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Cassel JB. What does "palliative care" represent in research using secondary data? J Pain Symptom Manage 2024:S0885-3924(24)00861-3. [PMID: 39032677 DOI: 10.1016/j.jpainsymman.2024.07.011] [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: 05/07/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
While much research has been done regarding "palliative care" using retrospective cohort studies of large datasets, the data sources may not be capturing specialty palliative care services. This article aims to clarify what source data are used in such studies, how specialty palliative care services are determined to have been provided or not, and mismatches between the nature of the data and the interpretation of researchers. Major US data sources that are examined include cancer registries such as the National Cancer Database; health systems' internal data; state and nation-level hospital admissions data; and claims data from Medicare and commercial payers. Problematic studies are common. Many used cancer registry data and mischaracterized palliative intent for a given cancer treatment as "palliative care services." Dozens relied on the diagnosis code for "encounter for palliative care" which lacks adequate validity for use in research. Researchers, peer-reviewers, and research consumers are cautioned about these potential pitfalls that lead to meaningless or misleading research papers. Suggestions are made regarding more rigorous methods and trustworthy data sources and additional research that can lead to consensus among researchers on these issues.
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Affiliation(s)
- J Brian Cassel
- Virginia Commonwealth University School of Medicine, 1101 E. Marshall Street, Suite 6030, Box 980230, Richmond VA USA.
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2
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Siech C, Baudo A, de Angelis M, Jannello LMI, Di Bello F, Goyal JA, Tian Z, Saad F, Shariat SF, Longo N, Carmignani L, de Cobelli O, Briganti A, Banek S, Mandel P, Kluth LA, Chun FKH, Karakiewicz PI. Use of inpatient palliative care in metastatic urethral cancer. Urol Oncol 2024; 42:221.e17-221.e22. [PMID: 38627106 DOI: 10.1016/j.urolonc.2024.03.019] [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: 02/02/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND In metastatic urethral cancer, temporal trends, and patterns of inpatient palliative care (IPC) use are unknown. METHODS Relying on the National Inpatient Sample (2006-2019), metastatic urethral cancer patients were stratified according to IPC use. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models (LRM) for the prediction of IPC use were fitted. RESULTS Of 1,106 metastatic urethral cancer patients, 199 (18%) received IPC. IPC use increased from 5.8 to 28.0% over time in the overall cohort (EAPC +9.8%; P < 0.001), from <12.5 to 35.1% (EAPC +11.2%; P < 0.001), and from <12.5 to 24.7% (EAPC +9.4%; P = 0.01) in respectively females and males. Lowest IPC rates were recorded in the Midwest (13.5%) vs. highest in the South (22.5%). IPC patients were more frequently female (44 vs. 37%), and more frequently exhibited bone metastases (45 vs. 34%). In multivariable LRM, female sex (multivariable odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05-2.02; P = 0.02), and bone metastases (OR 1.46, 95%CI 1.02-2.10; P = 0.04) independently predicted higher IPC rates. Conversely, hospitalization in the Midwest (OR 0.53, 95%CI 0.31-0.91; P = 0.02), and in the Northeast (OR 0.48, 95%CI 0.28-0.82; P = 0.01) were both associated with lower IPC use than hospitalization in the West. CONCLUSION IPC use in metastatic urethral cancer increased from a marginal rate of 5.8% to as high as 28%. Ideally, differences according to sex, metastatic site, and region should be addressed to improve IPC use rates.
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Affiliation(s)
- Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Francesco Di Bello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Séverine Banek
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Philipp Mandel
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Luis A Kluth
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Felix K H Chun
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Ting J, Songer K, Bailey V, Rotman C, Lipsitz S, Rosenberg AR, Delgado-Corcoran C, Moynihan KM. Impact of Subspecialty Pediatric Palliative Care on Children with Heart Disease; A Systematic Review and Meta-analysis. Pediatr Cardiol 2024:10.1007/s00246-024-03535-4. [PMID: 38907871 DOI: 10.1007/s00246-024-03535-4] [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: 03/16/2024] [Accepted: 05/23/2024] [Indexed: 06/24/2024]
Abstract
While many experts in pediatric cardiology have emphasized the importance of palliative care involvement, very few studies have assessed the influence of specialty pediatric palliative care (SPPC) involvement for children with heart disease. We conducted a systematic review using keywords related to palliative care, quality of life and care-satisfaction, and heart disease. We searched PubMed, EMBASE, CINAHL, CENTRAL and Web of Science in December 2023. Screening, data extraction and methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Pairs of trained reviewers independently evaluated each article. All full texts excluded from the review were hand-screened for eligible references including systematic reviews in general pediatric populations. Two reviewers independently extracted: (1) study design; (2) methodology; (2) setting; (3) population; (4) intervention/exposure and control definition; (5) outcome measures; and (6) results. Of 4059 studies screened, 9 met inclusion criteria including two with overlapping patient data. Study designs were heterogenous, including only one randomized control and two historical control trials with SPPC as a prospective intervention. Overall, there was moderate to high risk of bias. Seven were single centers studies. In combined estimates, patients who received SPPC were more likely to have advance care planning documented (RR 2.7, [95%CI 1.6, 4.7], p < 0.001) and resuscitation limits (RR 4.0, [2.0, 8.1], p < 0.001), while half as likely to have active resuscitation at end-of-life ([0.3, 0.9], p = 0.032). For parental stress, receipt of SPPC improved scores by almost half a standard deviation (RR 0.48, 95%CI 0.10, 0.86) more than controls. Ultimately, we identified a paucity of high-quality data studying the influence of SPPC; however, findings correlate with literature in other pediatric populations. Findings suggest benefits of SPPC integration for patients with heart disease and their families.
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Affiliation(s)
- James Ting
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn Songer
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Valerie Bailey
- Department of Cardiology, Boston Children's Hospital, MS BCH3215, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Chloe Rotman
- Medical Library, Boston Children's Hospital, Boston, MA, USA
| | - Stuart Lipsitz
- Department of General Internal Medicine and Primary Care, Center for Patient Safety, Research, and Practice, Brigham and Women's Hospital, Boston, MA, USA
| | - Abby R Rosenberg
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | | | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, MS BCH3215, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Heitner R, Chambers B, Silvers A, Bowman B, Johnson KS. "Palliative Care" as an Outcome Measure and Its Impact on Our Interpretation of Racial Disparities. J Pain Symptom Manage 2024; 67:e114-e116. [PMID: 37827453 DOI: 10.1016/j.jpainsymman.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Rachael Heitner
- Center to Advance Palliative Care at the Brookdale Department of Geriatrics and Palliative Medicine (R.H., B.C., A.S., B.B.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Geriatrics (K.S.J.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Geriatrics Research Education and Clinical Center (K.S.J.), Veteran Affairs Health System, Durham, North Carolina, USA.
| | - Brittany Chambers
- Center to Advance Palliative Care at the Brookdale Department of Geriatrics and Palliative Medicine (R.H., B.C., A.S., B.B.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Geriatrics (K.S.J.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Geriatrics Research Education and Clinical Center (K.S.J.), Veteran Affairs Health System, Durham, North Carolina, USA
| | - Allison Silvers
- Center to Advance Palliative Care at the Brookdale Department of Geriatrics and Palliative Medicine (R.H., B.C., A.S., B.B.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Geriatrics (K.S.J.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Geriatrics Research Education and Clinical Center (K.S.J.), Veteran Affairs Health System, Durham, North Carolina, USA
| | - Brynn Bowman
- Center to Advance Palliative Care at the Brookdale Department of Geriatrics and Palliative Medicine (R.H., B.C., A.S., B.B.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Geriatrics (K.S.J.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Geriatrics Research Education and Clinical Center (K.S.J.), Veteran Affairs Health System, Durham, North Carolina, USA
| | - Kimberly S Johnson
- Center to Advance Palliative Care at the Brookdale Department of Geriatrics and Palliative Medicine (R.H., B.C., A.S., B.B.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Geriatrics (K.S.J.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Geriatrics Research Education and Clinical Center (K.S.J.), Veteran Affairs Health System, Durham, North Carolina, USA
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McKee MN, Palama BK, Hall M, LaBelle JL, Bohr NL, Hoehn KS. Racial and Ethnic Differences in Inpatient Palliative Care for Pediatric Stem Cell Transplant Patients. Pediatr Crit Care Med 2022; 23:417-424. [PMID: 35190500 PMCID: PMC9203872 DOI: 10.1097/pcc.0000000000002916] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Racial/ethnic disparities in utilizing inpatient palliative care services are well documented in the adult literature. However, the impact of racial/ethnic disparities in the context of pediatric palliative care is less well understood even in high-acuity patient populations such as stem cell transplant patients. We investigated racial/ethnic differences in the utilization of inpatient palliative care consultations (IPCCs) for pediatric stem cell transplant patients. STUDY DESIGN A retrospective cohort study was conducted using the Pediatric Health Information System database. A generalized linear mixed effects model was developed to assess demographic and clinical characteristics associated with the likelihood of receiving IPCC. SETTING Thirty-eight tertiary pediatric hospitals in the United States. PATIENTS Pediatric patients undergoing stem cell transplantation for any indication from January 2017 to December 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 1,193 inpatient encounters studied, 12% (n = 143) included a palliative care consult. IPCC rates varied across hospitals with a median rate of 5.97% (interquartile range, 0.00-20.71). In multivariable analyses, Hispanic/Latinx patients were 59% less likely to receive IPCC compared with non-Hispanic White patients (odds ratio [OR], 0.41; 95% CI, 0.21-0.78). This difference persisted after adjusting for all other sociodemographic and clinical factors. In terms of the other clinical characteristics, having a malignant condition and mechanical ventilation were associated with significantly increased odds of receiving IPCC for the entire cohort (OR Malignancy: 1.93; 95% CI: 1.07-3.51; OR Mechanical Ventilation: 2.37; 95% CI: 1.36-4.13). The remainder of the variables were not found to be significantly associated with IPCC. CONCLUSIONS Racial and ethnic differences exist in the likelihood of receiving palliative care consultations among hospitalized pediatric stem cell transplant recipients. Evaluating the impact of systemic racism and social determinants on palliative care medicine as well as standardizing early integration of IPCC may potentially mitigate disparities in this population.
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Affiliation(s)
- Maya N. McKee
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Brett K. Palama
- Department of Pediatrics, University of Chicago Medicine Comer Children’s Hospital, Chicago, IL
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - James L. LaBelle
- Department of Pediatric Hematology, Oncology & Stem Cell Transplantation, University of Chicago, Comer Children’s Hospital, Chicago, IL
| | - Nicole L. Bohr
- Department of Nursing Research and EBP, University of Chicago Medical Center, Chicago, IL
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, University of Chicago Medicine, Chicago, IL
| | - K. Sarah Hoehn
- Department of Pediatric Critical Care, University of Chicago Medicine Comer Children’s Hospital
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Joo MK, Yoo JW, Mojtahedi Z, Kim P, Hwang J, Koo JS, Kang HT, Shen JJ. Ten-year trends of utilizing palliative care and palliative procedures in patients with gastric Cancer in the United States from 2009 to 2018 - a nationwide database study. BMC Health Serv Res 2022; 22:20. [PMID: 34980097 PMCID: PMC8725552 DOI: 10.1186/s12913-021-07404-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/13/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives Little is known about the current status and the changing trends of hospitalization and palliative care consultation of patients with gastric cancer in the United States. The aim of this study was to evaluate the changing trend in the number of hospitalization, palliative care consultation, and palliative procedures in the US during a recent 10-year period using a nationwide database. Methods This was a retrospective study that analyzed the National Inpatient Sample (NIS) database of 2009–2018. Patients aged more than 18 years who were diagnosed with a gastric cancer using International Classification of Diseases (ICD)-9 and 10 codes were included. Palliative care consultation included palliative care (ICD-9, V66.7; ICD-10, Z51.5) and advanced care planning (ICD-9, V69.89; ICD-10, Z71.89). Palliative procedures included percutaneous or endoscopic bypass, gastrostomy or enterostomy, dilation, drainage, nutrition, and irrigation for palliative purpose. Results and discussion A total of 86,430 patients were selected and analyzed in this study. Using a compound annual growth rate (CAGR) approach, the annual number of hospitalizations of gastric cancer patients was found to be decreased during 2009–2018 (CAGR: -0.8%, P = 0.0084), while utilization rates of palliative care and palliative procedures increased (CAGR: 9.3 and 1.6%, respectively; P < 0.0001). Multivariable regression analysis revealed that palliative care consultation was associated with reduced total hospital charges (−$34,188, P < 0.0001). Conclusion Utilization of palliative care consultation to patients with gastric cancer may reduce use of medical resources and hospital costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07404-1.
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Affiliation(s)
- Moon Kyung Joo
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA. .,Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea.
| | - Ji Won Yoo
- Department of Internal Medicine, School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zahra Mojtahedi
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA
| | - Pearl Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA
| | - Jinwook Hwang
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.,Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospita, Korea University College of Medicine, Ansan, Republic of Korea
| | - Ja Seol Koo
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.,Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospita, Korea University College of Medicine, Ansan, Republic of Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jay J Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA.
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