CMS and the Dartmouth Atlas in 2012. Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia but not for heart failure. Higher quality of care was associated with lower rates of mortality for both pneumonia and heart failure. Greater acute care bed availability was associated with increased readmission rates for both conditions (p < 0.05 for all). Conclusions Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia as reported by CMS. While causality is not established, it is possible that hospice referrals might directly affect CMS outcome metrics. Further clarification of the relationship between hospice referral patterns and publicly reported CMS outcomes appears warranted. Electronic supplementary material The online version of this article (10.1186/s12913-017-2801-3) contains supplementary material, which is available to authorized users.
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Lage DE, Nipp RD, D'Arpino SM, Moran SM, Johnson PC, Wong RL, Pirl WF, Hochberg EP, Traeger LN, Jackson VA, Cashavelly BJ, Martinson HS, Greer JA, Ryan DP, Temel JS, El-Jawahri A. Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer. J Clin Oncol 2017; 36:76-82. [PMID: 29068784 DOI: 10.1200/jco.2017.74.0340] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with advanced cancer experience potentially burdensome transitions of care after hospitalizations. We examined predictors of discharge location and assessed the relationship between discharge location and survival in this population. Methods We conducted a prospective study of 932 patients with advanced cancer who experienced an unplanned hospitalization between September 2014 and March 2016. Upon admission, we assessed patients' physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire-4). The primary outcome was discharge location (home without hospice, postacute care [PAC], or hospice [any setting]). The secondary outcome was survival. Results Of 932 patients, 726 (77.9%) were discharged home without hospice, 118 (12.7%) were discharged to PAC, and 88 (9.4%) to hospice. Those discharged to PAC and hospice reported high rates of severe symptoms, including dyspnea, constipation, low appetite, fatigue, depression, and anxiety. Using logistic regression, patients discharged to PAC or hospice versus home without hospice were more likely to be older (odds ratio [OR], 1.03; 95% CI, 1.02 to 1.05; P < .001), live alone (OR, 1.95; 95% CI, 1.25 to 3.02; P < .003), have impaired mobility (OR, 5.08; 95% CI, 3.46 to 7.45; P < .001), longer hospital stays (OR, 1.15; 95% CI, 1.11 to 1.20; P < .001), higher Edmonton Symptom Assessment System physical symptoms (OR, 1.02; 95% CI, 1.003 to 1.032; P < .017), and higher Patient Health Questionnaire-4 depression symptoms (OR, 1.13; 95% CI, 1.01 to 1.25; P < .027). Patients discharged to hospice rather than PAC were more likely to receive palliative care consultation (OR, 4.44; 95% CI, 2.12 to 9.29; P < .001) and have shorter hospital stays (OR, 0.84; 95% CI, 0.77 to 0.91; P < .001). Patients discharged to PAC versus home had lower survival (hazard ratio, 1.53; 95% CI, 1.22 to 1.93; P < .001). Conclusion Patients with advanced cancer who were discharged to PAC facilities and hospice had substantial physical and psychological symptom burden, impaired physical function, and inferior survival compared with those discharged to home. These patients may benefit from interventions to enhance their quality of life and care.
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Affiliation(s)
- Daniel E Lage
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Ryan D Nipp
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Sara M D'Arpino
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Samantha M Moran
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - P Connor Johnson
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Risa L Wong
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - William F Pirl
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Ephraim P Hochberg
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Lara N Traeger
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Vicki A Jackson
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Barbara J Cashavelly
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Holly S Martinson
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Joseph A Greer
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - David P Ryan
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Jennifer S Temel
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Areej El-Jawahri
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
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Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision. Med Care 2017; 55:848-855. [PMID: 28692573 DOI: 10.1097/mlr.0000000000000776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine rates of hospice disenrollment and posthospice hospitalization among patients who are enrolled in hospices that provide continuous home care (CHC) (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). METHODS We performed a retrospective cohort study among Medicare fee-for-service decedents between July and December 2011, who were 66 years and older and had used hospice in their last 6 months of life. We used propensity score matching to account for potential confounding characteristics of hospices. Generalized estimating equation models were applied to estimate between CHC hospices and non-CHC hospices the associations of hospice disenrollment/hospitalization, adjusted for patient characteristics. We also conducted subgroup analyses to examine how the association might have differed by hospice size, and by the percentage of enrollees who received CHC. RESULTS After matching, we identified 936 pairs of CHC and non-CHC hospices, well balanced in terms of organizational characteristics. In fully adjusted models, compared with non-CHC hospices, CHC hospices had significantly lower disenrollment rates (adjusted rate ratio, 0.73; 95% confidence interval, 0.60-0.87), and lower hospitalization rates (adjusted rate ratio, 0.79; 95% confidence interval, 0.66-0.95). These associations were significantly more pronounced among larger hospices (those with >175 enrollees during study period), and among hospices in which at least 7.3% of enrollees used CHC. CONCLUSIONS CHC hospices had significantly lower rates of hospice disenrollment and posthospice hospitalization, suggesting CHC service available may enable higher quality of end-of-life care.
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Lee YS, Akhileswaran R, Ong EHM, Wah W, Hui D, Ng SHX, Koh G. Clinical and Socio-Demographic Predictors of Home Hospice Patients Dying at Home: A Retrospective Analysis of Hospice Care Association's Database in Singapore. J Pain Symptom Manage 2017; 53:1035-1041. [PMID: 28196785 DOI: 10.1016/j.jpainsymman.2017.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT Hospice care can be delivered in different settings, but many patients choose to receive it at home because of familiar surroundings. Despite their preferences, not every home hospice patient manages to die at home. OBJECTIVE To examine the independent factors associated with home hospice patient dying at home. METHODS Retrospective analysis of Hospice Care Association's database. Hospice Care Association is the largest home hospice provider in Singapore. The study included all patients who were admitted into home hospice service from January 1, 2004 to December 31, 2013. Cox proportional hazards modeling with time as constant was used to study the relationship between independent variables and home death. RESULTS A total of 19,721 patients were included in the study. Females (adjusted risk ratio [ARR] 1.09, 95% CI 1.04-1.15), older patients (ARR 1.01, 95% CI 1.00-1.01), shorter duration of home hospice stay (ARR 0.88, 95% CI 0.82-0.94), fewer episodes of hospitalization (ARR 0.81, 95% CI 0.75-0.86), living with caregivers (ARR 1.54, 95% CI 1.05-2.26), doctor (ARR 1.05, 95% CI 1.01-1.08) and nurse (ARR 1.06, 95% CI 1.04-1.08) visits were positive predictors of dying-at-home. Diagnosis of cancer (ARR 0.93, 95% CI 0.86-1.00) was a negative predictor of dying-at-home. CONCLUSION Female, older age, living with a caregiver, non-cancer diagnosis, more doctor and nurse visits, shorter duration of home hospice stays, and fewer episodes of acute hospitalizations are predictive of dying-at-home for home hospice patients.
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Affiliation(s)
- Yee Song Lee
- National University Health System (NUHS), Singapore, Singapore.
| | | | - Eng Hock Marcus Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Win Wah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - David Hui
- University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Sheryl Hui-Xian Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Boucher NA, Kuchibhatla M, Johnson KS. Meeting Basic Needs: Social Supports and Services Provided by Hospice. J Palliat Med 2017; 20:642-646. [PMID: 28186839 DOI: 10.1089/jpm.2016.0459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Describe social goods and services for which hospices assist patients and families and the resources hospices use to do so. BACKGROUND Basic social supports and services not routinely covered by insurers may be needed by terminally ill patients and their families. Little is known about hospices' provision of such social supports and services. METHODS A 2014-2015 cross-sectional survey of hospices nationwide. Participating hospices had been in operation for at least 3 years and were located in any of the 50 states or District of Columbia. Hospices were surveyed about availability and sources of internal funds and referral to obtain basic social supports for patients. Descriptive statistics, bivariate analysis, and categorization were used to describe hospice practices. Measures included frequency and nature of goods and services provision in the prior year; and extent to which hospices used internal funds or community referral for goods and services. RESULTS Over 80% (n = 203) reported internal funds covered services not reimbursed by insurers; 78% used funds in last year. Hospices used internal funds for food (81.7%), shelter (57.8%), utility bills (73.5%), and funeral costs (50%). Hospices referred patients/families to community organizations to obtain a similar range of services, including transportation, clothing, linens/towels, furniture/appliances, home repairs, and caregiver support. DISCUSSION Hospices are using internal resources and accessing community resources to provide patients with basic social needs not routinely covered by insurance.
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Affiliation(s)
- Nathan A Boucher
- 1 Division of Geriatric Medicine, Geriatric Research, Education and Clinical Center, Durham VA Medical Center , Durham, North Carolina.,2 Division of Geriatric Medicine, Center for the Study of Aging and Human Development, Duke University , Durham, North Carolina
| | - Maragatha Kuchibhatla
- 2 Division of Geriatric Medicine, Center for the Study of Aging and Human Development, Duke University , Durham, North Carolina.,3 Division of Geriatric Medicine, School of Medicine, Duke University , Durham, North Carolina
| | - Kimberly S Johnson
- 1 Division of Geriatric Medicine, Geriatric Research, Education and Clinical Center, Durham VA Medical Center , Durham, North Carolina.,2 Division of Geriatric Medicine, Center for the Study of Aging and Human Development, Duke University , Durham, North Carolina.,3 Division of Geriatric Medicine, School of Medicine, Duke University , Durham, North Carolina
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Wang SY, Aldridge MD, Canavan M, Cherlin E, Bradley E. Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment. J Pain Symptom Manage 2016; 52:813-821. [PMID: 27697564 PMCID: PMC5154927 DOI: 10.1016/j.jpainsymman.2016.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/20/2016] [Accepted: 05/25/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Among the four levels of hospice care, continuous home care (CHC) is the most expensive care, and infrequently provided in practice. OBJECTIVES To identify hospice and patient characteristics associated with the use of CHC and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. METHODS Using 100% fee-for-service Medicare claims data for beneficiaries aged 66 years or older who died between July and December 2011, we identified the percentage of hospice agencies in which patients used CHC in 2011 and determined hospice and patient characteristics associated with the use of CHC. Using multivariable analyses, we examined the associations between CHC utilization and hospice disenrollment and hospitalization after hospice enrollment, adjusted for hospice and patient characteristics. RESULTS Only 42.7% of hospices (1533 of 3592 hospices studied) provided CHC to at least one patient during the study period. Patients enrolled with for-profit, larger, and urban located hospices were more likely to use CHC (P < 0.001). Within these 1533 hospices, only 11.4% of patients used CHC. Patients who were white, had cancer, and had more comorbidities were more likely to use CHC. In multivariable models, compared with patients who did not use CHC, patients who used CHC were less likely to have hospice disenrollment (adjusted odds ratio 0.21; 95% CI 0.19, 0.23) and less likely to be hospitalized after hospice enrollment (adjusted odds ratio 0.37; 95% CI 0.34, 0.40). CONCLUSION Although a minority of patients uses CHC, such services may be protective against hospice disenrollment and hospitalization after hospice enrollment.
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Affiliation(s)
- Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; James J. Peters VA Medical Center, Bronx, New York, USA
| | - Maureen Canavan
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Emily Cherlin
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Elizabeth Bradley
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
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Prioleau PG, Soones TN, Ornstein K, Zhang M, Smith CB, Wajnberg A. Predictors of Place of Death of Individuals in a Home-Based Primary and Palliative Care Program. J Am Geriatr Soc 2016; 64:2317-2321. [PMID: 27640817 DOI: 10.1111/jgs.14465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate factors associated with place of death of individuals in the Mount Sinai Visiting Doctors Program (MSVD). DESIGN A retrospective chart review was performed of all MSVD participants who died in 2012 to assess predictors of place of death in the last month of life. SETTING MSVD, a home-based primary and palliative care program in New York. PARTICIPANTS MSVD participants who were discharged from the program because of death between January 2012 and December 2012 and died at home, in inpatient hospice, or in the hospital (N = 183). MEASUREMENTS Electronic medical records were reviewed to collect information on demographic characteristics, physician visits, and end-of-life conversations. RESULTS Of 183 participants, 103 (56%) died at home, approximately twice the national average; 28 (15%) died in inpatient hospice; and 52 (28%) died in the hospital. Bivariate analyses showed that participants who were white, aged 90 and older, non-Medicaid, or had a recorded preference for place of death were more likely to die outside the hospital. Diagnoses and living situation were not significantly associated with place of death. Multivariate logistic regression analysis showed no statistical association between place of death and home visits in the last month of life (odds ratio = 1.21, 95% confidence interval = 0.52-2.77). CONCLUSION Home-based primary and palliative care results in a high likelihood of nonhospital death, although certain demographic characteristics are strong predictors of death in the hospital. For MSVD participants, home visits in the last month of life were not associated with death outside the hospital.
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Affiliation(s)
| | - Tacara N Soones
- Department of Geriatrics and Palliative Medicine, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Katherine Ornstein
- Department of Geriatrics and Palliative Medicine, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.,Division of General Internal Medicine, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Meng Zhang
- Department of Geriatrics and Palliative Medicine, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Cardinale B Smith
- Division of Hematology and Medical Oncology, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ania Wajnberg
- Division of General Internal Medicine, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
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Riggs A, Breuer B, Dhingra L, Chen J, Hiney B, McCarthy M, Portenoy RK, Knotkova H. Hospice Enrollment After Referral to Community-Based, Specialist-Level Palliative Care: Incidence, Timing, and Predictors. J Pain Symptom Manage 2016; 52:170-7. [PMID: 27208866 DOI: 10.1016/j.jpainsymman.2016.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/11/2016] [Accepted: 02/29/2016] [Indexed: 11/29/2022]
Abstract
CONTEXT Referral to community-based palliative care may increase the likelihood of hospice enrollment. OBJECTIVES This retrospective cohort study evaluated the incidence, timing, and predictors of hospice enrollment after referral to a community-based palliative care program. METHODS Data from 1505 homebound patients referred to community-based palliative care during 2010-2013 were analyzed using multivariate linear and logistic regression. RESULTS Mean (SD) age was 70.4 (16.7) years; 58.8% were women, and race/ethnicity was diverse (white 32.9%, black 29.8%, Hispanic 28.6%, Asian 5.4%). Patients received palliative care services for a mean (SD) of 10.2 (10.2) months (median 6.9; range 0.03-52.2 months). A total of 362 patients (24.1%) were enrolled in hospice after receiving palliative care services for a mean (SD) of 4.8 (6.8) months (median 7.9; range 0.09-25.7 months). The median hospice length of stay was approximately twice as long as other patients enrolled in hospice during the same period. The probability of hospice enrollment increased with shorter duration of palliative care, cancer diagnosis, poorer performance status, and a lower likelihood of poverty. Similarly, significant predictors of a shorter duration of palliative care services before hospice enrollment included both sociodemographic and clinical factors. CONCLUSION Almost one-quarter of patients were enrolled in hospice while receiving community-based palliative care, and hospice length of stay was relatively long for those who did. Both sociodemographic and clinical characteristics were associated with hospice-related outcomes. Studies are needed to further explore predictors and outcomes of hospice enrollment from palliative care.
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Affiliation(s)
- Alexa Riggs
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Brenda Breuer
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Bronx, New York, USA
| | - Jack Chen
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Barbara Hiney
- MJHS Hospice and Palliative Care, New York, New York, USA
| | - Maureen McCarthy
- The Center for Hospice & Palliative Care, New York, New York, USA
| | - Russell K Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Bronx, New York, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Bronx, New York, USA.
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Chen H, Nicolson DJ, Macleod U, Allgar V, Dalgliesh C, Johnson M. Does the use of specialist palliative care services modify the effect of socioeconomic status on place of death? A systematic review. Palliat Med 2016; 30:434-45. [PMID: 26330454 PMCID: PMC4838174 DOI: 10.1177/0269216315602590] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer patients in lower socioeconomic groups are significantly less likely to die at home and experience more barriers to access to palliative care. It is unclear whether receiving palliative care may mediate the effect of socioeconomic status on place of death. AIM This review examines whether and how use of specialist palliative care may modify the effect of socioeconomic status on place of death. DESIGN A systematic review was conducted. Eligible papers were selected and the quality appraised by two independent reviewers. Data were synthesised using a narrative approach. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO and Web of Knowledge were searched (1997-2013). Bibliographies were scanned and experts contacted. Papers were included if they reported the effect of both socioeconomic status and use of specialist palliative care on place of death for adult cancer patients. RESULTS Nine studies were included. All study subjects had received specialist palliative care. With regard to place of death, socioeconomic status was found to have (1) no effect in seven studies and (2) an effect in one study. Furthermore, one study found that the effect of socioeconomic status on place of death was only significant when patients received standard specialist palliative care. When patients received more intense care adapted to their needs, the effect of socioeconomic status on place of death was no longer seen. CONCLUSION There is some evidence to suggest that use of specialist palliative care may modify the effect of socioeconomic status on place of death.
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Affiliation(s)
- Hong Chen
- Hull York Medical School, University of Hull, Hull, UK
| | | | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Victoria Allgar
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
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Blackhall LJ, Read P, Stukenborg G, Dillon P, Barclay J, Romano A, Harrison J. CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic. J Palliat Med 2015; 19:57-63. [PMID: 26624851 DOI: 10.1089/jpm.2015.0272] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies suggest that outpatient palliative care can reduce hospitalization and increase hospice utilization for patients with cancer, however there are insufficient resources to provide palliative care to all patients from time of diagnosis. It is also unclear whether inpatient consultation alone provides similar benefits. A better understanding of the timing, setting, and impact of palliative care for patients with cancer is needed. OBJECTIVES The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care. DESIGN The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program is a phased intervention integrating outpatient palliative care into cancer care. In Year 1 patients were referred at the discretion of their oncologist. SETTING Academic medical center. MEASUREMENTS We compared EOL hospitalization, hospice utilization, and costs of care for CARE Track patients compared to those never seen by palliative care or seen only in hospital. RESULTS Patients were referred a median of 72.5 days prior to death. CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups. Inpatient consultation alone did not impact these variables. However, only approximately half of patients with incurable cancers were referred to this program. CONCLUSION Referral outpatient palliative care within 3 months of death improved EOL care and reduced costs, benefits not seen with inpatient care only. However, many patients were never referred, and methods of systematically identifying appropriate patients are needed.
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Affiliation(s)
- Leslie J Blackhall
- 1 Department of Palliative Care, University of Virginia , Charlottesville, Virginia.,2 Department of Internal Medicine, University of Virginia , Charlottesville, Virginia
| | - Paul Read
- 3 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia
| | - George Stukenborg
- 4 Department of Health Services Research, University of Virginia , Charlottesville, Virginia
| | - Patrick Dillon
- 5 Department of Medical Oncology, University of Virginia , Charlottesville, Virginia
| | - Joshua Barclay
- 2 Department of Internal Medicine, University of Virginia , Charlottesville, Virginia
| | - Andrew Romano
- 5 Department of Medical Oncology, University of Virginia , Charlottesville, Virginia
| | - James Harrison
- 3 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia
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Minding the gap: access to palliative care and the homeless. BMC Palliat Care 2015; 14:62. [PMID: 26582035 PMCID: PMC4650146 DOI: 10.1186/s12904-015-0059-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With an ever increasing number of individuals living with chronic and terminal illnesses, palliative care as an emerging field is poised for unprecedented expansion. Today's rising recognition of its key role in patients' illnesses has led to increased interest in access to palliative care. It is known that homelessness as a social determinant of health has been associated with decreased access to health resources in spite of poorer health outcomes and some would argue, higher need. This article aims to discuss the current state of affairs with regards to accessing palliative care for the homeless in Canada. DISCUSSION Recent review of the literature reveals differential access to palliative care services and outcomes with differing socio-economic status (SES). Notably, individuals of lower SES and in particular, those who are homeless have poorer health outcomes in addition to poor access to quality palliative care. Current palliative care services are ill equipped to care for this vulnerable population and most programs are built upon an infrastructure that is prohibitive for the homeless to access its services. A preliminary review of existing Canadian programs in place to address this gap in access identified a paucity of sporadic palliative care programs across the country with a focus on homeless and vulnerably-housed individuals. It is apparent that there is no unified national strategy to address this gap in access. The changing landscape of the Canadian population calls for an expansion of palliative care as a field and as many have put it, as a right. The right to access quality palliative and end of life care should not be confined to particular population groups. This article calls for the development of a unified national strategy to address this glaring gap in our healthcare provision and advocates for attention to and adoption of policy and processes that would support the homeless populations' right to quality palliative care.
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Pype P, Symons L, Wens J, Van den Eynden B, Stes A, Deveugele M. Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: a focus group study. BMC FAMILY PRACTICE 2014; 15:36. [PMID: 24552145 PMCID: PMC3936999 DOI: 10.1186/1471-2296-15-36] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/17/2014] [Indexed: 11/28/2022]
Abstract
Background There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care professionals and professionals from organizations who provide training and education. Methods Five focus groups were brought together in Belgium, with a total of 29 participants, including members of the three categories mentioned above. They were analysed using a constant comparison method. Results The analysis revealed that undergraduate education and continuing medical education (CME) while in practice, is insufficient to prepare GPs for their palliative work. Workplace learning (WPL) through collaboration with specialized palliative home-care nurses seems to be a valuable alternative. Conclusions The effectiveness of undergraduate education might be enhanced by adding practical experience. Providers of continuing medical education should look to organize interactive, practice-based and interprofessional sessions. Therefore, teachers need to be trained to run small group discussions. In order to optimize workplace learning, health care professionals should be trained to monitor each other’s practice and to provide effective feedback. Further research is needed to clarify which aspects of interprofessional teamwork (e.g. professional hierarchy, agreements on tasks and responsibilities) influence the effectiveness of workplace learning.
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Affiliation(s)
- Peter Pype
- Department of Family Medicine and Primary Health Care, Ghent University, UZ-6 K3, De Pintelaan 185, 9000 Gent, Belgium.
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