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Varilek BM, Da Rosa P. Analysis of Palliative Care Knowledge and Symptom Burden Among Female Veterans With Serious Illness: A Cross-Sectional Study. Am J Hosp Palliat Care 2024; 41:641-650. [PMID: 37385594 DOI: 10.1177/10499091231187341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Background: The female Veteran population is rapidly growing, as is their use of Veterans Affairs (VA) medical centers (VAMCs). Additionally, 90% of female Veterans are under 65 years old, meaning healthcare providers at VAMCs must be ready to manage the complex serious illnesses that affect female Veterans as they age. These serious illnesses require proper medical management, which can include palliative care. However, little palliative care research includes female Veterans. Aims: The aims of this cross-sectional study were to examine palliative care knowledge and symptom burden among female Veterans' and examine factors associated a symptom burden scale. Methods: Consenting participants completed online questionnaires, including the Palliative Care Knowledge Scale (PaCKS), Condensed Memorial Symptom Assessment Scale (CMSAS), and demographics. Descriptive statistics characterized the sample, bivariate association were carried out with a Chi-square and t test. A generalized linear model explored associations between CMSAS and its subscales with sociodemographic, number of serious illnesses, and facility type (VAMC vs civilian facility). Results: 152 female Veterans completed the survey. PaCKS scores were consistent across our sample. Physical symptoms were rated higher for those receiving care at VAMCs compared to civilian facilities (P = .02) in the bivariate analysis. The factors associated with CMSAS were age, employment status and number of serious illnesses (all P < .05). Conclusions: Palliative care can assist female Veterans with serious illness. More research is needed to further explore variables associated with symptom burden among female Veterans such as age, employment status, and number of serious illnesses.
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Affiliation(s)
- Brandon M Varilek
- College of Nursing, South Dakota State University, Sioux Falls, SD, USA
| | - Patricia Da Rosa
- Office of Nursing Research, College of Nursing, South Dakota State University, Brookings, SD, USA
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Sullivan DR, Jones KF, Wachterman M, Griffin H, Kinder D, Gilbert D, Thorpe JM, Feder SL, Ersek M, Kutney-Lee A. Opportunities to Improve End-of-Life Care Quality among Patients with Short Terminal Admissions. J Pain Symptom Manage 2024:S0885-3924(24)00789-9. [PMID: 38810950 DOI: 10.1016/j.jpainsymman.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Little is known about Veterans who die during a short terminal admission, which renders them ineligible for the Department of Veterans Affairs (VA) Bereaved Family Survey. We sought to describe this population and identify opportunities to improve end-of-life (EOL) care quality. METHODS Retrospective, cohort analysis of Veteran decedents who died in a VA inpatient setting between October 2018-September 2019. Veterans were dichotomized by short (<24 hours) and long (≥24 hours) terminal admissions; sociodemographics, clinical characteristics, VA and non-VA healthcare use, and EOL care quality indicators were compared. RESULTS Among 17,033 inpatient decedents, 723 (4%) had short terminal admissions. Patients with short compared to long terminal admissions were less likely to have a VA hospitalization (38% vs. 54%) in the last 90 days of life and were more likely to die in an intensive care (49% vs 21%) or acute care (27% vs 18%) unit. Patients with a short compared to long admission were about half as likely to receive hospice (33% vs 64%) or palliative care (33% vs 69%). Most patients with short admissions (76%) had a life-limiting condition (e.g., cancer, chronic obstructive pulmonary disease) and those with cancer were more likely to receive palliative care compared to those with non-cancer conditions. CONCLUSIONS Veterans with short terminal admissions are less likely to receive hospice or palliative care compared to patients with long terminal admissions. Many patients with short terminal admissions, such as those with life-limiting conditions (especially cancer), receive aspects of high-quality EOL care, however, opportunities for improvement exist.
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Affiliation(s)
- Donald R Sullivan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland OR, USA; Center to Improve Veteran Involvement in Care, Portland Veteran Affairs Healthcare System, Portland OR, USA.
| | - Katie F Jones
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston MA, USA; Department of Medicine, Harvard Medical School, Boston MA, USA
| | - Melissa Wachterman
- Section of General Internal Medicine, Veterans Affairs Boston Health Care System, Boston MA, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Hilary Griffin
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia PA, USA
| | - Daniel Kinder
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia PA, USA
| | - Dawn Gilbert
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia PA, USA
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA; University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Shelli L Feder
- Yale University School of Nursing, Orange CT, USA; West Haven Department of Veterans Affairs, West Haven CT, USA
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia PA, USA; Leonard Davis Institute, University of Pennsylvania, Philadelphia PA, USA
| | - Ann Kutney-Lee
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia PA, USA; Center for Health Equity and Research Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia PA, USA; University of Pennsylvania School of Nursing, Philadelphia PA, USA
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Moghanaki D, Taylor J, Bryant AK, Vitzthum LK, Sebastian N, Gutman D, Burns A, Huang Z, Lewis JA, Spalluto LB, Williams CD, Sullivan DR, Slatore CG, Behera M, Stokes WA. Lung Cancer Survival Trends in the Veterans Health Administration. Clin Lung Cancer 2024; 25:225-232. [PMID: 38553325 PMCID: PMC11098707 DOI: 10.1016/j.cllc.2024.02.009] [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: 12/04/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Lung cancer survival is improving in the United States. We investigated whether there was a similar trend within the Veterans Health Administration (VHA), the largest integrated healthcare system in the United States. MATERIALS AND METHODS Data from the Veterans Affairs Central Cancer Registry were analyzed for temporal survival trends using Kaplan-Meier estimates and linear regression. RESULTS A total number of 54,922 Veterans were identified with lung cancer diagnosed from 2010 to 2017. Histologies were classified as non-small-cell lung cancer (NSCLC) (64.2%), small cell lung cancer (SCLC) (12.9%), and 'other' (22.9%). The proportion with stage I increased from 18.1% to 30.4%, while stage IV decreased from 38.9% to 34.6% (both P < .001). The 3-year overall survival (OS) improved for stage I (58.6% to 68.4%, P < .001), stage II (35.5% to 48.4%, P < .001), stage III (18.7% to 29.4%, P < .001), and stage IV (3.4% to 7.8%, P < .001). For NSCLC, the median OS increased from 12 to 21 months (P < .001), and the 3-year OS increased from 24.1% to 38.3% (P < .001). For SCLC, the median OS remained unchanged (8 to 9 months, P = .10), while the 3-year OS increased from 9.1% to 12.3% (P = .014). Compared to White Veterans, Black Veterans with NSCLC had similar OS (P = .81), and those with SCLC had higher OS (P = .003). CONCLUSION Lung cancer survival is improving within the VHA. Compared to White Veterans, Black Veterans had similar or higher survival rates. The observed racial equity in outcomes within a geographically and socioeconomically diverse population warrants further investigation to better understand and replicate this achievement in other healthcare systems.
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Affiliation(s)
- Drew Moghanaki
- Veterans Affairs Greater Los Angeles Healthcare System, Radiation Oncology Service, Los Angeles, CA; University of California Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA.
| | | | - Alex K Bryant
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University, Palo Alto, CA; Office of Research and Development, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Nikhil Sebastian
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - David Gutman
- Department of Psychiatry, Atlanta Veterans Affairs Health Care System, Decatur, GA; Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Abigail Burns
- Foundation for Atlanta Veterans Education and Research, Decatur, GA
| | - Zhonglu Huang
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jennifer A Lewis
- Education and Clinical Center (GRECC) and Medicine Service, Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Nashville, TN; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Lucy B Spalluto
- Vanderbilt-Ingram Cancer Center, Nashville, TN; Education and Clinical Center (GRECC), Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Nashville, TN; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC
| | - Donald R Sullivan
- Division of Pulmonary, Oregon Health and Science University, Allergy and Critical Care Medicine, Portland, OR; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Cancer Prevention and Control Program, Oregon Health and Science University Knight Cancer Institute, Portland, OR
| | - Christopher G Slatore
- Division of Pulmonary, Oregon Health and Science University, Allergy and Critical Care Medicine, Portland, OR; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, OR; Department of Radiation Medicine, Oregon Health and Science University Knight Cancer Institute, Portland, OR
| | | | - William A Stokes
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
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Cohen AB, McDonald WM, O'Leary JR, Omer ZB, Fried TR. High-Intensity Care for Nursing Home Residents with Severe Dementia Hospitalized at the End of Life: A Mixed Methods Study. J Am Med Dir Assoc 2024; 25:871-875. [PMID: 38462230 PMCID: PMC11065599 DOI: 10.1016/j.jamda.2024.02.001] [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: 10/25/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE For nursing home residents with severe dementia, high-intensity medical treatment offers little possibility of benefit but has the potential to cause significant distress. Nevertheless, mechanical ventilation and intensive care unit (ICU) transfers have increased in this population. We sought to understand how and why such care is occurring. DESIGN Mixed methods study, with retrospective collection of qualitative and quantitative data. SETTING Department of Veterans Affairs (VA) hospitals. METHODS Using the Minimum Data Set, we identified veterans aged ≥65 years who had severe dementia, lived in nursing homes, and died in 2013. We selected those who underwent mechanical ventilation or ICU transfer in the last 30 days of life. We restricted our sample to patients receiving care at VA hospitals because these hospitals share an electronic medical record, from which we collected structured information and constructed detailed narratives of how medical decisions were made. We used qualitative content analysis to identify distinct paths to high-intensity treatment in these narratives. RESULTS Among 163 veterans, 41 (25.2%) underwent mechanical ventilation or ICU transfer. Their median age was 85 (IQR, 80-94), 97.6% were male, and 67.5% were non-Hispanic white. More than a quarter had living wills declining some or all treatment. There were 5 paths to high-intensity care. The most common (18 of 41 patients) involved families who struggled with decisions. Other patients (15 of 41) received high-intensity care reflexively, before discussion with a surrogate. Four patients had families who advocated repeatedly for aggressive treatment, against clinical recommendations. In 2 cases, information about the patient's preferences was erroneous or unavailable. In 2 cases, there was difficulty identifying a surrogate. CONCLUSIONS AND IMPLICATIONS Our findings highlight the role of surrogates' difficulty with decision making and of health system-level factors in end-of-life ICU transfers and mechanical ventilation among nursing home residents with severe dementia.
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Affiliation(s)
- Andrew B Cohen
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA.
| | | | - John R O'Leary
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Zehra B Omer
- Department of Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Terri R Fried
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
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Varilek BM, Isaacson MJ. Coming to Terms: Female Veterans' Experience of Serious Illness. J Hosp Palliat Nurs 2024; 26:98-103. [PMID: 38227787 DOI: 10.1097/njh.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Female veteran populations are growing internationally and are more likely than men to develop certain serious illnesses, including some cancers. In the United States, fewer than 50% of eligible female veterans sought care at Veteran Affairs facilities. In addition, female veterans are not well represented within palliative care research, and little research exists that explores the female veteran experience of living with a serious illness. The purpose of this study was to explore female veterans' experiences of living with a serious illness. This study reports the qualitative findings from a multimethod study using qualitative inquiry to explore female veterans' experiences of living with a serious illness. Participants completed individual, semistructured interviews. Braun and Clarke's method of reflexive thematic analysis guided the analysis. Ten participants shared their experiences, and 3 themes emerged: "You call this quality of life?", coming to terms, and "it" dictates everything. This study highlights the impaired quality of life of female veterans. Palliative care can serve to improve quality of life and return a sense of control back to female veterans. Nurses at all levels can have a positive impact in improving palliative care delivery for the female veteran population in both civilian and government health care sectors.
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Silva RS, Barbosa LC, Brandão MAG, Carneiro RDS, Félix NDDC, Alves MB. Geropalliative Caring Model analysis and assessment according to Fawcett's criteria. Rev Esc Enferm USP 2024; 57:e20230288. [PMID: 38411456 PMCID: PMC10890787 DOI: 10.1590/1980-220x-reeusp-2023-0288en] [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: 08/28/2023] [Accepted: 11/28/2023] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES To analyze and assess Lee Geropaliative Caring Model according to Fawcett's criteria. METHOD A theoretical-reflective study about the Geropaliative Caring Model. The analysis resulted in a detailed review of the scope, context and content of a situation-specific theory, in order to determine aspects related to nursing practice and research, and assessment addressed the concrete concepts developed in theory, their significance, internal consistency, parsimony, testability and empirical and pragmatic adequacy in nursing as a discipline. RESULTS Based on the analysis, a situation-specific theory was used based on the science of care and aimed at caring for older adults undergoing palliation and their families, structured into four fields, namely: (1) aligning care; (2) keeping safe; (3) comforting body/mind/spirit; and (4) facilitating transitions. FINAL CONSIDERATIONS The analyzed and assessed theory leads to a structure that includes well-defined, delimited and interrelated concepts, based on the science of care as a grand theory that allowed Geropaliative Care Model derivation.
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Affiliation(s)
- Rudval Souza Silva
- Universidade do Estado da Bahia, Colegiado de Enfermagem, Senhor do Bonfim, BA, Brazil
- Universidade Federal da Bahia, Programa de Pós-graduação em Enfermagem e Saúde, Salvador, BA, Brazil
| | - Larissa Coelho Barbosa
- Universidade Federal da Bahia, Programa de Pós-graduação em Enfermagem e Saúde, Salvador, BA, Brazil
| | | | | | | | - Manuela Bastos Alves
- Universidade do Estado da Bahia, Colegiado de Enfermagem, Senhor do Bonfim, BA, Brazil
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Patel A, Walling A, Kanwal F, Serper M, Hernaez R, Sundaram V, Kaplan D, Taddei T, Mahmud N. Rates, patterns, and predictors of specialty palliative care consultation among patients with acute-on-chronic liver failure. JHEP Rep 2024; 6:100976. [PMID: 38274489 PMCID: PMC10808910 DOI: 10.1016/j.jhepr.2023.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024] Open
Abstract
Background & Aims There is growing acceptance that principles of palliative care should be integrated into the management of serious illnesses affecting the liver, such as acute-on-chronic liver failure (ACLF). However, rates, patterns, and predictors of specialty palliative care consultation among patients with ACLF have not been well-described. Methods We performed a retrospective cohort study of patients hospitalized with ACLF between 1/1/2008 and 12/31/2018 using the VOCAL cohort. Patients were followed until 6/2021. We used mixed-effects regression analyses to identify significant patient and facility factors associated with palliative care consultation. We examined timing of consultation, the influence of ACLF characteristics, and facility-level variation on receipt of palliative care consultation. Results We identified 21,987 patients hospitalized with ACLF, of whom 30.5% received specialty palliative care consultation. Higher ACLF grade (ACLF-2 [odds ratio (OR) 1.82, 95% CI 1.67-1.99], ACLF-3 [OR 3.06, 95% CI 2.76-3.40]), prior specialty palliative care consultation (OR 2.62, 95% CI 2.36-2.91), and hepatocellular carcinoma (OR 2.10, 95% CI 1.89-2.33) were associated with consultation. Consultation occurred latest and closest to the time of death for patients with ACLF-3 compared to ACLF-1 and ACLF-2. Significant facility-level variation in consultation persisted among patients with ACLF-3, despite adjusting for multiple patient and facility factors. Conclusion In this large cohort of hospitalized patients with ACLF, specialty palliative care consultation was rare, more common in patients with higher grade ACLF, and tended to occur closer to the time of death for the sickest patients. Greater attention should be placed on earlier integration of palliative care during acute hospitalizations in patients with ACLF. Impact and implications Though palliative care consultation is recommended for patients with acute-on-chronic liver failure, there is no data demonstrating how often this occurs during hospitalizations, on a population level. We found that consultation occurs in only 30.5% of patients and occurs later for patients with grade 3 acute-on-chronic liver failure. Our data should provoke clinicians to urgently consider quality improvement efforts to integrate palliative care into the management of these seriously ill patients.
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Affiliation(s)
- Arpan Patel
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, CA, United States
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Anne Walling
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, CA, United States
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
- Department of Internal Medicine, Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Leonard David Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
- Department of Internal Medicine, Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Vinay Sundaram
- Karsh Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - David Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Tamar Taddei
- Division of Digestive Diseases, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Leonard David Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Wachterman MW, Smith D, Carpenter JG, Griffin HL, Thorpe J, Feder SL, Hoelter J, Ersek M, Shreve S, Kutney-Lee A. A comparison of end-of-life care quality for Veterans receiving hospice in VA nursing homes and community nursing homes. J Am Geriatr Soc 2024; 72:59-68. [PMID: 37947240 PMCID: PMC10842969 DOI: 10.1111/jgs.18606] [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: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND While the Veterans Health Administration (VA) has long provided hospice care within VA community living centers (CLCs, i.e., VA nursing homes), an increasing number of Veterans are receiving hospice in VA-contracted community nursing homes (CNHs). However, little data exist about the quality of end-of-life (EOL) care provided in CNHs. The aim of this study was to compare family ratings of the quality of EOL care provided to Veterans receiving hospice in VA CLCs and VA-contracted CNHs. METHODS We conducted a retrospective analysis of national data from VA's electronic medical record and Bereaved Family Survey (BFS) for Veterans who received hospice in VA CLCs or VA-contracted CNHs between October 2021 and March 2022. The final sample included 1238 Veterans who died in either a CLC (n = 1012) or a CNH (n = 226) and whose next-of-kin completed the BFS. Our primary outcome was the BFS global rating of care received in the last 30 days of life. Secondary outcomes included BFS items related to symptom management, communication, emotional and spiritual support, and information about burial and survivor benefits. We compared unadjusted and adjusted proportions for all BFS outcomes between those who received hospice in CLCs and CNHs. RESULTS The adjusted proportion of family members who gave the best possible rating (a score of 9 or 10 out of a possible 10) for the overall care received near EOL was more than 13 percentage points higher for Veterans who received hospice in VA CLCs compared to VA-contracted CNHs. Our findings also revealed quality gaps of even greater magnitude in specific EOL care-focused domains. CONCLUSIONS Our findings document inadequacies in the quality of multiple aspects of EOL care provided to Veterans in CNH-based hospice and illuminate the urgent need for policy and practice interventions to improve this care.
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Affiliation(s)
- Melissa W Wachterman
- Section of General Internal Medicine, Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dawn Smith
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joan G Carpenter
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Hillary L Griffin
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua Thorpe
- Center for Health Equity Research and Promotion, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA
- University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Shelli L Feder
- Yale University School of Nursing, Orange, Connecticut, USA
- Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Jillian Hoelter
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Scott Shreve
- US Department of Veteran Affairs, Hospice and Palliative Care Program, Washington, DC, USA
- Lebanon VA Medical Center, Lebanon, Pennsylvania, USA
| | - Ann Kutney-Lee
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Wice M, Rudolph JL, Jiang L, Edmonson HM, Page JS, Wu WC, Defillo-Draiby J. Trends in Palliative Care Utilization in Deceased Veterans With Heart Failure. Palliat Med Rep 2023; 4:344-349. [PMID: 38155911 PMCID: PMC10754341 DOI: 10.1089/pmr.2023.0067] [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: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Background Specialist-level palliative care in the final days does not allow time to alleviate symptoms and suffering. This analysis examined the change in the time from initial specialty-level palliative care to death among Veterans with heart failure. Methods This retrospective cohort study examined Veterans with a diagnosis of heart failure (HF) who died between 2011 and 2021. We examined the decedents from each year as a separate cohort. The primary outcome was time from specialty-level palliative care (SPC) encounter to death in the year death occurred. Results Of the cohort (n = 232,079), 56.5% did not receive SPC. Specialist-level palliative care >90 days before death more than doubled from 10.1% (2011) to 26.2% (2021), and Specialist-level palliative care in the last day of life was cut from 2.5% to 0.9%. Conclusion For Veterans with HF, specialist-level palliative care moved earlier in the disease course and has a substantial growth opportunity.
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Affiliation(s)
- Mitchell Wice
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Geriatrics and Extended Care, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James L. Rudolph
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Gerontology and Health Services Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
| | - Hal M. Edmonson
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John S. Page
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Wen Chih Wu
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Julio Defillo-Draiby
- Center of Innovation in Long Term Services and Support, Providence VA Healthcare System, Providence, Rhode Island, USA
- Geriatrics and Extended Care, Providence VA Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Hooker ER, Chapa J, Vranas KC, Niederhausen M, Goodlin SJ, Slatore CG, Sullivan DR. Intersection of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer. J Palliat Med 2023; 26:1474-1481. [PMID: 37262128 PMCID: PMC10658737 DOI: 10.1089/jpm.2023.0040] [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] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Background: Hospice and palliative care (PC) are important components of lung cancer care and independently provide benefits to patients and their families. Objective: To better understand the relationship between hospice and PC and factors that influence this relationship. Methods: A retrospective cohort study of patients diagnosed with advanced lung cancer (stage IIIB/IV) within the U.S. Veterans Health Administration (VA) from 2007 to 2013 with follow-up through 2017 (n = 22,907). Mixed logistic regression models with a random effect for site, adjustment for patient variables, and propensity score weighting were used to examine whether the association between PC and hospice use varied by U.S. region and PC team characteristics. Results: Overall, 57% of patients with lung cancer received PC, 69% received hospice, and 16% received neither. Of those who received hospice, 60% were already enrolled in PC. Patients who received PC had higher odds of hospice enrollment than patients who did not receive PC (adjusted odds ratio = 3.25, 95% confidence interval: 2.43-4.36). There were regional differences among patients who received PC; the predicted probability of hospice enrollment was 85% and 73% in the Southeast and Northeast, respectively. PC team and facility characteristics influenced hospice use in addition to PC; teams with the shortest duration of existence, with formal team training, and at lower hospital complexity were more likely to use hospice (all p < 0.05). Conclusions: Among patients with advanced lung cancer, PC was associated with hospice enrollment. However, this relationship varied by geographic region, and PC team and facility characteristics. Our findings suggest that regional PC resource availability may contribute to substitution effects between PC and hospice for end-of-life care.
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Affiliation(s)
- Elizabeth R. Hooker
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Joaquin Chapa
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kelly C. Vranas
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Portland Veterans Affairs Medical Center, Divisions of Pulmonary Critical Care Medicine, Portland, Oregon, USA
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Oregon Health and Science University—Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah J. Goodlin
- Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Donald R. Sullivan
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
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11
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Feder SL, Zhan Y, Abel EA, Smith D, Ersek M, Fried T, Redeker NS, Akgün KM. Validation of Electronic Health Record-Based Algorithms to Identify Specialist Palliative Care Within the Department of Veterans Affairs. J Pain Symptom Manage 2023; 66:e475-e483. [PMID: 37364737 PMCID: PMC10527602 DOI: 10.1016/j.jpainsymman.2023.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The measurement of specialist palliative care (SPC) across Department of Veterans Affairs (VA) facilities relies on algorithms applied to administrative databases. However, the validity of these algorithms has not been systematically assessed. MEASURES In a cohort of people with heart failure identified by ICD 9/10 codes, we validated the performance of algorithms to identify SPC consultation in administrative data and differentiate outpatient from inpatient encounters. INTERVENTION We derived separate samples of people by receipt of SPC using combinations of stop codes signifying specific clinics, current procedural terminology (CPT), a variable representing encounter location, and ICD-9/ICD-10 codes for SPC. We calculated sensitivity, specificity, and positive and negative predictive values (PPV, NPV) for each algorithm using chart review as the reference standard. OUTCOMES Among 200 people who did and did not receive SPC (mean age = 73.9 years (standard deviation [SD] = 11.5), 98% male, 73% White), the validity of the stop code plus CPT algorithm to identify any SPC consultation was: Sensitivity = 0.89 (95% Confidence Interval [CI] 0.82-0.94), Specificity = 1.0 [0.96-1.0], PPV = 1.0 [0.96-1.0], NPV = 0.93 [0.86-0.97]. The addition of ICD codes increased sensitivity but decreased specificity. Among 200 people who received SPC (mean age = 74.2 years [SD = 11.8], 99% male, 71% White), algorithm performance in differentiating outpatient from inpatient encounters was: Sensitivity = 0.95 (0.88-0.99), Specificity = 0.81 (0.72-0.87), PPV = 0.38 (0.29-0.49), and NPV = 0.99 (0.95-1.0). Adding encounter location improved the sensitivity and specificity of this algorithm. CONCLUSIONS VA algorithms are highly sensitive and specific in identifying SPC and in differentiating outpatient from inpatient encounters. These algorithms can be used with confidence to measure SPC in quality improvement and research across the VA.
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Affiliation(s)
- Shelli L Feder
- Yale School of Nursing (S.L.F., Y.Z.), Orange, Connecticut, USA; VA Connecticut Healthcare System (S.L.F., E.A.A., T.F., K.M.A.), West Haven, Connecticut, USA.
| | - Yan Zhan
- Yale School of Nursing (S.L.F., Y.Z.), Orange, Connecticut, USA
| | - Erica A Abel
- VA Connecticut Healthcare System (S.L.F., E.A.A., T.F., K.M.A.), West Haven, Connecticut, USA; Yale School of Medicine (E.A.C., T.F., K.M.A.), Orange, Connecticut, USA
| | - Dawn Smith
- Veterans Experience Center, Corporal Michael J. Crescenz VA Medical Center (D.S., M.E.), Philadelphia, Pennsylvania, USA
| | - Mary Ersek
- Veterans Experience Center, Corporal Michael J. Crescenz VA Medical Center (D.S., M.E.), Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing (M.E.), Philadelphia, Pennsylvania, USA
| | - Terri Fried
- VA Connecticut Healthcare System (S.L.F., E.A.A., T.F., K.M.A.), West Haven, Connecticut, USA; Yale School of Medicine (E.A.C., T.F., K.M.A.), Orange, Connecticut, USA; Yale Program on Aging (T.F.), New Haven, Connecticut, USA
| | - Nancy S Redeker
- University of Connecticut School of Nursing (N.S.R.), Storrs, Connecticut, USA
| | - Kathleen M Akgün
- VA Connecticut Healthcare System (S.L.F., E.A.A., T.F., K.M.A.), West Haven, Connecticut, USA; Yale School of Medicine (E.A.C., T.F., K.M.A.), Orange, Connecticut, USA
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12
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Gold ND, Mallard AJ, Hermann JC, Zeifman RJ, Pagni BA, Bogenschutz MP, Ross S. Exploring the Potential Utility of Psychedelic Therapy for Patients With Amyotrophic Lateral Sclerosis. J Palliat Med 2023; 26:1408-1418. [PMID: 37167080 DOI: 10.1089/jpm.2022.0604] [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: 05/13/2023] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is an aggressive, terminal neurodegenerative disease that causes death of motor neurons and has an average survival time of 3-4 years. ALS is the most common motor neuron degenerative disease and is increasing in prevalence. There is a pressing need for more effective ALS treatments as available pharmacotherapies do not reverse disease progression or provide substantial clinical benefit. Furthermore, despite psychological distress being highly prevalent in ALS patients, psychological treatments remain understudied. Psychedelics (i.e., serotonergic psychedelics and related compounds like ketamine) have seen a resurgence of research into therapeutic applications for treating a multitude of neuropsychiatric conditions, including psychiatric and existential distress in life-threatening illnesses. Methods: We conducted a narrative review to examine the potential of psychedelic assisted-psychotherapy (PAP) to alleviate psychiatric and psychospiritual distress in ALS. We also discussed the safety of using psychedelics in this population and proposed putative neurobiological mechanisms that may therapeutically intervene on ALS neuropathology. Results: PAP has the potential to treat psychological dimensions and may also intervene on neuropathological dimensions of ALS. Robust improvements in psychiatric and psychospiritual distress from PAP in other populations provide a strong rationale for utilizing this therapy to treat ALS-related psychiatric and existential distress. Furthermore, relevant neuroprotective properties of psychedelics warrant future preclinical trials to investigate this area in ALS models. Conclusion: PAP has the potential to serve as an effective treatment in ALS. Given the lack of effective treatment options, researchers should rigorously explore this therapy for ALS in future trials.
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Affiliation(s)
- Noah D Gold
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Austin J Mallard
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jacob C Hermann
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard J Zeifman
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Broc A Pagni
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Michael P Bogenschutz
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Stephen Ross
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
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13
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Harrison KL, Cenzer I, Smith AK, Hunt LJ, Kelley AS, Aldridge MD, Covinsky KE. Functional and clinical needs of older hospice enrollees with coexisting dementia. J Am Geriatr Soc 2023; 71:785-798. [PMID: 36420734 PMCID: PMC10023265 DOI: 10.1111/jgs.18130] [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: 06/22/2022] [Revised: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Medicare Hospice Benefit increasingly serves people dying with dementia. We sought to understand characteristics, hospice use patterns, and last-month-of-life care quality ratings among hospice enrollees with dementia coexisting with another terminal illness as compared to enrollees with a principal hospice diagnosis of dementia, and enrollees with no dementia. METHODS We conducted a pooled cross-sectional study among decedent Medicare beneficiaries age 70+ using longitudinal data from the National Health and Aging Trends Study (NHATS) (last interview before death; after-death proxy interview) linked to Medicare hospice claims (2011-2017). We used unadjusted and adjusted regression analyses to compare characteristics of hospice enrollees with coexisting dementia to two groups: (1) enrollees with a principal dementia diagnosis, and (2) enrollees with no dementia. RESULTS Among 1105 decedent hospice enrollees age 70+, 40% had coexisting dementia, 16% had a principal diagnosis of dementia, and 44% had no dementia. In adjusted analyses, enrollees with coexisting dementia had high rates of needing help with 3-6 activities of daily living, similar to enrollees with principal dementia (62% vs. 67%). Enrollees with coexisting dementia had high clinical needs, similar to those with no dementia, for example, 63% versus 61% had bothersome pain. Care quality was worse for enrollees with coexisting dementia versus principal dementia (e.g., 61% vs. 79% had anxiety/sadness managed) and similar to those with no dementia. Enrollees with coexisting dementia had similar hospice use patterns as those with principal diagnoses and higher rates of problematic use patterns compared to those with no dementia (e.g., 16% vs. 10% live disenrollment, p = 0.004). CONCLUSIONS People with coexisting dementia have functional needs comparable to enrollees with principal diagnoses of dementia, and clinical needs comparable to enrollees with no dementia. Changes to hospice care models and policy may be needed to ensure appropriate dementia care.
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Affiliation(s)
- Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Lauren J Hunt
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, USA
| | - Amy S Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai, New York, USA
- James J. Peters Bronx VA Medical Center, Bronx, New York, USA
| | - Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai, New York, USA
- James J. Peters Bronx VA Medical Center, Bronx, New York, USA
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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14
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Cornell PY, Halladay CW, Montano AR, Celardo C, Chmelka G, Silva JW, Rudolph JL. Social Work Staffing and Use of Palliative Care Among Recently Hospitalized Veterans. JAMA Netw Open 2023; 6:e2249731. [PMID: 36598783 PMCID: PMC9856777 DOI: 10.1001/jamanetworkopen.2022.49731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Palliative care improves quality of life for patients and families but may be underused. OBJECTIVE To assess the association of an intervention to increase social work staffing in Veterans Health Administration primary care teams with use of palliative care among veterans with a recent hospitalization. DESIGN, SETTING, AND PARTICIPANTS This cohort study used differences-in-differences analyses of the change in palliative care use associated with implementation of the Social Work Patient Aligned Care Team (PACT) staffing program, conducted from October 1, 2016, to September 30, 2019. The study included 71 VA primary care sites serving rural veterans. Participants were adult veterans who received primary care services from a site enrolled in the program and who received inpatient hospital care. Data were analyzed from January 2020 to August 2022. EXPOSURES The PACT staffing program was a clinic-level intervention that provided 3-year seed funding to Veterans Health Administration medical centers to hire 1 or more additional social workers in primary care teams. Staggered timing of the intervention enabled comparison of mean outcomes across sites before and after the intervention. MAIN OUTCOMES AND MEASURES The primary outcome was the number of individuals per 1000 veterans who had any palliative care use in 30 days after an inpatient hospital stay. RESULTS The analytic sample included 43 200 veterans (mean [SD] age, 65.34 [13.95] years; 37 259 [86.25%] men) and a total of 91 675 episodes of inpatient hospital care. Among the total cohort, 8611 veterans (9.39%) were Black, 77 069 veterans (84.07%) were White, and 2679 veterans (2.92%) were another race (including American Indian or Alaskan Native, Asian, and Native Hawaiian or other Pacific Islander). A mean of 14.5 individuals per 1000 veterans (1329 individuals in all) used palliative care after a hospital stay. After the intervention, there was an increase of 15.6 (95% CI, 9.2-22.3) individuals per 1000 veterans using palliative or hospice care after a hospital stay, controlling for national time trends and veteran characteristics-a 2-fold difference relative to the mean. CONCLUSIONS AND RELEVANCE This cohort study found significant increases in use of palliative care for recently hospitalized veterans whose primary care team had additional social work staffing. These findings suggest that social workers may increase access to and/or use of palliative care. Future work should assess the mechanism for this association and whether the increase in palliative care is associated with other health or health care outcomes.
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Affiliation(s)
- Portia Y. Cornell
- Center of Innovation for Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
- Brown University School of Public Health, Providence, Rhode Island
| | - Christopher W. Halladay
- Center of Innovation for Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | | | - Caitlin Celardo
- National Social Work Program, Care Management and Social Work Services, Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia
- Northport VA Medical Center, Northport, New York
| | - Gina Chmelka
- National Social Work Program, Care Management and Social Work Services, Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia
- Tomah VA Medical Center, Tomah, Wisconsin
| | - Jennifer W. Silva
- National Social Work Program, Care Management and Social Work Services, Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia
- VA Tennessee Valley Healthcare System, Nashville
| | - James L. Rudolph
- Center of Innovation for Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
- Brown University School of Public Health, Providence, Rhode Island
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15
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Reinke LF, Sullivan DR, Slatore C, Dransfield MT, Ruedebusch S, Smith P, Rise PJ, Tartaglione EV, Vig EK, Au DH. A Randomized Trial of a Nurse-Led Palliative Care Intervention for Patients with Newly Diagnosed Lung Cancer. J Palliat Med 2022; 25:1668-1676. [PMID: 35649214 DOI: 10.1089/jpm.2022.0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Specialist palliative care improves quality of life (QOL), symptom burden, and may prolong survival among patients with advanced lung cancer. Previous trials focused on advanced disease, and less is known about patients across a broad range of stages. Objective: We sought to assess the effect of a nurse-led telephone-based primary palliative care intervention that focused on patients across a broad range of stages. Design, Setting, and Participants: We conducted a multisite randomized controlled trial in the United States involving patients diagnosed within two months with any stage or histology of lung cancer to compare the effects of a telephone-based palliative care intervention delivered by registered nurses trained in primary palliative care versus usual care. Main Outcomes and Measures: The primary outcome was the Functional Assessment of Cancer Therapy-Lung Scale Total Outcome Index (FACT-L TOI), which measures QOL and symptoms. We estimated having 80% power to detect a 5-point change from baseline to three months. Secondary outcome was a change in satisfaction of care, measured by the FAMCARE-P13. Results: A total of 151 patients were enrolled over 30 months. Patients were, on average, male (98%), age 70 years, White (85%), and 36% diagnosed with stage I-II, and 64% had stage III-IV. In comparison to usual care, patients in the nurse-led intervention did not report improvement in QOL from baseline to three months follow-up or demonstrate differences in treatment effect by site or cancer stage: FACT-L TOI 1.03 (95% confidence interval [CI]: -3.98 to 6.04). Satisfaction with care did not significantly improve: 0.66 (95% CI: -2.01 to 3.33). Conclusions: Among patients with newly diagnosed lung cancer, a nurse-led, primary palliative care intervention did not significantly improve QOL, symptom burden, or satisfaction of care. In contrast to several clinical trials demonstrating the effectiveness of delivering specialty palliative care with disease-modifying treatments on QOL among patients with advanced lung cancer, this intervention did not significantly improve QOL among patients with any stage lung cancer. Future research should identify which specific components of primary palliative care improve outcomes for patients newly diagnosed with lung cancer.
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Affiliation(s)
- Lynn F Reinke
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Donald R Sullivan
- Department of Veterans Affairs, Portland Health Care System, Health Services R&D, Portland, Oregon, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Christopher Slatore
- Department of Veterans Affairs, Portland Health Care System, Health Services R&D, Portland, Oregon, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Mark T Dransfield
- Department of Veterans Affairs, Division of Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susan Ruedebusch
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Patti Smith
- Department of Veterans Affairs, Division of Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Peter J Rise
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Erica V Tartaglione
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA
| | - Elizabeth K Vig
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA.,Geriatric and Palliative Care Medicine Division, School of Medicine, University of Washington, Seattle, Washington, USA
| | - David H Au
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, Washington, USA.,Pulmonary and Critical Care Medicine Division, School of Medicine, University of Washington, Seattle, Washington, USA
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16
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Burke RE, Ashcraft LE, Manges K, Kinosian B, Lamberton CM, Bowen ME, Brown RT, Mavandadi S, Hall DE, Werner RM. What matters when it comes to measuring
Age‐Friendly
Health System transformation. J Am Geriatr Soc 2022; 70:2775-2785. [DOI: 10.1111/jgs.18002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Robert E. Burke
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
- Division of General Internal Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
| | - Laura Ellen Ashcraft
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Kirstin Manges
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Bruce Kinosian
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Division of Geriatric Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Geriatrics and Extended Care Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Cait M. Lamberton
- Wharton School at the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Mary E. Bowen
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
- School of Nursing University of Delaware Newark Delaware USA
| | - Rebecca T. Brown
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Division of Geriatric Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Geriatrics and Extended Care Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Shahrzad Mavandadi
- Mental Illness Research, Education, and Clinical Center Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Daniel E. Hall
- Center for Health Equity Research and Promotion VA Pittsburgh Healthcare System Pittsburgh Pennsylvania USA
- Department of Surgery, School of Medicine University of Pittsburgh Medical Center (UPMC) Pittsburgh Pennsylvania USA
- Geriatrics Research Education and Clinical Center VA Pittsburgh Healthcare System Pittsburgh Pennsylvania USA
- Wolff Center at University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
| | - Rachel M. Werner
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
- Division of General Internal Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
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17
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Naik AD, Walling AM. Getting patients ready for "in the moment" decisions. J Am Geriatr Soc 2022; 70:2474-2477. [PMID: 35781226 DOI: 10.1111/jgs.17935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Aanand D Naik
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA.,UTHealth Consortium on Aging, University of Texas Health Science Center, Houston, Texas, USA.,VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Anne M Walling
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Texas, USA.,VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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