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Spacey A, Heaslip V, Szczepura K. Exploring end of life care provision during medical imaging in hospitals: Analysis of survey data from the UK radiography workforce. Radiography (Lond) 2024; 30:1308-1316. [PMID: 39053187 DOI: 10.1016/j.radi.2024.07.003] [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: 05/17/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Patients receiving end-of-life care often undergo medical imaging examinations in hospitals to inform symptom management and care. Yet little is known about the experiences of the radiography workforce who deliver it. This study aims to describe and explore experiences of the UK radiography workforce delivering medical imaging as part of patients' end-of-life care. METHODS A mixed method cross-sectional online survey disseminated via social media and national organisations from September 2023 to January 2024. Diagnostic radiographers, assistant practitioners and radiology assistants involved in the medical imaging of patients receiving end-of-life care in UK hospitals. RESULTS 120 valid responses were received. Most respondents received no education/training (91.6%) on the role of medical imaging in end-of-life care, despite 87.7% expressing a need for education, particularly around adopting supportive/palliative-centric communication techniques. Although most respondents (89.2%) had heard of end-of-life care, some had difficulty understanding the role of medical imaging in end-of-life care. Insufficient information provided on imaging requests hindered the workforces' ability to determine and understand the appropriate use of medical imaging during end-of-life care. These uncertainties exacerbated negative emotions, with 80.8% of respondents indicating that they felt emotional during or after imaging patients on end-of-life care. CONCLUSION Educational and policy needs were identified around facilitating more supportive/palliative-centric communication techniques and providing the radiography workforce with the knowledge to better understand, explain, deliver and where necessary, challenge the use of medical imaging in end-of-life care. IMPLICATIONS FOR PRACTICE This study has evidenced the important role the radiography workforce play in generalist end-of-life care. However, there is a need for training to support practitioners as well as appropriate policies to develop supportive and high-quality end-of-life care in medical imaging.
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Affiliation(s)
- A Spacey
- School of Health and Society, University of Salford, UK.
| | - V Heaslip
- School of Nursing Society, University of Salford, UK.
| | - K Szczepura
- School of Health and Society, University of Salford, UK.
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2
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Kjelle E, Brandsæter IØ, Andersen ER, Hofmann BM. Cost of Low-Value Imaging Worldwide: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:485-501. [PMID: 38427217 PMCID: PMC11178636 DOI: 10.1007/s40258-024-00876-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Imaging with low or no benefit for the patient undermines the quality of care and amounts to vast opportunity costs. More than 3.6 billion imaging examinations are performed annually, and about 20-50% of these are of low value. This study aimed to synthesize knowledge of the costs of low-value imaging worldwide. METHODS This systematic review was based on the PRISMA statement. The database search was developed in Medline and further adapted to Embase-Ovid, Cochrane Library, and Scopus. Primary empirical studies assessing the costs of low-value diagnostic imaging were included if published between 2012 and March 2022. Studies designed as randomized controlled trials, non-randomized trials, cohort studies, cross-sectional studies, descriptive studies, cost analysis, cost-effectiveness analysis, and mixed-methods studies were eligible. The analysis was descriptive. RESULTS Of 5,567 records identified, 106 were included. Most of the studies included were conducted in the USA (n = 76), and a hospital or medical center was the most common setting (n = 82). Thirty-eight of the included studies calculated the costs of multiple imaging modalities; in studies with only one imaging modality included, conventional radiography was the most common (n = 32). Aggregated costs for low-value examinations amounts to billions of dollars per year globally. Initiatives to reduce low-value imaging may reduce costs by up to 95% without harming patients. CONCLUSIONS This study is the first systematic review of the cost of low-value imaging worldwide, documenting a high potential for cost reduction. Given the universal challenges with resource allocation, the large amount used for low-value imaging represents a vast opportunity cost and offers great potential to improve the quality and efficiency of care.
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Affiliation(s)
- Elin Kjelle
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Ingrid Øfsti Brandsæter
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Eivind Richter Andersen
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Bjørn Morten Hofmann
- Department of Health Sciences, Gjøvik at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics at the University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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3
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Kim DH, Youk J, Byun JM, Koh Y, Hong J, Kim TM, Kim I, Yoon SS, Yoo SH, Shin DY. Effects of tertiary palliative care on the pattern of end-of-life care in patients with hematologic malignancies in Korea. Eur J Haematol 2024; 112:743-755. [PMID: 38154958 DOI: 10.1111/ejh.14165] [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] [Received: 10/04/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Patients with hematologic malignancies (HMs) often face challenges in accessing palliative care (PC) and receiving quality end-of-life (EOL) care. We examined factors associated with referrals to tertiary PC and the effects of tertiary PC on EOL care in patients with HMs. METHOD We included patients with HMs who were admitted to a university-affiliated hospital and died during hospitalization between January 2018 and December 2021. We investigated the receipt of PC consultations, patient characteristics, and EOL care indicators. RESULTS Overall, 487 patients were included in the analysis, with 156 (32%) undergoing PC consultation. Sex, residence, disease status, and admission purpose were factors associated with the likelihood of PC consultation, and there has been an increasing trend in the frequency of consultations in recent cases. A higher proportion of patients who received PC completed advance statements and life-sustaining treatment documents. Patients who received PC had lower rates of aggressive EOL care, including chemotherapy and intensive care unit admission, than those who did not receive PC. Notably, PC reduced the number of blood transfusions. CONCLUSION Tertiary PC aims to reduce aggressive EOL care through patient-centered goal-of-care discussions. Therefore, there is an imperative need for concerted efforts toward seamless integration of PC.
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Affiliation(s)
- Dong Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeonghwan Youk
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [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] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
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5
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Spacey A, Heaslip V, Szczepura K. Understanding experiences of the radiography workforce delivering medical imaging as part of patients' end of life care: An exploratory qualitative interview study. Radiography (Lond) 2024; 30:132-140. [PMID: 37924722 DOI: 10.1016/j.radi.2023.10.019] [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: 07/05/2023] [Revised: 09/30/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION People nearing the end of life often require medical imaging in hospitals to manage symptoms and care, despite this little is known about the experiences of those delivering it. The aim of this study is therefore to explore the experiences of the radiography workforce delivering medical imaging as part of patients' end-of-life care. METHOD Qualitative design using semi-structured interviews and thematic analysis. A total of 8 participants participated in the study including registered diagnostic radiographers (n = 5), imaging assistants (n = 2) and assistant practitioners (n = 1). All have been involved in the medical imaging of patients receiving end of life care in UK hospitals. RESULTS Findings identified an absence of end of life care policy guidance and education accessible to radiography staff, limiting their ability to provide evidenced based care for those nearing the end of life during medical imaging examinations. Findings also suggest difficulty in identifying patients receiving end of life care further hindered staffs' ability to adapt their care to provide a more person-centred approach. Lastly, the workforce felt an accumulative emotional burden following their interactions with patients nearing the end of life. CONCLUSION There is a clear need to develop policy and education to support the radiography workforce to ensure care is appropriately identified and adapted to those nearing the end of life. Furthermore, staff support and wellbeing needs to be considered. IMPLICATIONS FOR PRACTICE Future research is required exploring the patient perspective to understand their experiences so that the education and practice provision is driven by patient need. International exploration of end of life care in medical imaging is recommended to explore whether similar challenges related to clinical practice exist in other countries.
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Affiliation(s)
- A Spacey
- School of Health and Society, University of Salford, UK.
| | - V Heaslip
- Directorate of Nursing and Midwifery, University of Salford, UK.
| | - K Szczepura
- School of Health and Society, University of Salford, UK.
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Raghavan K, Copeland TP, Rabow M, Ladenheim M, Marks A, Pantilat SZ, O'Riordan D, Seidenwurm D, Franc B. Palliative care and imaging utilisation for patients with cancer. BMJ Support Palliat Care 2022; 12:e813-e820. [PMID: 30826736 PMCID: PMC6773516 DOI: 10.1136/bmjspcare-2018-001572] [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] [Received: 05/23/2018] [Revised: 01/01/2019] [Accepted: 01/16/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This observational study explores the association between palliative care (PC) involvement and high-cost imaging utilisation for patients with cancer patients during the last 3 months of life. METHODS Adult patients with cancer who died between 1 January 2012 and 31 May 2015 were identified. Referral to PC, intensity of PC service use, and non-emergent oncological imaging utilisation were determined. Associations between PC utilisation and proportion of patients imaged and mean number of studies per patient (mean imaging intensity (MII)) were assessed for the last 3 months and the last month of life. Similar analyses were performed for randomly matched case-control pairs (n = 197). Finally, the association between intensity of PC involvement and imaging utilisation was assessed. RESULTS 3784 patients were included, with 3523 (93%) never referred to PC and 261 (7%) seen by PC, largely before the last month of life (61%). Similar proportions of patients with and without PC referral were imaged during the last 3 months, while a greater proportion of patients with PC referral were imaged in the last month of life. PC involvement was not associated with significantly different MII during either time frame. In the matched-pairs analysis, a greater proportion of patients previously referred to PC received imaging in the period between the first PC encounter and death, and in the last month of life. MII remained similar between PC and non-PC groups. Finally, intensity of PC services was similar for imaged and non-imaged patients in the final 3 months and 1 month of life. During these time periods, increased PC intensity was not associated with decreased MII. CONCLUSIONS PC involvement in end-of-life oncological care was not associated with decreased use of non-emergent, high-cost imaging. The role of advanced imaging in the PC setting requires further investigation.
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Affiliation(s)
- Kesav Raghavan
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Timothy P Copeland
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Michael Rabow
- Palliative Care Program, University of California San Francisco, San Francisco, California, USA
| | - Maya Ladenheim
- Palliative Care Program, University of California San Francisco, San Francisco, California, USA
| | - Angela Marks
- Palliative Care Program, University of California San Francisco, San Francisco, California, USA
| | - Steven Z Pantilat
- Palliative Care Program, University of California San Francisco, San Francisco, California, USA
| | - David O'Riordan
- Palliative Care Program, University of California San Francisco, San Francisco, California, USA
| | | | - Benjamin Franc
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Lo H, Eder N, Boten D, Jenssen C, Nuernberg D. Handheld Ultrasound (HHUS): Potential for Home Palliative Care. Ultrasound Int Open 2022; 8:E68-E76. [PMID: 36937375 PMCID: PMC10023243 DOI: 10.1055/a-1999-7834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/24/2022] [Indexed: 03/19/2023] Open
Abstract
Due to the severity of their disease, palliative care patients often present complex clinical symptoms and complaints like pain, shortness of breath, nausea, loss of appetite, and fatigue. Solely relying on the information available from the history and physical examination often causes uncertainty among palliative care physicians regarding treatment decisions during home visits, potentially leading to unnecessary hospitalizations or transfer to cross-sectional imaging in radiological practices. A rational approach is essential to avoid diagnostic aggressiveness while still providing the imaging information required for optimal palliative care. Bedside use of handheld ultrasound (HHUS) has the potential to expand the diagnostic and therapeutic spectrum in the case of symptom exacerbation but is still underutilized. In this review, we evaluate the potential uses of HHUS in home care settings to provide a more accurate diagnosis of the most common symptoms in palliative patients and to guide bedside interventions such as bladder catheterization, thoracentesis, paracentesis, venous access, and regional anesthesia. Specific training programs for ultrasound in palliative care are currently not available. Adequate documentation is warranted but fraught with technological and privacy issues. Expert supervision and quality assurance are necessary. Despite its limitation and challenges, we suggest that HHUS leads to improved clinical decision-making, expedited symptom relief, and reduced complications without burdening of the patient and costly transfer to hospital or specialty consultations.
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Affiliation(s)
- Hendra Lo
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine – Gastroenterology, Diabetology
and Hepatology, Vivantes Hospital Neukölln, Berlin,
Germany
- Correspondence Mr. Hendra Lo Brandenburg
Medical University Theodor Fontane, Institute for Clinical Ultrasound
(BICUS) and Faculty of Health Sciences Brandenburg, Fehrbelliner
Straße 3816816NeuruppinGermany+ 49
3391 3914710
,
| | - Nicole Eder
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - David Boten
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
| | - Christian Jenssen
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - Dieter Nuernberg
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
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Shen C, Kwon M, Moss JL, Schaefer E, Zhou S, Dodge D, Ruffin MT. Utilization of Mammography During the Last Year of Life Among Older Breast Cancer Survivors. J Womens Health (Larchmt) 2022; 31:941-948. [PMID: 35394350 DOI: 10.1089/jwh.2021.0517] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Mammography is generally recommended for breast cancer survivors. However, discussion is ongoing about stopping surveillance mammography when life expectancy is <5-10 years as the benefit of screening might be diminished toward the end of life. The utilization pattern of mammography in the last year of life among this population has not been well studied. Methods: We identified 58,736 females diagnosed with breast cancer between January 2002 and December 2015, who died at the age of at least 67, from the SEER-Medicare database. We examined the utilization patterns of mammography during their last year of life and investigated factors associated with the use of mammography at the end of life using a multivariable logistic regression model. Results: Overall, 28.5% of the patients received mammography during the last year of life. Multivariable logistic regression showed that older age (OR = 0.31, 95% CI = 0.29-0.34, p < 0.001 for 95 vs. 85 years old), more advanced cancer stage (OR = 0.22, 95% CI = 0.20-0.24 p < 0.001 for distant vs. localized disease), and higher comorbidity score (OR = 0.92, 95% CI = 0.91-0.93, p < 0.001 for every 1-point increase) were associated with less mammography use. Age was nonlinearly associated with mammography use, with a steady proportion of patients receiving a mammography until approximately age 80 and then a sharp decrease thereafter. Conclusion: This population-based study found that a sizable proportion of older breast cancer survivors received mammography during the last year of life.
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Affiliation(s)
- Chan Shen
- Department of Surgery and College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Michelle Kwon
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jennifer L Moss
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Daleela Dodge
- Department of Surgery and College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Mack T Ruffin
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Gu YF, Lin FP, Epstein RJ. How aging of the global population is changing oncology. Ecancermedicalscience 2022; 15:ed119. [PMID: 35211208 PMCID: PMC8816510 DOI: 10.3332/ecancer.2021.ed119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Population aging is causing a demographic redistribution with implications for the future of healthcare. How will this affect oncology? First, there will be an overall rise in cancer affecting older adults, even though age-specific cancer incidences continue to fall due to better prevention. Second, there will be a wider spectrum of health functionality in this expanding cohort of older adults, with differences between “physiologically older” and “physiologically younger” patients becoming more important for optimal treatment selection. Third, greater teamwork with supportive care, geriatric, mental health and rehabilitation experts will come to enrich oncologic decision-making by making it less formulaic than it is at present. Success in this transition to a more nuanced professional mindset will depend in part on the development of user-friendly computational tools that can integrate a complex mix of quantitative and qualitative inputs from evidence-based medicine, functional and cognitive assessments, and the personal priorities of older adults.
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Affiliation(s)
- Yan Fei Gu
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China
| | - Frank P Lin
- Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,NH&MRC Clinical Trials Centre, 92 Parramatta Rd, Camperdown, Sydney 2050, Australia
| | - Richard J Epstein
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China.,Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,UNSW Clinical School, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney 2010, Australia.,https://orcid.org/0000-0002-4640-0195
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10
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van der Padt-Pruijsten A, Leys MBL, Hoop EOD, van der Heide A, van der Rijt CCD. The effect of a palliative care pathway on medical interventions at the end of life: a pre-post-implementation study. Support Care Cancer 2022; 30:9299-9306. [PMID: 36071303 PMCID: PMC9633459 DOI: 10.1007/s00520-022-07352-4] [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: 03/29/2022] [Accepted: 08/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Adequate integration of palliative care in oncological care can improve the quality of life in patients with advanced cancer. Whether such integration affects the use of diagnostic procedures and medical interventions has not been studied extensively. We investigated the effect of the implementation of a standardized palliative care pathway in a hospital on the use of diagnostic procedures, anticancer treatment, and other medical interventions in patients with incurable cancer at the end of their life. METHODS In a pre- and post-intervention study, data were collected concerning adult patients with cancer who died between February 2014 and February 2015 (pre-PCP period) or between November 2015 and November 2016 (post-PCP period). We collected information on diagnostic procedures, anticancer treatments, and other medical interventions during the last 3 months of life. RESULTS We included 424 patients in the pre-PCP period and 426 in the post-PCP period. No differences in percentage of laboratory tests (85% vs 85%, p = 0.795) and radiological procedures (85% vs 82%, p = 0.246) were found between both groups. The percentage of patients who received anticancer treatment or other medical interventions was lower in the post-PCP period (40% vs 22%, p < 0.001; and 42% vs 29%, p < 0.001, respectively). CONCLUSIONS Implementation of a PCP resulted in fewer medical interventions, including anticancer treatments, in the last 3 months of life. Implementation of the PCP may have created awareness among physicians of patients' impending death, thereby supporting caregivers and patients to make appropriate decisions about medical treatment at the end of life. TRIAL REGISTRATION NUMBER Netherlands Trial Register; clinical trial number: NL 4400 (NTR4597); date registrated: 2014-04-27.
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Affiliation(s)
- Annemieke van der Padt-Pruijsten
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands ,Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maria B. L. Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Doshmangir L, Hasanpoor E, Abou Jaoude GJ, Eshtiagh B, Haghparast-Bidgoli H. Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:839-855. [PMID: 34318445 DOI: 10.1007/s40258-021-00672-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE. METHODS This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified. RESULTS Among the 19 studies included, an average of 43.3% (95% CI 36.7-50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex. CONCLUSION The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients.
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Affiliation(s)
- Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran.
| | - Gerard Joseph Abou Jaoude
- Institute for Global Health, Center for Global Health Economics, University College London, London, UK
| | - Behzad Eshtiagh
- Institute for Global Health, Center for Global Health Economics, University College London, London, UK
| | - Hassan Haghparast-Bidgoli
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Cartoni C, Breccia M, Giesinger JM, Baldacci E, Carmosino I, Annechini G, Palumbo G, Armiento D, Niscola P, Tendas A, Brunetti GA, Minotti C, Marini MG, Reale L, Martone N, Martelli M, Efficace F. Early Palliative Home Care versus Hospital Care for Patients with Hematologic Malignancies: A Cost-Effectiveness Study. J Palliat Med 2020; 24:887-893. [PMID: 33270529 DOI: 10.1089/jpm.2020.0396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is paucity of data on the potential value of early palliative home care for patients with hematologic malignancies. Objective: To compare costs, use of resources, and clinical outcomes between an early palliative home care program and standard hospital care for active-advanced or terminal phase patients. Patients and Methods: In this real-life, nonrandomized comparative study, the allocation of advanced/terminal phase patients to either home or hospital was based on pragmatic considerations. Analysis focused on resources use, events requiring blood unit transfusions or parenteral therapy, patient-reported symptom burden, mean weekly cost of care (MWC), cost-minimization difference, and incremental cost-effectiveness ratio (ICER). Results: Of 119 patients, 59 patients cared at home were more debilitated and had a shorter survival than the 60 in hospital group (p = 0.001). Nevertheless, symptom burden was similar in both groups. At home the mean weekly number of transfusions (1.45) was lower than that at hospital (2.77). Higher rate of infections occurred at hospital (54%) versus home (21%; <0.001). MWC for hospitalization was significantly higher in a 3:1 ratio versus home care. Compared with hospital, domiciliary assistance produced a weekly saving of € 2314.9 for the health provider, with a charge of € 85.9 for the family, and was cost-effective by an ICER of € -7013.9 of prevented days of care for avoided infections. Conclusions: Current findings suggest that costs of early palliative home care for patients with hematologic malignancies are lower than standard hospital care costs. Domiciliary assistance may also be cost-effective by reducing the number of days to treat infections.
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Affiliation(s)
- Claudio Cartoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giovanna Palumbo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | | | | | | | - Clara Minotti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Luigi Reale
- Fondazione ISTUD, Institute of Management Studies, Milan, Italy
| | | | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research Unit, Rome, Italy
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13
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Soares LGL, Gomes RV, Palma A, Japiassu AM. Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil. Am J Hosp Palliat Care 2019; 37:594-599. [PMID: 31726853 DOI: 10.1177/1049909119888180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To examine quality indicators of end-of-life (EOL) care among privately insured people with cancer in Brazil. METHODS We evaluated medical records linked to health insurance databank to study consecutive patients who died of cancer. We collected information about demographics, cancer type, and quality indicators of EOL care including emergency department (ED) visits, intensive care unit (ICU) admissions, chemotherapy use, medical imaging utilization, blood transfusions, home care support, days of inpatient care, and hospital deaths. RESULTS We included 865 patients in the study. In the last 30 days of life, 62% visited the ED, 33% were admitted to the ICU, 24% received blood transfusions, and 51% underwent medical imaging. Only 1% had home care support in the last 60 days of life, and 29% used chemotherapy in the last 14 days of life. Patients had an average of 8 days of inpatient care and 52% died in the hospital. Patients with advanced cancer who used chemotherapy were more likely to visit the ED (78% vs 59%; P < .001), undergo medical imaging (67% vs 51%; P < .001), and die in the hospital (73% vs 50%; P = .03) than patients who did not use chemotherapy. In the multivariate analysis, chemotherapy use near death and advanced cancer were associated with ED visits and ICU admissions, respectively (odds ratio >1). CONCLUSION Our study suggests that privately insured people with cancer receive poor quality EOL care in Brazil. Further research is needed to assess the impact of improvements in palliative care provision in this population.
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Affiliation(s)
- Luiz Guilherme L Soares
- End of Life Care Study Group, Department of Health Services and Costs, Unimed Federação, Rio de Janeiro, Brazil.,Palliative Care Program, Hospital de Câncer/Rede Casa, Rio de Janeiro, Brazil
| | - Renato V Gomes
- End of Life Care Study Group, Department of Health Services and Costs, Unimed Federação, Rio de Janeiro, Brazil
| | - Alberto Palma
- End of Life Care Study Group, Department of Health Services and Costs, Unimed Federação, Rio de Janeiro, Brazil
| | - André M Japiassu
- Fundação Oswaldo Cruz, Research Laboratory of Intensive Care Medicine, Rio de Janeiro, Brazil
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14
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Baumgardner JR, Shahabi A, Linthicum MT, Zacker C, Lakdawalla DN. Share of Oncology Versus Nononcology Spending in Episodes Defined by the Centers for Medicare & Medicaid Services Oncology Care Model. J Oncol Pract 2019; 14:e699-e710. [PMID: 30423271 DOI: 10.1200/jop.18.00309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Performance-based payments to oncology providers participating in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM) are based, in part, on overall spending in 6-month episodes of care, including spending unrelated to oncology care. The amount of spending likely to occur outside of oncologists' purview is unknown. METHODS Following the OCM definition of an episode, we used SEER-Medicare data from 2006 to 2013 to identify episodes of cancer care for the following diagnoses: breast cancer (BC), non-small-cell lung cancer, renal cell carcinoma, multiple myeloma (MM), and chronic myeloid leukemia. Claims were categorized by service type and, separately, whether the content fell within the purview of oncology providers (classified as oncology, with all other claims nononcology). We calculated the shares of episode spending attributable to oncology versus nononcology services. RESULTS The percentage of oncology spending within OCM episodes ranged from 62.4% in BC to 85.5% in MM. The largest source of oncology spending was antineoplastic drug therapy, ranging from 21.8% of total episode spending in BC to 67.6% in chronic myeloid leukemia. The largest source of nononcology spending was acute hospitalization and inpatient physician costs, ranging from 6.6% of overall spending for MM to 10.4% for non-small-cell lung cancer; inpatient oncology spending contributed roughly similar shares to overall spending. CONCLUSION Most spending in OCM-defined episodes was attributable to services related to cancer care, especially antineoplastic drug therapy. Inability to control nononcology spending may present challenges for practices participating in the OCM, however.
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Affiliation(s)
- James R Baumgardner
- Precision Health Economics; University of Southern California, Los Angeles, CA; and Novartis Pharmaceuticals Corporation, Emmaus, PA
| | - Ahva Shahabi
- Precision Health Economics; University of Southern California, Los Angeles, CA; and Novartis Pharmaceuticals Corporation, Emmaus, PA
| | - Mark T Linthicum
- Precision Health Economics; University of Southern California, Los Angeles, CA; and Novartis Pharmaceuticals Corporation, Emmaus, PA
| | - Christopher Zacker
- Precision Health Economics; University of Southern California, Los Angeles, CA; and Novartis Pharmaceuticals Corporation, Emmaus, PA
| | - Darius N Lakdawalla
- Precision Health Economics; University of Southern California, Los Angeles, CA; and Novartis Pharmaceuticals Corporation, Emmaus, PA
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15
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Vallard A, Morisson S, Tinquaut F, Chauvin F, Oriol M, Chapelle C, Sotton S, Magné N, Tardy B, Bourmaud A. Drug Management in End-of-Life Hospitalized Palliative Care Cancer Patients: The RHESO Cohort Study. Oncology 2019; 97:217-227. [PMID: 31220846 DOI: 10.1159/000500783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Little data about the management of drugs in terminally ill palliative care cancer patients is available. The present study aimed at describing the evolution of anticancer and non-anticancer treatments (NACTs) in cancer patients in palliative care units. The second objective was to identify factors leading to the medical decision to withdraw or not NACTs. METHODS Data from 1,091 cancer patients hospitalized in palliative care units were prospectively collected in 2010-2011, through a multicenter, observational French cohort. RESULTS The median overall survival after admittance in palliative care units was 15 days. Specific anticancer treatments were systematically stopped in the first 24 h in palliative care units, but for 4.5% of patients. Regarding NACTs, patients were heavily treated with strong opioids (74%), corticosteroids (51%), and antidepressants (21.8%) until death. Antiulcer agents (63.4%), antibiotics (25.7%), thrombosis prevention (21.8%), antidiabetics (7.6%), and transfusions (4%) were often also continuously prescribed. In multivariate analysis, ECOG PS 4 was an independent predictor of continuous prescription of morphine and an independent predictor of discontinuation of corticosteroids, proton-pump inhibitors, antidiabetics, and preventive anticoagulant therapy. Infection symptoms independently predicted continuous prescription of paracetamol. Paralysis and cancer palpable mass independently predicted corticosteroid withdrawal. Brain metastases independently predicted antiulcer withdrawal. Hemorrhage independently predicted preventive anticoagulant withdrawal. Availability to a venous access independently predicted paracetamol and antiulcer continuous prescriptions. Co-prescriptions independently predicted continuous prescriptions (antibiotics with antiulcer, antifungals with antibiotics) or withdrawal (preventive anticoagulant with antiplatelets and antifungals). CONCLUSIONS NACT prescription remained commonplace in terminally ill palliative cancer patients, although their benefit is questionable.
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Affiliation(s)
- Alexis Vallard
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France,
| | - Stéphanie Morisson
- Department of Supportive Care, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Fabien Tinquaut
- Centre Hygée, Public Health Department, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Franck Chauvin
- Centre Hygée, Public Health Department, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Mathieu Oriol
- Centre Hygée, Public Health Department, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | | | - Sandrine Sotton
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Bernard Tardy
- INSERM 1408 CIC-EC, Saint Etienne, France.,UMR1059 SAINBIOSE, Jean Monnet University, Lyons PRES, Saint-Etienne, France.,Department of Intensive Care, University Hospital, Saint-Etienne, France
| | - Aurélie Bourmaud
- Centre Hygée, Public Health Department, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France.,INSERM 1408 CIC-EC, Saint Etienne, France.,EA HEalth Services Performance Research HESPER 7425, Lyon 1 University, Lyon, France
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16
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Soares LGL, Gomes RV, Japiassu AM. Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil. Am J Hosp Palliat Care 2019; 36:775-779. [DOI: 10.1177/1049909119828086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; P < .001), to receive blood transfusions (57% vs 38%; P = .05), and to die in the hospital (76% vs 39%; P = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital.
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Affiliation(s)
- Luiz Guilherme L. Soares
- Department of Health Services and Costs, End of Life Care Study Group, Unimed Federação Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renato Vieira Gomes
- Department of Health Services and Costs, End of Life Care Study Group, Unimed Federação Rio de Janeiro, Rio de Janeiro, Brazil
| | - André M. Japiassu
- Research Laboratory of Intensive Care Medicine, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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17
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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