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Yip YY, Hwong WY, McCarthy SA, Hassan Chin AA, Woon YL. Duration of Referral-to-Death and its Associated Factors Among Cancer and Noncancer Patients: Retrospective Cohort Study of a Community Palliative Care Setting in Malaysia. J Palliat Care 2023; 38:111-125. [PMID: 36464769 DOI: 10.1177/08258597221143195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Addressing timely community palliative care integration is prioritized due to the increased burden of noncommunicable diseases. Objectives: To compare referral-to-death duration among palliative cancer and noncancer patients and to determine its associated factors in a Malaysian community palliative care center. Methods: This retrospective cohort study included decedents referred to a Malaysian community palliative care center between January 2017 and December 2019. Referral-to-death is the interval between the date of community palliative care referral and to date of death. Besides descriptive analyses, negative binomial regression analyses were conducted to identify factors associated with referral-to-death among both groups. Results: Of 4346 patients referred, 86.7% (n = 3766) and 13.3% (n = 580) had primary diagnoses of cancer and noncancer respectively. Median referral-to-death was 32 days (interquartile range [IQR]: 12-81) among cancer patients and 19 days (IQR: 7-78) among noncancer patients. The shortest referral-to-death among cancer patients was for liver cancer (median: 22 days; IQR: 8-58.5). Noncancer patients with dementia, heart failure, and multisystem organ failure had the shortest referral-to-death at 14 days. Among cancer patients, longer referral-to-death was associated with women compared to men (IRR: 1.26; 95% CI: 1.16-1.36) and patients 80 to 94 years old compared to those below 50 years old (IRR: 1.19; 95% CI: 1.02-1.38). Cancer patients with analgesics prescribed before or upon referral had 29% fewer palliative care days compared to no prescribing analgesics. In contrast, noncancer patients 50 to 64 years old had shorter referral-to-death compared to those below 50 years old (IRR: 0.51; 95% CI: 0.28-0.91). Conclusion: Shorter referral-to-death among noncancer patients indicated possible access inequities with delayed community palliative care integration. Factors associated with referral-to-death are considered in developing targeted approaches ensuring timely and equitable community palliative care.
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Affiliation(s)
- Yan Yee Yip
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Wen Yea Hwong
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor Darul Ehsan, Malaysia.,Julius Center for Health Sciences and Primary Care, 8124University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - Yuan Liang Woon
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor Darul Ehsan, Malaysia
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Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, Deliens L, Bennett MI. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC Med 2020; 18:368. [PMID: 33239021 PMCID: PMC7690105 DOI: 10.1186/s12916-020-01829-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Early provision of palliative care, at least 3-4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature. METHODS We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker's criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death). RESULTS One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as 'good' quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries. CONCLUSIONS Duration of palliative care is much shorter than the 3-4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.
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Affiliation(s)
- Roberta I Jordan
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Yousuf ElMokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Catriona E Jackson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Helen L Edwards
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Luc Deliens
- End-of-Life Care Research Group, Ghent University, Ghent, Belgium.,Vrije Universiteit Brussel, Brussels, Belgium
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Busquet-Duran X, Jiménez-Zafra EM, Manresa-Domínguez JM, Tura-Poma M, Bosch-delaRosa O, Moragas-Roca A, Galera Padilla MC, Martin Moreno S, Martínez-Losada E, Crespo-Ramírez S, López-Garcia AI, Torán-Monserrat P. Describing Complexity in Palliative Home Care Through HexCom: A Cross-Sectional, Multicenter Study. J Multidiscip Healthc 2020; 13:297-308. [PMID: 32256078 PMCID: PMC7090197 DOI: 10.2147/jmdh.s240835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Complexity has become a core issue in caring for patients with advanced disease and/or at the end-of-life. The Hexagon of Complexity (HexCom) is a complexity assessment model in the process of validation in health-care settings. Our objective is to use the instrument to describe differences in complexity across disease groups in specific home care for advanced disease and/or at the end-of-life patients, both in general and as relates to each domain and subdomain. METHODS Cross-sectional study of home care was conducted in Catalonia. The instrument includes 6 domains of needs (clinical, psychological/emotional, social/family, spiritual, ethical, and death-related), 4 domains of resources (intrapersonal, interpersonal, transpersonal, and practical), and 3 levels of complexity (High (H), Moderate (M), and Low (L)). Interdisciplinary home care teams assessed and agreed on the level of complexity for each patient. RESULTS Forty-three teams participated (74.1% of those invited). A total of 832 patients were assessed, 61.4% of which were cancer patients. Moderate complexity was observed in 385 (47.0%) cases and high complexity in 347 (42.4%). The median complexity score was 51 for cancer patients and 23 for patients with dementia (p<0.001). We observed the highest level of complexity in the social/family domain. Patients/families most frequently used interpersonal resources (80.5%). CONCLUSIONS This study sheds light on the high-intensity work of support teams, the importance of the social/family domain and planning the place of death, substantial differences in needs and resources across disease groups, and the importance of relationship wellbeing at the end-of-life.
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Affiliation(s)
- Xavier Busquet-Duran
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
- Multidisciplinary Research Group on Health and Society (GREMSAS), Barcelona, Spain
- Department of Nursing, University Foundation of Bages (FUB), University of Vic. Central University of Catalunya, Barcelona, Spain
| | - Eva Maria Jiménez-Zafra
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
| | - Josep Maria Manresa-Domínguez
- Multidisciplinary Research Group on Health and Society (GREMSAS), Barcelona, Spain
- Metropolitan Nord Unit of Research Support, University Institute of Research in Primary Care (IDIAP) Jordi Gol, Barcelona, Spain
- Department of Nursing, Autonomous University of Barcelona, Barcelona, Spain
| | - Magda Tura-Poma
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
| | | | - Anna Moragas-Roca
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
| | - Maria Concepción Galera Padilla
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
| | - Susana Martin Moreno
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
| | - Emilio Martínez-Losada
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
| | | | - Ana Isabel López-Garcia
- Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain
| | - Pere Torán-Monserrat
- Multidisciplinary Research Group on Health and Society (GREMSAS), Barcelona, Spain
- Metropolitan Nord Unit of Research Support, University Institute of Research in Primary Care (IDIAP) Jordi Gol, Barcelona, Spain
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Nabal M, Bescos M, Barcons M, Torrubia P, Trujillano J, Requena A. New symptom-based predictive tool for survival at seven and thirty days developed by palliative home care teams. J Palliat Med 2014; 17:1158-63. [PMID: 24922117 DOI: 10.1089/jpm.2013.0630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM This study sought to develop models to predict survival at 7 and 30 days based on symptoms detected by palliative home care teams (PHCTs). MATERIALS AND METHODS This prospective analytic study included a 6-month recruitment period with patient monitoring until death or 180 days after recruitment. The inclusion criteria consisted of age greater than 18 years, advanced cancer, and treatment provided by participating PHCTs between April and July 2009. The study variables included death at 7 or 30 days, survival time, age, gender, place of residence, type of tumor and extension, presence of 11 signs and symptoms measured with a 0-3 Likert scale, functional and cognitive status, and use of a subcutaneous butterfly needle. The statistics applied included a descriptive analysis according to the percentage or mean±standard deviation. For symptom comparison between surviving and nonsurviving patients, the χ(2) test was used. Classification and regression tree (CART) methodology was used for model development. An internal validation system (cross-validation with 10 partitions) was used to ensure generalization of the models. The area under the receiver operating characteristics (ROC) curve was calculated (with a 95% confidence interval) to assess the validation of the models. RESULTS A total of 698 patients were included. The mean age of the patients was 73.7±12 years, and 60.3% were male. The most frequent type of neoplasm was digestive (37.6%). The mean Karnofsky score was 51.8±14, the patients' cognitive status according to the Pfeiffer test was 2.6±4 errors, and 8.3% of patients required a subcutaneous butterfly needle. Each model provided 8 decision rules with a probability assignment range between 2.2% and 99.1%. The model used to predict the probability of death at 7 days included the presence of anorexia and dysphagia and the level of consciousness, and this model produced areas under the curve (AUCs) of 0.88 (0.86-0.90) and 0.81 (0.79-0.83). The model used to predict the probability of death at 30 days included the presence of asthenia and anorexia and the level of consciousness, and this model produced AUCs of 0.78 (0.77-0.80) and 0.77 (0.75-0.79). CONCLUSION For patients with advanced cancer treated by PHCTs, the use of classification schemes and decision trees based on specific symptoms can help clinicians predict survival at 7 and 30 days.
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Affiliation(s)
- Maria Nabal
- 1 Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova , Lleida, Institut Català de la Salut, IRB Lleida, Spain
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