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Pihlaja H, Rantala H, Leivo-Korpela S, Lehtimäki L, Lehto JT, Piili RP. Specialist Palliative Care Consultation for Patients with Nonmalignant Pulmonary Diseases: A Retrospective Study. Palliat Med Rep 2023; 4:108-115. [PMID: 37095866 PMCID: PMC10122226 DOI: 10.1089/pmr.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/26/2023] Open
Abstract
Background Few patients with chronic nonmalignant pulmonary diseases receive specialist palliative care consultation, despite their high symptom burden in end of life. Objectives To study palliative care decision making, survival, and hospital resource usage in patients with nonmalignant pulmonary diseases with or without a specialist palliative care consultation. Methods A retrospective chart review of all patients with a chronic nonmalignant pulmonary disease and a palliative care decision (palliative goal of therapy), who were treated in Tampere University Hospital, Finland, between January 1, 2018 and December 31, 2020. Results A total of 107 patients were included in the study, 62 (58%) had chronic obstructive pulmonary disease (COPD), and 43 (40%) interstitial lung disease (ILD). Median survival after palliative care decision was shorter in patients with ILD than in patients with COPD (59 vs. 213 days, p = 0.004). Involvement of a palliative care specialist in the decision making was not associated with the survival. Patients with COPD who received palliative care consultation visited less often emergency room (73% vs. 100%, p = 0.019) and spent fewer days in the hospital (7 vs. 18 days, p = 0.007) during the last year of life. When a palliative care specialist attended the decision making, the presence and opinions of the patients were recorded more often, and the patients were more frequently referred to a palliative care pathway. Conclusions Specialist palliative care consultation seems to enable better end-of-life care and supports shared decision making for patients with nonmalignant pulmonary diseases. Therefore, palliative care consultations should be utilized in nonmalignant pulmonary diseases preferably before the last days of life.
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Affiliation(s)
- Hanna Pihlaja
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
- Address correspondence to: Hanna Pihlaja, MD, TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Building, Arvo Ylpön katu 34, Tampere 33520, Finland.
| | - Heidi Rantala
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Sirpa Leivo-Korpela
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Geriatrics, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Juho T. Lehto
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Reetta P. Piili
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
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Yamanaka T, Kidana K, Yamaguchi Y, Hirahara S, Hirakawa Y, Mizuki M, Arai H, Akishita M, Miura H. Palliative home care for older patients with respiratory disease in Japan: Practices and opinions of physicians. Geriatr Gerontol Int 2022; 22:943-949. [PMID: 36190740 DOI: 10.1111/ggi.14487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022]
Abstract
AIM Older adults at the end-of-life stage receiving home visits from physicians often experience symptoms such as dyspnea, pain and fatigue, among others. This study aimed to investigate the practices and opinions of physicians providing home visits regarding palliative care for older adults with respiratory symptoms due to non-malignant diseases in Japan. METHODS A nationwide questionnaire survey on home palliative care for non-cancer chronic respiratory diseases was sent to 2988 home-care physicians in 2020 through postal mail and/or email. The questions focused on their background, their use of rating scales to evaluate the intensity of dyspnea, and their practices and opinions regarding home palliative care for respiratory diseases or symptoms. RESULTS Valid responses were collected from 592 physicians (19.8%). A total of 251 participants (43.1%) used a rating scale to evaluate the intensity of dyspnea. While 87.8%, 86.6%, 67.3%, and 60.0% of physicians considered pulmonary rehabilitation, morphine, sedative medications, and non-invasive positive pressure ventilation (NPPV), respectively, as effective in relieving respiratory distress, 73.0%, 66.9%, 57.3%, and 55.2% of those physicians, respectively, used each modality to relieve respiratory distress. Frequently involved physicians in the aforementioned care prescribed morphine or sedative medications and used NPPV more frequently. CONCLUSIONS This study found a discrepancy between the proportion of physicians who considered palliative care as effective and those who prescribed it. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiwami Kidana
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Yamaguchi
- Department of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Satoshi Hirahara
- Tokyo Fureai Medical Co-op Research and Education Center, Tokyo, Japan
| | | | - Maiko Mizuki
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu, Japan
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Isenberg SR, Meaney C, May P, Tanuseputro P, Quinn K, Qureshi D, Saunders S, Webber C, Seow H, Downar J, Smith TJ, Husain A, Lawlor PG, Fowler R, Lachance J, McGrail K, Hsu AT. The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015. BMC Health Serv Res 2021; 21:331. [PMID: 33849539 PMCID: PMC8045222 DOI: 10.1186/s12913-021-06335-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. Methods Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. Results There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). Conclusions Increased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06335-1.
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Affiliation(s)
- Sarina R Isenberg
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Peter Tanuseputro
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kieran Quinn
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Division of Internal Medicine, Sinai Health, Toronto, Canada
| | - Danial Qureshi
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Colleen Webber
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Canada
| | - James Downar
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Thomas J Smith
- Department of Medicine, Johns Hopkins Hospital and Health System, Baltimore, USA.,Department of Oncology, Johns Hopkins Hospital and Health System, Baltimore, USA
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada
| | - Peter G Lawlor
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Rob Fowler
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Tory Trauma Program, Sunnybrook Hospital, Toronto, Canada
| | - Julie Lachance
- End-of-Life Care Unit, Strategic Policy Branch, Health Canada, Ottawa, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Amy T Hsu
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
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Philip J, Collins A, Smallwood N, Chang YK, Mo L, Yang IA, Corte T, McDonald CF, Hui D. Referral criteria to palliative care for patients with respiratory disease: a systematic review. Eur Respir J 2021; 58:13993003.04307-2020. [PMID: 33737407 DOI: 10.1183/13993003.04307-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Advanced non-malignant respiratory diseases are associated with significant patient morbidity, yet access to palliative care occurs late, if at all. AIM To examine referral criteria for palliative care among patients with advanced non-malignant respiratory disease, with a view to developing a standardised set of referral criteria. DESIGN Systematic review of all studies reporting on referral criteria to palliative care in advanced non-malignant respiratory disease, with a focus on chronic obstructive pulmonary disease and interstitial lung disease. DATA SOURCES A systematic review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline was undertaken using electronic databases (Ovid, MEDLINE, Ovid Embase, and PubMed). RESULTS Searches yielded 2052 unique titles, which were screened for eligibility resulting in 62 studies addressing referral criteria to palliative care in advanced non-malignant respiratory disease. Of 18 categories put forward for referral to palliative care, the most commonly discussed factors were hospital use (69% of papers), indicators of poor respiratory status (47%), physical and emotional symptoms (37%), functional decline (29%), need for advanced respiratory therapies (27%), and disease progression (26%). CONCLUSION Clinicians consider referral to specialist palliative care for a wide range of disease- and needs-based criteria. Our findings highlight the need to standardise palliative care access by developing consensus referral criteria for patients with advanced non-malignant respiratory illnesses.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Parkville, Australia .,Palliative Care Service, St Vincent's Hospital, Fitzroy, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Natasha Smallwood
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Li Mo
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA.,The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tamera Corte
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, Australia.,Centre of Research Excellence for Pulmonary Fibrosis, National Health and Medical Research Council, New South Wales, Australia
| | - Christine F McDonald
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
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