1
|
Salins N, Rao A, Dhyani VS, Prasad A, Mathew M, Damani A, Rao K, Nair S, Shanbhag V, Rao S, Iyer S, Gursahani R, Mani RK, Simha S. Palliative and end-of-life care practices for critically ill patients and their families in a peri-intensive care setting: A protocol for an umbrella review. Palliat Support Care 2024:1-8. [PMID: 38420705 DOI: 10.1017/s1478951524000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES This umbrella review will summarize palliative and end-of-life care practices in peri-intensive care settings by reviewing systematic reviews in intensive care unit (ICU) settings. Evidence suggests that integrating palliative care into ICU management, initiating conversations about care goals, and providing psychological and emotional support can significantly enhance patient and family outcomes. METHODS The Joanna Briggs Institute (JBI) methodology for umbrella reviews will be followed. The search will be carried out from inception until 30 September 2023 in the following databases: Cochrane Library, SCOPUS, Web of Science, CINAHL Complete, Medline, EMBASE, and PsycINFO. Two reviewers will independently conduct screening, data extraction, and quality assessment, and to resolve conflicts, adding a third reviewer will facilitate the consensus-building process. The quality assessment will be carried out using the JBI Critical Appraisal Checklist. The review findings will be reported per the guidelines outlined in the Preferred Reporting Items for Overviews of Reviews statement. RESULTS This umbrella review seeks to inform future research and practice in critical care medicine, helping to ensure that end-of-life care interventions are optimized to meet the needs of critically ill patients and their families.
Collapse
Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arathi Rao
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vijay Shree Dhyani
- Evidence Synthesis Specialist, Kasturba Medical College, Manipal, Karnataka, India
| | - Ashmitha Prasad
- Department of Pallitaive Medicine, Karunashraya Bangalore Hospice Trust, Bangalore, India
| | - Mebin Mathew
- Department of Pallitaive Medicine, Karunashraya Bangalore Hospice Trust, Bangalore, India
| | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Krithika Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shreya Nair
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shwethapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth University Medical College, Pune, India
| | - Roop Gursahani
- Department of Neurology, P D Hinduja Hospital, Mahim, Mumbai, India
| | - R K Mani
- Department of Critical care, Yashoda Super Speciality Hospitals, Ghaziabad, India
| | - Srinagesh Simha
- Department of Pallitaive Medicine, Karunashraya Bangalore Hospice Trust, Bangalore, India
| |
Collapse
|
2
|
MacMartin MA, Sacks OA, Austin AM, Chakraborti G, Stedina EA, Skinner JS, Barnato AE. Association Between Opening a Palliative Care Unit and Hospital Care for Patients With Serious Illness. J Palliat Med 2023; 26:1240-1246. [PMID: 37040303 DOI: 10.1089/jpm.2022.0447] [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: 04/12/2023] Open
Abstract
Background: Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center. Methods: We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation. Results: There were 16,611 patients in the pre-PCU period and 18,305 patients in the post-PCU period. The post-PCU cohort was slightly older, with a higher Charlson index (p < 0.001 for both). Post-PCU, unadjusted rates of DNR and CMO increased from 16.4% to 18.3% (p < 0.001) and 9.3% to 11.5% (p < 0.001), respectively. Post-PCU, median time to DNR was unchanged (0 days), and time to CMO decreased from 6 to 5 days. The adjusted odds ratio was 1.08 (p = 0.01) for DNR and 1.19 (p < 0.001) for CMO. Significant interaction between care period and palliative care consultation for DNR (p = 0.04) and CMO (p = 0.01) suggests an important role for palliative care engagement. Conclusions: The opening of a PCU at a single center was associated with increased rates of DNR and CMO status for seriously ill patients.
Collapse
Affiliation(s)
- Meredith A MacMartin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Section of Palliative Care, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Olivia A Sacks
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Gouri Chakraborti
- Analytics Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Elizabeth A Stedina
- Analytics Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jonathan S Skinner
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Section of Palliative Care, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
3
|
El Hachem P, Pasniciuc S, Khurana S, Samala RV, Rybicki LA, Lagman RL, Davis MP. Characteristics of Patients with Cancer Readmitted Within 30 Days to an Acute Palliative Care Unit. J Palliat Care 2023; 38:200-206. [PMID: 35929121 DOI: 10.1177/08258597221119325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE(S) For patients with cancer, the emergence of acute palliative care units (APCU) may hold promise in curtailing hospital readmissions. The study aims to describe the characteristics of patients readmitted to an APCU. METHODS This retrospective study examined patients with cancer readmitted within 30 days to an APCU. Readmissions were further classified as either potentially preventable or non-preventable. RESULTS Out of 734 discharges from July 1, 2014 to July 1, 2015, 69 (9%) readmissions were identified and analyzed. For index admissions, median length of stay was five days, and one (1%) was discharged home with hospice care. For readmissions, median time from index admission to readmission was nine days, median length of stay was six days, three (4%) patients died, and 20 (30%) went home with hospice. Ten (14.5%) readmissions were deemed potentially preventable (95% CI 7.2-25.0%). Race/ethnicity-White/Black/Hispanic/Others-was 60%, 10%, 20% and 10%, respectively, among potentially preventable readmissions and 76%, 22%, 2% and 0%, respectively, among potentially non-preventable readmissions (P = .012). Potentially preventable readmissions were more likely to have venous thromboembolism (40% vs. 12%, P = .046) and more reasons for readmission (median 2 vs. 1, P = .019). CONCLUSIONS Among patients with cancer readmitted to an APCU, one out of seven was potentially preventable and a far larger proportion was discharged with hospice care compared to the index admission. Recognition of disease course, meaningful goals of care discussions and timely transition to hospice care may reduce rehospitalization in this population.
Collapse
Affiliation(s)
- Pierre El Hachem
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Silviu Pasniciuc
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Saurabh Khurana
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Renato V Samala
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Lisa A Rybicki
- Department of Quantitative Health Sciences, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Ruth L Lagman
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Mellar P Davis
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
4
|
Han HJ, Yeh JC, McNichol M, Buss MK. Delivering Palliative Care to Hospitalized Oncology Patients: A Scoping Review. J Pain Symptom Manage 2023; 65:e137-e153. [PMID: 36243248 DOI: 10.1016/j.jpainsymman.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Early, longitudinal integration of palliative care (PC) is recommended for patients with advanced cancer, in both inpatient and outpatient settings. Despite the growth of specialty PC teams in the last decade, the majority of PC is still delivered in the inpatient setting using a traditional referral-based consult delivery model. However, traditional consultation can lead to significant variation or delay in inpatient PC utilization. New care delivery models and strategies are emerging to deliver PC to hospitalized oncology patients who would most benefit from their services and to better align with professional society recommendations. OBJECTIVES To identify different care models to deliver PC to ho`spitalized oncology patients and summarize their impact on patient and health system-related outcomes. METHODS We conducted a scoping review of peer-reviewed articles from 2006 to 2021 evaluating delivery of PC to oncology patients in acute inpatient care. We abstracted study characteristics, the study's intervention and comparison arms, and outcomes related to specialty PC intervention. RESULTS We identified four delivery models that have been reported to deliver PC: 1) traditional referral-based consultation, 2) criterion-based or "triggered" consultation, 3) co-rounding with primary inpatient team, and 4) PC clinicians serving as the primary team. We summarize the known outcomes data from each model, and compare the benefits and limitations of each model. CONCLUSION Our findings provide guidance to health systems about care delivery models to deploy and implement inpatient PC resources to best serve their unique populations.
Collapse
Affiliation(s)
- Harry J Han
- Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Jonathan C Yeh
- Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McNichol
- Division of Knowledge Services, Department of Information Services (M.M.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary K Buss
- Division of Palliative Care, Department of Medicine (M.K.B.), Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Rao SR, Salins N, Remawi BN, Rao S, Shanbaug V, Arjun NR, Bhat N, Shetty R, Karanth S, Gupta V, Jahan N, Setlur R, Simha S, Walshe C, Preston N. Stakeholder engagement as a strategy to enhance palliative care involvement in intensive care units: A theory of change approach. J Crit Care 2023; 75:154244. [PMID: 36681613 DOI: 10.1016/j.jcrc.2022.154244] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Adult patients admitted to intensive care units in the terminal phase experience high symptom burden, increased costs, and diminished quality of dying. There is limited literature on palliative care engagement in ICU, especially in lower-middle-income countries. This study explores a strategy to enhance palliative care engagement in ICU through a stakeholder participatory approach. METHODS Theory of Change approach was used to develop a hypothetical causal pathway for palliative care integration into ICUs in India. Four facilitated workshops and fifteen research team meetings were conducted virtually over three months. Thirteen stakeholders were purposively chosen, and three facilitators conducted the workshops. Data included workshop discussion transcripts, online chat box comments, and team meeting minutes. These were collected, analysed and represented as theory of change map. RESULTS The desired impact of palliative care integration was good death. Potential long-term outcomes identified were fewer deaths in ICUs, discharge against medical advice, and inappropriate admissions; increased referrals to palliative care; and improved patient and family satisfaction. Twelve preconditions were identified, and eleven key interventions were developed. Five overarching assumptions related to contextual factors influencing the outcomes of interventions. CONCLUSION Theory of change framework facilitated the identification of proposed mechanisms and interventions underpinning palliative care integration in ICUs.
Collapse
Affiliation(s)
- Seema Rajesh Rao
- Karunashraya Institute for Palliative Care Education and Research, Bangalore Hospice Trust - Karunashraya, Bangalore PIN:560037, India.
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka State PIN: 576104, India.
| | - Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, UK.
| | - Shwetapriya Rao
- Department of Critical Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka State PIN: 576104, India.
| | - Vishal Shanbaug
- Department of Critical Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka State PIN: 576104, India.
| | - N R Arjun
- Department of Critical Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka State PIN: 576104, India.
| | - Nitin Bhat
- Department of General Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka State PIN: 576104, India.
| | - Rajesh Shetty
- Clinical Services and Lead Critical Care, Manipal Hospital Whitefield, Bangalore, Karnataka State PIN: 560066, India.
| | - Sunil Karanth
- Department of Critical Care Medicine, Manipal Hospital, Old Airport Road, Bangalore, Karnataka State PIN: 560017, India.
| | - Vivek Gupta
- Department of Cardiac Anaesthesia and Intensive Care, Hero DMC Heart Institute, Ludhiana, Punjab PIN:141001, India
| | - Nikahat Jahan
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra PIN:411040, India
| | - Rangraj Setlur
- Base Hospital, Barrackpore, West Bengal PIN:700120, India
| | - Srinagesh Simha
- Karunashraya Institute for Palliative Care Education and Research, Bangalore Hospice Trust - Karunashraya, Bangalore PIN:560037, India.
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, LA1 4AT, UK.
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, LA1 4AT, UK.
| |
Collapse
|
6
|
Cripe LD, Vater LB, Lilly JA, Larimer A, Hoffmann ML, Frankel RM. Goals of care communication and higher-value care for patients with advanced-stage cancer: A systematic review of the evidence. PATIENT EDUCATION AND COUNSELING 2022; 105:1138-1151. [PMID: 34489147 DOI: 10.1016/j.pec.2021.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/23/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Goals-of-care communication (GOCC) is recommended to increase the value of cancer care near the end of life (EOL). OBJECTIVES Conduct a systematic review of the evidence that GOCC is associated with higher-value care. METHODS We searched PubMed, Scopus, Ovid MEDLINE, EMBASE, EMB Reviews, CINAHL, and PsycInfo from inception to July 2019. We analyzed the population,design, and results and the authors' definitions of GOCC. Risk of bias was assessed. RESULTS Thirty-two articles were selected. Ten articles reported results from 8 interventions; 17 characterized participants' perspectives; and 5 were retrospective The topics, behaviors, timing, and anticipated outcomes of GOCC varied significantly and were indistinguishable from practices such as advance care planning. GOCC typically focused on treatment outcomes rather than patients' goals. Four of 5 interventions increased evidence of GOCC after clinician training. Only one reported improved patient outcomes. CONCLUSION No consensus exists about what GOCC entails. There is limited evidence that GOCC increases the value of EOL care. PRACTICE IMPLICATIONS Future studies should focus on how to engage patients in conversations about their personal goals and integrate their goals into care planning. Clinicians can encourage GOCC by explaining how patients' goals influence decisions especially as treatment options become limited.
Collapse
Affiliation(s)
- Larry D Cripe
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Laura B Vater
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Jason A Lilly
- Indiana University Health, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Medical Library, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Angeline Larimer
- Indiana University Purdue University at Indianapolis (IUPUI), 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Mary Lynn Hoffmann
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Richard M Frankel
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Regenstrief Institute, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Purdue University at Indianapolis (IUPUI), 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Health, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Medical Library, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| |
Collapse
|
7
|
Effect of Intensive Psychological Nursing Intervention on HAMD and SF-36 Scores in Patients with Severe Liver Cancer in ICU. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4452308. [PMID: 35432836 PMCID: PMC9007641 DOI: 10.1155/2022/4452308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
The aim of the study was to explore the effect of intensive psychological nursing intervention on HAMD and SF-36 scores in patients with severe liver cancer in intensive care unit (ICU). 134 critically ill patients with liver cancer in ICU who underwent resection of primary liver cancer from July 2019 to November 2021 were selected. The patients were randomly divided into control group and study group. The patients in the control group received routine nursing. The patients in the study group received intensive psychological nursing intervention on the basis of routine nursing. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the MOS 36-item short-form health survey (SF-36) scores before and after nursing were compared between the two groups. The satisfaction of the two groups of patients with nursing was counted. The HAMA, HAMD, and SF-36 scores of patients receiving intensive psychological nursing intervention were significantly better than those receiving routine nursing. The nursing satisfaction of patients receiving intensive psychological nursing intervention was significantly higher than that of patients receiving routine nursing. Intensive psychological nursing intervention for patients with severe liver cancer in ICU can significantly reduce HAMD, improve SF-36 score, and patient nursing satisfaction. It is worthy of wide clinical promotion.
Collapse
|
8
|
Grabda M, Lim FA. Palliative Care Consult Among Older Adult Patients in Intensive Care Units: An Integrative Review. Crit Care Nurs Q 2021; 44:248-262. [PMID: 33595971 DOI: 10.1097/cnq.0000000000000358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A review of the literature indicates that there are many benefits of palliative care consultations for patients in the intensive care unit (ICU). Patients who received palliative care treatment were found to have a better emotional state, received less invasive procedures, and had a shorter ICU length of stay. It is noted that patients who could benefit from palliative care treatments may not be identified due to failures to meet the criteria for palliative care consultations. A culture change is needed to improve palliative services, and to standardize when and how it is used.
Collapse
Affiliation(s)
- Marina Grabda
- New York University Langone Health Hospital (Ms Grabda); and NYU Meyers College of Nursing, New York (Dr Lim)
| | | |
Collapse
|
9
|
Abstract
Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. Existing evidence supports that timely involvement of specialist palliative care teams can enhance the care delivered by oncology teams. This review provides a state-of-the-science synopsis of the literature that supports each of the five clinical models of specialist palliative care delivery, including outpatient clinics, inpatient consultation teams, acute palliative care units, community-based palliative care, and hospice care. The roles of embedded clinics, nurse-led models, telehealth interventions, and primary palliative care also will be discussed. Outpatient clinics represent the key point of entry for timely access to palliative care. In this setting, patient care can be enhanced longitudinally through impeccable symptom management, monitoring, education, and advance care planning. Inpatient consultation teams provide expert symptom management and facilitate discharge planning for acutely symptomatic hospitalized patients. Patients with the highest level of distress and complexity may benefit from an admission to acute palliative care units. In contrast, community-based palliative care and hospice care are more appropriate for patients with a poor performance status and low to moderate symptom burden. Each of these five models of specialist palliative care serve a different patient population along the disease continuum and complement one another to provide comprehensive supportive care. Additional research is needed to define the standards for palliative care interventions and to refine the models to further improve access to quality palliative care.
Collapse
Affiliation(s)
- David Hui
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
10
|
Hui D, De La Rosa A, Chen J, Dibaj S, Guay MD, Heung Y, Liu D, Bruera E. State of palliative care services at US cancer centers: An updated national survey. Cancer 2020; 126:2013-2023. [PMID: 32049358 PMCID: PMC7160033 DOI: 10.1002/cncr.32738] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/15/2019] [Accepted: 12/29/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study examined the changes in outpatient palliative care services at US cancer centers over the past decade. METHODS Between April and August 2018, all National Cancer Institute (NCI)-designated cancer centers and a random sample of 1252 non-NCI-designated cancer centers were surveyed. Two surveys used previously in a 2009 national study were sent to each institution: a 22-question cancer center executive survey regarding palliative care infrastructure and attitudes toward palliative care and an 82-question palliative care program leader survey regarding detailed palliative care structures and processes. Survey findings from 2018 were compared with 2009 data from 101 cancer center executives and 96 palliative care program leaders. RESULTS The overall response rate was 69% (140 of 203) for the cancer center executive survey and 75% (123 of 164) for the palliative care program leader survey. Among NCI-designated cancer centers, a significant increase in outpatient palliative care clinics was observed between 2009 and 2018 (59% vs 95%; odds ratio, 12.3; 95% confidence interval, 3.2-48.2; P < .001) with no significant changes in inpatient consultation teams (92% vs 90%; P = .71), palliative care units (PCUs; 26% vs 40%; P = .17), or institution-operated hospices (31% vs 18%; P = .14). Among non-NCI-designated cancer centers, there was no significant increase in outpatient palliative care clinics (22% vs 40%; P = .07), inpatient consultation teams (56% vs 68%; P = .27), PCUs (20% vs 18%; P = .76), or institution-operated hospices (42% vs 23%; P = .05). The median interval from outpatient palliative care referral to death increased significantly, particularly for NCI-designated cancer centers (90 vs 180 days; P = 0.01). CONCLUSIONS Despite significant growth in outpatient palliative care clinics, there remain opportunities for improvement in the structures and processes of palliative care programs.
Collapse
Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allison De La Rosa
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Chen
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seyedeh Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marvin Delgado Guay
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yvonne Heung
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
11
|
Block BL. Does the Term Intensive Care Unit Promote Aggressive Treatment? JAMA Intern Med 2018; 178:1579-1580. [PMID: 30422219 DOI: 10.1001/jamainternmed.2018.5400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brian L Block
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco
| |
Collapse
|
12
|
Shinall MC, Martin SF, Nelson J, Miller RS, Semler MW, Zimmerman EE, Noblit CC, Ely EW, Karlekar M. Five-Year Experience of an Inpatient Palliative Care Unit at an Academic Referral Center. Am J Hosp Palliat Care 2018; 35:1057-1062. [PMID: 29325441 DOI: 10.1177/1049909117751878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Palliative care units (PCUs) staffed by specialty-trained physicians and nurses have been established in a number of medical centers. The purpose of this study is to review the 5-year experience of a PCU at a large, urban academic referral center. METHODS We retrospectively reviewed a prospectively collected database of all admissions to the PCU at Vanderbilt University Medical Center in the first 5 years of its existence, from 2012 through 2017. RESULTS Over these 5 years, there were 3321 admissions to the PCU. No single underlying disease process accounted for the majority of the patients, but the largest single category of patients were those with malignancy, who accounted for 38% of admissions. Transfers from the intensive care unit accounted for 50% of admissions, with 43% of admissions from a hospital floor and 7% coming from the emergency department or a clinic. Median length of stay in the PCU was 3 days. In hospital deaths occurred for 50% of admitted patients, while 38% of patients were discharged from the PCU to hospice. CONCLUSION These data show that a successful PCU is enabled by buy in from a wide variety of referring specialists and by a multidisciplinary palliative care team focused on care of the actively dying patient as well as pain and symptom management, advance care planning, and hospice referral since a large proportion of referred patients do not die in house.
Collapse
Affiliation(s)
- Myrick C Shinall
- 1 Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara F Martin
- 1 Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jill Nelson
- 1 Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard S Miller
- 2 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew W Semler
- 3 Division of Allergy, Pulmonology, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eli E Zimmerman
- 4 Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christy C Noblit
- 3 Division of Allergy, Pulmonology, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- 3 Division of Allergy, Pulmonology, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,5 Tennessee Valley Veteran's Affairs Geriatrics Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Mohana Karlekar
- 1 Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
13
|
The Case for Dual Training in Geriatric Medicine and Palliative Care: The Time is Now. Am J Hosp Palliat Care 2017; 35:364-370. [DOI: 10.1177/1049909117696251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The majority of older adults die from chronic illnesses which are preceded by years of progressive decline and increasing symptom burden. Delivery of high-quality care cannot take place without sufficient numbers of health professionals with appropriate training and skills in both geriatric and palliative care medicine. Despite the surge in aging population and the majority of deaths being attributed to patients with multiple comorbidities, very few health-care providers undergo dual training in these areas. Thus, the nation is facing a health-care crisis as the number of geriatric patients with chronic disease increasingly outpaces the number of physicians with adequate skills to manage them. Joint training in palliative care and geriatric medicine could prepare physicians to better manage our aging population by addressing all their health-care needs irrespective of their stage of disease emphasizing patient-directed care.
Collapse
|