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Sullivan DR, Jones KF, Wachterman MW, Griffin HL, Kinder D, Smith D, Thorpe J, 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
CONTEXT 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. OBJECTIVES 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. CONCLUSION 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 (D.R.S.), Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland Oregon, USA; Center to Improve Veteran Involvement in Care (D.R.S.), Portland Veteran Affairs Healthcare System, Portland Oregon, USA.
| | - Katie F Jones
- New England Geriatric Research Education and Clinical Center (K.F.J.), Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA; Department of Medicine (K.F.J.), Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa W Wachterman
- Section of General Internal Medicine (M.W.), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA; Division of General Internal Medicine (M.W.), Brigham and Women's Hospital, Boston MA, USA; Department of Psychosocial Oncology and Palliative Care (M.W.), Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Hilary L Griffin
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Daniel Kinder
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Dawn Smith
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua Thorpe
- Center for Health Equity Research and Promotion (J.M.T.), Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA; University of North Carolina School of Pharmacy (J.M.T.), Chapel Hill, North Carolina, USA
| | - Shelli L Feder
- Yale University School of Nursing (S.L.F.), Orange, Connecticut, USA; West Haven Department of Veterans Affairs (S.L.F.), West Haven, Connecticut, USA
| | - Mary Ersek
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Leonard Davis Institute (M.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Kutney-Lee
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Center for Health Equity and Research Promotion (A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; University of Pennsylvania (A.K.L.), School of Nursing, Philadelphia, Pennsylvania, USA
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2
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Chen J, Huan J, Chen C, Xu W, Jia A. Enhancing hospice care with psychological support and a nomogram to predict delirium in patients with advanced solid tumors. Am J Cancer Res 2024; 14:2478-2492. [PMID: 38859841 PMCID: PMC11162653 DOI: 10.62347/trqo1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/28/2024] [Indexed: 06/12/2024] Open
Abstract
To assesses the impact of integrating hospice care with psychological interventions on patient well-being and to introduce a predictive nomogram model for delirium that incorporates clinical and psychosocial variables, thereby improving the accuracy in hospice care environments. Data from 381 patients treated from September 2018 to February 2023 were analyzed. The patients were divided into a control group (n=177, receiving standard care) and an experimental group (n=204, receiving combined hospice care and psychological interventions) according to the treatment modality. The duration of care extended until the patient's discharge from the hospital or death. The experimental group demonstrated significant improvements in emotional well-being and a lower incidence of delirium compared to the control group. Specifically, emotional well-being assessments revealed marked improvements in the experimental group, as evidenced by lower scores on the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) post-intervention. The nomogram model, developed using logistic regression based on clinical characteristics, effectively predicted the risk of delirium in patients with advanced cancer. Significant predictors in the model included ECOG score ≥3, Palliative Prognostic Index score ≥6, opioid usage, polypharmacy, infections, sleep disorders, organ failure, brain metastases, electrolyte imbalances, activity limitations, pre-care SAS score ≥60, pre-care SDS score ≥63, and pre-care KPS score ≥60. The model's predictive accuracy was validated, showing AUC values of 0.839 for the training cohort and 0.864 for the validation cohort, with calibration and Decision Curve Analysis (DCA) confirming its clinical utility. Integrating hospice care with psychological interventions not only significantly enhanced the emotional well-being of advanced cancer patients but also reduced the actual incidence of delirium. This approach, offering a valuable Nomogram model for precise care planning and risk management, underscores the importance of integrated, personalized care strategies in advanced cancer management.
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Affiliation(s)
- Juan Chen
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Jingjing Huan
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Chunyan Chen
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Wenxia Xu
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Aiqun Jia
- Department of Oncology, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
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Snow S, Gabrielson D, Lim H, Tehfe M, Brezden-Masley C. Best Practices for Managing Patients with Unresectable Metastatic Gastric and Gastroesophageal Junction Cancer in Canada. Curr Oncol 2024; 31:2552-2565. [PMID: 38785472 PMCID: PMC11120513 DOI: 10.3390/curroncol31050191] [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: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
Gastric cancer (GC) is one of the most common types of cancer and is associated with relatively low survival rates. Despite its considerable burden, there is limited guidance for Canadian clinicians on the management of unresectable metastatic GC and gastroesophageal junction cancer (GEJC). Therefore, we aimed to discuss best practices and provide expert recommendations for patient management within the current Canadian unresectable GC and GEJC landscape. A multidisciplinary group of Canadian healthcare practitioners was assembled to develop expert recommendations via a working group. The often-rapid progression of unresectable GC and GEJC and the associated malnutrition have a significant impact on the patient's quality of life and ability to tolerate treatment. Hence, recommendations include early diagnosis, identification of relevant biomarkers to improve personalized treatment, and relevant support to manage comorbidities. A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services, is needed to optimize possible outcomes for patients. Where possible, patients with unresectable GC and GEJC would benefit from access to clinical trials and innovative treatments.
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Affiliation(s)
- Stephanie Snow
- Division of Medical Oncology, Department of Medicine, Dalhousie University, QEII-Bethune Building, Suite 449 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Denise Gabrielson
- Division of Hematology/Oncology, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Howard Lim
- Division of Medical Oncology, BC Cancer Vancouver, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Mustapha Tehfe
- Centre Hospitalier de l’Université de Montréal, 1000 Saint-Denis St, Montréal, QC H2X 0C1, Canada;
| | - Christine Brezden-Masley
- School of Medicine University of Toronto, Mount Sinai Hospital, 1284-600, University Avenue, Toronto, ON M5G 1X5, Canada;
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4
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Chutarattanakul L, Jarusukthavorn V, Dejkriengkraikul N, Oo MZ, Tint SS, Angkurawaranon C, Wiwatkunupakarn N. Misconception between palliative care and euthanasia among Thai general practitioners: a cross-sectional study. BMC Palliat Care 2024; 23:96. [PMID: 38600512 PMCID: PMC11007896 DOI: 10.1186/s12904-024-01430-6] [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: 01/04/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Palliative care lower medical expenses and enhances quality of life, but misconception with euthanasia delays timely care and makes inappropriate patient management. OBJECTIVE To examine the magnitude of misconceptions between palliative care and euthanasia among Thai general practitioners, explore the association with knowledge, attitudes, and practical experience, and assess the association between misconception and confidence in practicing and referring patients to palliative care centers. METHODS All 144 general practitioners who were going to start residency training at Maharaj Nakorn Chiang Mai Hospital in 2021 participated in this observational cross-sectional study. A chi-square test was utilized to examine the relationship between misconception and knowledge, attitude, practical experience, confidence to practice, and confidence to refer patients. Multivariable logistic regression was carried out while controlling for age, sex, knowledge, attitude, and experience to examine the relationship between misconception and confidence to practice and refer patients for palliative care. Statistical significance was defined at p < 0.05. RESULTS About 41% of general physicians had misconceptions regarding palliative care and euthanasia. High knowledge was associated with a lower level of misconception (p = 0.01). The absence of misconceptions was weakly associated with a higher level of confidence in practicing palliative care, with an adjusted odds ratio of 1.51 (95% confidence interval 0.73 to 3.10, p = 0.07). CONCLUSION High misconception rates between palliative care and euthanasia among young Thai physicians might impact their confidence in delivering palliative care. Training initiatives for medical students and practitioners can mitigate misconceptions, fostering better palliative care utilization in Thailand.
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Affiliation(s)
- Lalita Chutarattanakul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Viriya Jarusukthavorn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Myo Zin Oo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Soe Sandi Tint
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand.
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand.
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Russell KB, Forbes C, Qi S, Link C, Watson L, Deiure A, Lu S, Silvius J, Kelly B, Bultz BD, Schulte F. End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study. Cancers (Basel) 2024; 16:1294. [PMID: 38610971 PMCID: PMC11011194 DOI: 10.3390/cancers16071294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer is the primary underlying condition for most Canadians who are provided Medical Assistance in Dying (MAID). However, it is unknown whether cancer patients who are provided MAID experience disproportionally higher symptom burden compared to those who are not provided MAID. Thus, we used a propensity-score-matched cohort design to evaluate longitudinal symptom trajectories over the last 12 months of patients' lives, comparing cancer patients in Alberta who were and were not provided MAID. We utilized routinely collected retrospective Patient-Reported Outcomes (PROs) data from the Edmonton Symptom Assessment System (ESAS-r) reported by Albertans with cancer who died between July 2017 and January 2019. The data were analyzed using mixed-effect models for repeated measures to compare differences in symptom trajectories between the cohorts over time. Both cohorts experienced increasing severity in all symptoms in the year prior to death (β from 0.086 to 0.231, p ≤ .001 to .002). Those in the MAID cohort reported significantly greater anxiety (β = -0.831, p = .044) and greater lack of appetite (β = -0.934, p = .039) compared to those in the non-MAID cohort. The majority (65.8%) of patients who received MAID submitted their request for MAID within one month of their death. Overall, the MAID patients did not experience disproportionally higher symptom burden. These results emphasize opportunities to address patient suffering for all patients with cancer through routine collection of PROs as well as targeted and early palliative approaches to care.
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Affiliation(s)
- K. Brooke Russell
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Caitlin Forbes
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
| | - Siwei Qi
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
| | - Claire Link
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
| | - Linda Watson
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Andrea Deiure
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
| | - Shuang Lu
- Surveillance and Reporting, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
| | - James Silvius
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Provincial Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta T2W 1S7, Canada
| | - Brian Kelly
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Barry D. Bultz
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
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6
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Johnston BM, Miller M, Normand C, Cardona M, May P, Lowney AC. Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale. BMC Palliat Care 2024; 23:46. [PMID: 38374101 PMCID: PMC10877897 DOI: 10.1186/s12904-024-01384-9] [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: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience. METHODS We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England between 2019 and 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 h of presentation using two established tools: EQ-5D-5 L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS). RESULTS Completion rate was 68% (n = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5 L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores. CONCLUSION Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.
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Affiliation(s)
- Bridget M Johnston
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland.
| | - Mary Miller
- Department of Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Medicine, Oxford University, Oxford, England
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Magnolia Cardona
- Faculty of Health and Behavioural Sciences, School of Psychology, The University of Queensland, Brisbane, Australia
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, Australia
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Aoife C Lowney
- Department of Palliative Care, Marymount University Hospital and Hospice and Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
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7
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Singh J, Grov EK, Turzer M, Stensvold A. Hospitalizations and re-hospitalizations at the end-of-life among cancer patients; a retrospective register data study. BMC Palliat Care 2024; 23:39. [PMID: 38350961 PMCID: PMC10863145 DOI: 10.1186/s12904-024-01370-1] [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: 09/26/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Patients with incurable cancer are frequently hospitalized within their last 30 days of life (DOL) due to numerous symptoms and concerns. These hospitalizations can be burdensome for the patient and the caregivers and are therefore considered a quality indicator of end-of-life care. This retrospective cohort study aims to investigate the rates and potential predictors of hospitalizations and re-hospitalizations within the last 30 DOL. METHODS This register data study included 383 patients with non-curable cancer who died in the pre-covid period between July 2018 and December 2019. Descriptive statistics with Chi-squared tests for the categorical data and logistic regression analysis were used to identify factors associated with hospitalization within the last 30 DOL. RESULTS A total of 272 (71%) had hospitalizations within the last 30 days of life and 93 (24%) had > 1 hospitalizations. Hospitalization was associated with shorter time from palliative care unit (PCU) referral to death, male gender, age < 80 years and systemic anticancer therapy (SACT) within the last 30 DOL. The most common treatment approaches initiated during re-hospitalizations remained treatment for suspected or confirmed infection (45%), pleural or abdominal paracentesis (20%) and erythrocytes transfusion (18%). CONCLUSION Hospitalization and re-hospitalization within the last 30 DOL were associated with male gender, age below 80, systemic anticancer therapy and suspected or confirmed infection.
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Affiliation(s)
- J Singh
- Department of Oncology, Østfold Hospital Trust, PO Box 300, Graalum, 1714, Norway.
- Faculty of Health Sciences, Oslo Metropolitan University, St.Olavs Plass, PO Box 4, Oslo, 0130, Norway.
| | - E K Grov
- Faculty of Health Sciences, Oslo Metropolitan University, St.Olavs Plass, PO Box 4, Oslo, 0130, Norway
| | - M Turzer
- Department of Oncology, Østfold Hospital Trust, PO Box 300, Graalum, 1714, Norway
| | - A Stensvold
- Department of Oncology, Østfold Hospital Trust, PO Box 300, Graalum, 1714, Norway
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8
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Boddaert MS, Fransen HP, de Nijs EJM, van Gerven D, Spierings LEA, Raijmakers NJH, van der Linden YM. Association between Inappropriate End-of-Life Cancer Care and Specialist Palliative Care: A Retrospective Observational Study in Two Acute Care Hospitals. Cancers (Basel) 2024; 16:721. [PMID: 38398112 PMCID: PMC10886868 DOI: 10.3390/cancers16040721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
A substantial number of patients with life-threatening illnesses like cancer receive inappropriate end-of-life care. Improving their quality of end-of-life care is a priority for patients and their families and for public health. To investigate the association between provision, timing, and initial setting of hospital-based specialist palliative care and potentially inappropriate end-of-life care for patients with cancer in two acute care hospitals in the Netherlands, we conducted a retrospective observational study using hospital administrative databases. All adults diagnosed with or treated for cancer in the year preceding their death in 2018 or 2019 were included. The main exposure was hospital-based specialist palliative care initiated >30 days before death. The outcome measures in the last 30 days of life were six quality indicators for inappropriate end-of-life care (≥2 ED-visits, ≥2 hospital admissions, >14 days hospitalization, ICU-admission, chemotherapy, hospital death). We identified 2603 deceased patients, of whom 14% (n = 359) received specialist palliative care >30 days before death (exposure group). Overall, 27% (n = 690) received potentially inappropriate end-of-life care: 19% in the exposure group, versus 28% in the non-exposure group (p < 0.001). The exposure group was 45% less likely to receive potentially inappropriate end-of-life care (AOR 0.55; 95% CI 0.41 to 0.73). Early (>90 days) and late (≤90 and >30 days) initiation of specialist palliative care, as well as outpatient and inpatient initiation, were all associated with less potentially inappropriate end-of-life care (AOR 0.49; 0.62; 0.32; 0.64, respectively). Thus, timely access to hospital-based specialist palliative care is associated with less potentially inappropriate end-of-life care for patients with cancer. The outpatient initiation of specialist palliative care seems to enhance this result.
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Affiliation(s)
- Manon S. Boddaert
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Heidi P. Fransen
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Ellen J. M. de Nijs
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Dagmar van Gerven
- Department of Medical Oncology, Alrijne Hospital, 2353 GA Leiderdorp, The Netherlands
| | | | - Natasja J. H. Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Yvette M. van der Linden
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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9
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Kenny P, Liu D, Fiebig D, Hall J, Millican J, Aranda S, van Gool K, Haywood P. Specialist Palliative Care and Health Care Costs at the End of Life. PHARMACOECONOMICS - OPEN 2024; 8:31-47. [PMID: 37910343 PMCID: PMC10781921 DOI: 10.1007/s41669-023-00446-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIMS The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliative care (SPC) for decedents who died from cancer or another life-limiting illness. METHODS The decedents were participants in a cohort study of older residents of the state of New South Wales, Australia. Using linked survey and administrative health data from 2007 to 2016, two cohorts were identified: n = 10,535 where the cause of death was cancer; and n = 11,179 where the cause of death was another life-limiting illness. Costs of various types were analysed with separate risk-adjusted linear regression models for the last 1, 3, 6, 9 and 12 months before death and for both cohorts. SPC was categorised according to time to death from first contact with the service as 1-7 days, 7-30 days, 30-180 days and more than 180 days. RESULTS SPC use was higher among the cancer cohort (30.0%) relative to the non-cancer cohort (4.8%). The mean costs over the final year of life were AU$55,037 (SD 45,059) for the cancer cohort and AU$35,318 (SD 41,948) for the non-cancer cohort. Earlier use of SPC was associated with higher costs over the last year of life but lower costs in the last 1 and 3 months for both cohorts. Initiating SPC use more than 180 days before death was associated with a mean difference relative to the no SPC group of AU$15,590 (95% CI 10,617 to 20,562) and AU$13,739 (95% CI 733 to 26,746) over the last year of life for those dying from cancer and another illness, respectively. The same differences over the last month of life were - AU$2810 (95% CI - 3945 to - 1676) and - AU$4345 (95% CI - 6625 to - 2066). Admitted hospital care was the major driver of costs, with longer SPC associated with lower rates of death in hospital for both cohorts. CONCLUSION Early initiation of SPC was associated with higher costs over the last year of life and lower costs over the last months of life. This was the case for both the cancer and non-cancer cohorts, and appeared to be largely attributed to reduced hospitalisation. Although further investigation is required, our results suggest that expanding the availability of SPC services to provide more equitable access could enable patients to spend more time at their usual place of residence, reduce pressure on inpatient services and facilitate death at home when that is preferred.
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Affiliation(s)
- Patricia Kenny
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia.
| | - Dan Liu
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Denzil Fiebig
- School of Economics, University of New South Wales, Sydney, NSW, Australia
| | - Jane Hall
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Jared Millican
- Concord Centre for Palliative Care, Sydney Local Health District, Sydney, NSW, Australia
| | - Sanchia Aranda
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kees van Gool
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
- Pricing and analytics, Independent Hospital and Aged Care Pricing Authority, Sydney, NSW, Australia
| | - Philip Haywood
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
- Health Division, OECD, Paris, France
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Hamdan KM, Al-Bashaireh AM, Al-Dalahmeh M, Saifan AR, Albqoor MA, Shaheen AM. Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan. Acute Crit Care 2023; 38:469-478. [PMID: 38052512 DOI: 10.4266/acc.2023.00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/03/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study's purpose was to examine nurses' knowledge and attitudes toward palliative care. METHODS A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data. RESULTS We measured nurses' knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type. CONCLUSIONS ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.
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Affiliation(s)
| | - Ahmad M Al-Bashaireh
- Faculty of Health Science, Higher Colleges of Technologies, Fujairah, United Arab Emirates
| | | | | | | | - Abeer M Shaheen
- Community Health Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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11
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Aamodt WW, Bilker WB, Willis AW, Farrar JT. Sociodemographic and Geographic Disparities in End-of-Life Health Care Intensity Among Medicare Beneficiaries With Parkinson Disease. Neurol Clin Pract 2023; 13:e200171. [PMID: 37251369 PMCID: PMC10212234 DOI: 10.1212/cpj.0000000000200171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/30/2023] [Indexed: 05/31/2023]
Abstract
Background and Objective Current studies of end-of-life care in Parkinson disease (PD) do not focus on diverse patient samples or provide national views of end-of-life resource utilization. We determined sociodemographic and geographic differences in end-of-life inpatient care intensity among persons with PD in the United States (US). Methods This retrospective cohort study included Medicare Part A and Part B beneficiaries 65 years and older with a qualifying PD diagnosis who died between January 1, 2017, and December 31, 2017. Medicare Advantage beneficiaries and those with atypical or secondary parkinsonism were excluded. Primary outcomes included rates of hospitalization, intensive care unit (ICU) admission, in-hospital death, and hospice discharge in the last 6 months of life. Descriptive analyses and multivariable logistic regression models compared differences in end-of-life resource utilization and treatment intensity. Adjusted models included demographic and geographic variables, Charlson Comorbidity Index score, and Social Deprivation Index score. The national distribution of primary outcomes was mapped and compared by hospital referral region using Moran I. Results Of 400,791 Medicare beneficiaries with PD in 2017, 53,279 (13.3%) died. Of decedents, 33,107 (62.1%) were hospitalized in the last 6 months of life. In covariate-adjusted regression models using White male decedents as the reference category, odds of hospitalization was greater for Asian (AOR 1.38; CI 1.11-1.71) and Black (AOR 1.23; CI 1.08-1.39) male decedents and lower for White female decedents (AOR 0.80; CI 0.76-0.83). ICU admissions were less likely in female decedents and more likely in Asian, Black, and Hispanic decedents. Odds of in-hospital death was greater among Asian (AOR 2.49, CI 2.10-2.96), Black (AOR 1.11, CI 1.00-1.24), Hispanic (AOR 1.59; CI 1.33-1.91), and Native American (AOR 1.49; CI 1.05-2.10) decedents. Asian and Hispanic male decedents were less likely to be discharged to hospice. In geographical analyses, rural-dwelling decedents had lower odds of ICU admission (AOR 0.77; CI 0.73-0.81) and hospice discharge (AOR 0.69; CI 0.65-0.73) than urban-dwelling decedents. Nonrandom clusters of primary outcomes were observed across the US, with highest rates of hospitalization in the South and Midwest (Moran I = 0.134; p < 0.001). Discussion Most persons with PD in the US are hospitalized in the last 6 months of life, and treatment intensity varies by sex, race, ethnicity, and geographic location. These group differences emphasize the importance of exploring end-of-life care preferences, service availability, and care quality among diverse populations with PD and may inform new approaches to advance care planning.
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Affiliation(s)
- Whitley W Aamodt
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
| | - Warren B Bilker
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
| | - Allison W Willis
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
| | - John T Farrar
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
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12
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Mah SJ, Carter Ramirez DM, Eiriksson LR, Schnarr K, Gayowsky A, Seow H. Palliative care utilization across health sectors for patients with gynecologic malignancies in Ontario, Canada from 2006 to 2018. Gynecol Oncol 2023; 175:169-175. [PMID: 37392530 DOI: 10.1016/j.ygyno.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Early palliative care (PC) is associated with improved patient quality of life, less aggressive end-of-life care, and prolonged survival. We evaluated patterns of PC delivery in gynecologic oncology. METHODS We conducted a population-based, retrospective cohort study of gynecologic cancer decedents in Ontario from 2006 to 2018 using linked administrative health care data. RESULTS The cohort included 16,237 decedents; 51.1% died of ovarian cancer, 30.3% uterine cancer, 12.1% cervical cancer, and 6.5% vulvar/vaginal cancers. Palliative care was most often delivered in the hospital inpatient setting in 81%, and 53% received specialist PC. PC was first received during hospital admission in 53%, and by outpatient physician care in only 23%. Palliative care was initiated a median 193 days prior to death, with the lowest two quintiles initiating care ≤70 days before death. The average user of PC resources (third quintile) received 68 days of PC. While cumulative use of community PC gradually increased over the final year of life, institutional palliative care use exponentially rose from 12 weeks until death. On multivariable analyses, predictors of initiating palliative care during a hospital admission included age ≥70 years at death, ≤3 month cancer survival, having cervical or uterine cancer, not having a primary care provider, or being in the lowest 3 income quintiles. CONCLUSION Most palliative care is initiated and delivered during hospital admission, and is initiated late in a significant proportion. Strategies to increase access to anticipatory and integrated palliative care may improve the quality of the disease course and the end of life.
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Affiliation(s)
- Sarah J Mah
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Canada.
| | - Daniel M Carter Ramirez
- Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, Canada
| | - Lua R Eiriksson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Canada
| | - Kara Schnarr
- Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, Canada
| | | | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Canada
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13
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Integrating Palliative Care into Oncology Care Worldwide: The Right Care in the Right Place at the Right Time. Curr Treat Options Oncol 2023; 24:353-372. [PMID: 36913164 PMCID: PMC10009840 DOI: 10.1007/s11864-023-01060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/14/2023]
Abstract
OPINION STATEMENT While the benefits of early palliative care are indisputable, most of the current evidence has emerged from resource-rich settings in urban areas of high-income countries, with an emphasis on solid tumors in outpatient settings; this model of palliative care integration is not currently scalable internationally. A shortage of specialist palliative care clinicians means that in order to meet the needs of all patients who require support at any point along their advanced cancer trajectory, palliative care must also be provided by family physicians and oncology clinicians who require training and mentorship. Models of care that facilitate the timely provision of seamless palliative care across all settings (inpatient, outpatient, and home-based care), with clear communication between clinicians, are crucial to the provision of patient-centred palliative care. The unique needs of patients with hematological malignancies must be further explored and existing models of palliative care provision modified to meet these needs. Finally, care must be provided in an equitable and culturally sensitive manner, recognizing the challenges associated with the delivery of high-quality palliative care to both patients in high-income countries who live in rural areas, as well as to those in low- and middle-income countries. A one-size-fits-all model will not suffice, and there is an urgent need to develop innovative context-specific models of palliative care integration worldwide, in order to provide the right care, in the right place, and at the right time.
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14
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Robertson C, Watanabe SM, Sinnarajah A, Potapov A, Faily V, Tarumi Y, Baracos VE. Association between Consultation by a Comprehensive Integrated Palliative Care Program and Quality of End-of-Life Care in Patients with Advanced Cancer in Edmonton, Canada. Curr Oncol 2023; 30:897-907. [PMID: 36661717 PMCID: PMC9858595 DOI: 10.3390/curroncol30010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Literature assessing the impact of palliative care (PC) consultation on aggressive care at the end of life (EOL) within a comprehensive integrated PC program is limited. We retrospectively reviewed patients with advanced cancer who received oncological care at a Canadian tertiary center, died between April 2013 and March 2014, and had access to PC consultation in all healthcare settings. Administrative databases were linked, and medical records reviewed. Composite score for aggressive EOL care was calculated, assigning a point for each of the following: ≥2 emergency room visits, ≥2 hospitalizations, hospitalization >14 days, ICU admission, and chemotherapy administration in the last 30 days of life, and hospital death. Multivariable logistic regression was adjusted for age, sex, income, cancer type and PC consultation for ≥1 aggressive EOL care indicator. Of 1414 eligible patients, 1111 (78.6%) received PC consultation. In multivariable analysis, PC consultation was independently associated with lower odds of ≥1 aggressive EOL care indicator (OR 0.49, 95% CI 0.38−0.65, p < 0.001). PC consultation >3 versus ≤3 months before death had a greater effect on lower aggressive EOL care (mean composite score 0.59 versus 0.88, p < 0.001). We add evidence that PC consultation is associated with less aggressive care at the EOL for patients with advanced cancer.
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Affiliation(s)
- Cara Robertson
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Sharon M. Watanabe
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Queen’s University, Kingston, ON L1G 2B9, Canada
| | - Alexei Potapov
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Viane Faily
- Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI 53226, USA
| | - Yoko Tarumi
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
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15
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Mohyuddin GR, Sinnarajah A, Gayowsky A, Chan KKW, Seow H, Mian H. Quality of end-of-life care in multiple myeloma: A 13-year analysis of a population-based cohort in Ontario, Canada. Br J Haematol 2022; 199:688-695. [PMID: 35949180 DOI: 10.1111/bjh.18401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
Optimizing end-of-life (EOL) care for multiple myeloma (MM) represents an unmet need. An administrative cohort in Ontario, Canada was analysed between 2006 and 2018. Aggressive care was defined as two or more emergency-department visits in the last 30 days before death, or at least two new hospitalizations within 30 days of death, or an intensive care unit (ICU) admission within the last 30 days of life. Supportive care was defined as a physician house-call in the last two weeks before death, or a palliative nursing or personal support visit at home in the last 30 days before death. Among 5095 patients, 23.2% of patients received chemotherapy at EOL and 55.6% of patients died as inpatient. A minority received aggressive care at EOL [28.3%: autologous stem cell transplant (ASCT), 20.4%: non-ASCT], and a majority received supportive care at EOL (65.4%: ASCT, 61.5%: non-ASCT). Supportive care was less likely to be received by those aged over 80 years and in lower-income neighbourhoods. Supportive care at EOL increased from 56.0% in 2006 to 70.3% in 2018. Despite improvements, many patients with MM experience aggressive care at EOL. Even in a publicly funded health care system, disparities based on age, income and community size are present.
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Affiliation(s)
| | | | | | - Kelvin K W Chan
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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16
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Seow H, Barbera LC, McGrail K, Burge F, Guthrie DM, Lawson B, Chan KKW, Peacock SJ, Sutradhar R. Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score-Matched Cohort Study. JCO Oncol Pract 2022; 18:e183-e192. [PMID: 34388021 PMCID: PMC8758090 DOI: 10.1200/op.21.00299] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This study aimed to investigate the impact of early versus not-early palliative care among cancer decedents on end-of-life health care costs. METHODS Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, Canada. We identified those who received early palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of not-early palliative care, hard matched on age, sex, cancer type, and stage at diagnosis. We examined differences in average health system costs (including hospital, emergency department, physician, and home care costs) between groups in the last month of life. RESULTS We identified 144,306 cancer decedents, of which 37% received early palliative care. After matching, we created 36,238 pairs of decedents who received early and not-early (control) palliative care; there were balanced distributions of age, sex, cancer type (24% lung cancer), and stage (25% stage III and IV). Overall, 56.3% of early group versus 66.7% of control group used inpatient care in the last month (P < .001). Considering inpatient hospital costs in the last month of life, the early group used an average (±standard deviation) of $7,105 (±$10,710) versus the control group of $9,370 (±$13,685; P < .001). Overall average costs (±standard deviation) in the last month of life for patients in the early versus control group was $12,753 (±$10,868) versus $14,147 (±$14,288; P < .001). CONCLUSION Receiving early palliative care reduced average health system costs in the last month of life, especially via avoided hospitalizations.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada,Hsien Seow, PhD, Department of Oncology, McMaster University, 699 Concession St, 4th Fl, Rm 4-229, Hamilton, ON L8V 5C2, Canada; e-mail:
| | - Lisa C. Barbera
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Kimberlyn McGrail
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Fred Burge
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Dawn M. Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | | | | | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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17
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Specialist palliative care teams and characteristics related to referral rate: a national cross-sectional survey among hospitals in the Netherlands. BMC Palliat Care 2021; 20:175. [PMID: 34758792 PMCID: PMC8582112 DOI: 10.1186/s12904-021-00875-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Specialist palliative care teams (SPCTs) in hospitals improve quality of life and satisfaction with care for patients with advanced disease. However, referrals to SPCTs are often limited. To identify areas for improvement of SPCTs’ service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates. Methods We performed a secondary analysis of a national cross-sectional survey conducted among hospitals in the Netherlands from March through May 2018. For this survey, a previously developed online questionnaire, containing 6 consensus-based integration indicators, was sent to palliative care programme leaders in all 78 hospitals. For referral rate we calculated the number of annual inpatient referrals to the SPCT as a percentage of the number of total annual hospital admissions. Referral rate was dichotomized into high (≥ third quartile) and low (< third quartile). Characteristics of SPCTs with high and low referral rate were compared using univariate analyses. P-values < 0.05 were considered significant. Results In total, 63 hospitals (81%) participated in the survey, of which 62 had an operational SPCT. The palliative care programmes of these hospitals consisted of inpatient consultation services (94%), interdisciplinary staffing (61%), outpatient clinics (45%), dedicated acute care beds (21%) and community-based palliative care (27%). The median referral rate was 0.56% (IQR 0.23–1.0%), ranging from 0 to 3.7%. Comparing SPCTs with high referral rate (≥1%, n = 17) and low referral rate (< 1%, n = 45) showed significant differences for SPCTs’ years of existence, staffing, their level of education, participation in other departments’ team meetings, provision of education and conducting research. With regard to integration, significant differences were found for the presence of outpatient clinics and timing of referrals. Conclusion In the Netherlands, palliative care programmes and specialist palliative care teams in hospitals vary in their level of integration and development, with more mature teams showing higher referral rates. Appropriate staffing, dedicated outpatient clinics, education and research appear means to improve service penetration and timing of referral for patients with advanced diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00875-3.
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18
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Yu J, Houtrow AJ. Moving Pediatric Complex Care Forward: Big Data and National Research Collaborations. Pediatrics 2021; 148:peds.2021-051833. [PMID: 34349031 DOI: 10.1542/peds.2021-051833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Justin Yu
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania .,Departments of Pediatrics
| | - Amy J Houtrow
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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