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Ito Suffert SC, Motke BB, Linhares AB, Vargens AF, Alano TS, Lutz AT, Boff Borges R, Bica CG, Vargas Alves RJ. Evaluation of Direct Medical Costs and Associated Factors Within the Last 30 days of Life of Hospitalized Cancer Patients. Am J Hosp Palliat Care 2023; 40:1098-1105. [PMID: 36564870 DOI: 10.1177/10499091221147906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: An estimated 9.6 million people died from cancer globally in 2018, which is a reflection of the quality of patients' end-of-life care and its costs. Aim: To estimate direct medical costs of the last 30 days of oncology patients admitted to an inpatient clinic and to evaluate factors associated with medical costs at the end of life. Design: Cost-of-illness study with data from a retrospective cohort. Setting/Participants: We included patients aged 18 and older who were diagnosed with incurable cancer and who were admitted to a tertiary hospital in Brazil between January 1, 2018 and December 31, 2019. Results: Our sample included 109 patients with an average age of 69 (61‒76). The median overall survival was 4.3 (.9‒12.9) months. The median cost per patient per day related to hospitalization was BRL 119 (73‒181)/United States dollars [USD] 21 (13‒33). The cost of medication was BRL 66 (40‒105)/USD 12 (7‒19), representing 55.46% of costs while that of materials and supplies was BRL 30 (18‒49)/USD 5 (3‒9). In the multivariate analysis, when the limitation of interventions was recorded in the medical record, the median cost is reduced by BRL 50 (USD 9) per patient per day. Conclusions: The median cost per patient per day was BRL 119 (73‒181). The recording of limitations of therapeutic interventions in the medical record was a predictor variable that influenced the final medical cost of patients, suggesting that medical practice and decision-making in end-of-life care impact costs.
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Affiliation(s)
- Soraya C Ito Suffert
- Programa de Pós Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Bruna B Motke
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
| | - Armani B Linhares
- Undergraduate Program in Medicine. Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - André F Vargens
- Undergraduate Program in Medicine. Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Tainá S Alano
- Undergraduate Program in Medicine. Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Andreas T Lutz
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
| | - Rogério Boff Borges
- Unidade de Bioestatística, Diretoria de Pesquisa, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Claudia G Bica
- Programa de Pós Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Rafael José Vargas Alves
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
- Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brasil
- National Institute for Health Technology Assessment-IATS/CNPq, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Ito Suffert SC, Campos LS, Barros N, Bica CG. Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study. Chronic Illn 2023; 19:146-156. [PMID: 34812654 DOI: 10.1177/17423953211058416] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. METHODOLOGY The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). RESULTS Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [p = 0.367]), methadone (9.60% vs. 4.39% [p = 0.247]), midazolam (43.05% vs. 47.80% [p = 0.73]), blood transfusions (31.13% vs. 24.63% [p = 0.828]), enteral feeding (56.62% vs. 38.54% [p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [p = 0.435]). CONCLUSION This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.
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Affiliation(s)
- Soraya Camargo Ito Suffert
- 117303Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pósgraduação em Patologia, Porto Alegre, RS, Brazil
| | - Luciana Silveira Campos
- Hospital Nossa Senhora da Conceição Porto Alegre - Brasil, Porto Alegre, RS, Brazil.,26706Insituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Newton Barros
- 125208Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
| | - Claudia Giuliano Bica
- Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pósgraduação em Patologia, Porto Alegre, RS, Brazil
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Domingues VN, Castro L, Monteiro MD, Cordero da Silva JA, Rego F, Rego G. Advance Directives: Knowledge of the Topic Among Psychiatrists. Front Public Health 2022; 10:822577. [PMID: 35284390 PMCID: PMC8904751 DOI: 10.3389/fpubh.2022.822577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Advance directives are becoming increasingly important as health technologies evolve. We sought to assess psychiatrists' knowledge of advance directives, as this knowledge is fundamental to the implementation and drafting of these personal documents. Methods A previously published questionnaire that evaluated the knowledge of medical professors was used. The sample, composed of psychiatrists from Rio de Janeiro, Brazil, originated from a publicly available list. During the search process, the COVID-19 pandemic affected Brazil and the rest of the world, which influenced our methodology and results. Results A total of 40 psychiatrists participated in the study. The results obtained, although not significant, suggested that psychiatrists with an increased time of practice had more knowledge of advance directives. Nevertheless, less than half of the participants had knowledge about this topic. Conclusion The number of psychiatrists surveyed indicates the need for further studies on the subject. The influence of the COVID-19 pandemic on this study led to findings such as a change in sensitivity when addressing the topic and greater difficulty in contacting professionals.
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Affiliation(s)
| | - Luísa Castro
- Faculty of Medicine, University of Porto, Porto, Portugal
| | | | | | - Francisca Rego
- Faculty of Medicine, University of Porto, Porto, Portugal
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Cordeiro FR, Dos Santos Marques R, De Oliveira Silva K, Cruz Martins M, Vestena Zillmer JG, Sant'Ana Tristão F. Educação em saúde e final de vida no hospital. AVANCES EN ENFERMERÍA 2021. [DOI: 10.15446/av.enferm.v40n1.86942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: identificar ações de educação em saúde direcionadas às pessoas em final da vida e seus cuidadores, informais e formais, no hospital, além de avaliar o nível de evidência de tais ações.
Síntese do conteúdo: o estudo foi realizado entre dezembro de 2019 e janeiro de 2020, nas bases de dados Web of Science, Scopus e MEDLINE. Identificaram-se 6.762 artigos, dos quais 42 integram a análise por serem artigos originais ou de revisão escritos em português, espanhol, inglês ou francês; a amostra dos estudos foi composta por pacientes maiores de 19 anos, com doença avançada e/ou em final de vida ou cuidadores ou profissionais de saúde. Os dados foram agrupados por similaridade do tema das ações, conforme Polit e Beck, e o nível de evidência avaliado segundo Melnyk e Fineout-Overholt. O vídeo foi a ação com maior força de recomendação, seguida por cartilhas. As unidades temáticas foram “Ações para o controle da dor”, “Narrativas sobre o final da vida”, “Planejamento de cuidados”, “Dialogando sobre os cuidados paliativos” e “Comunicação e final de vida”.
Conclusões: ações de educação em saúde no final da vida devem considerar as tecnologias da informação e da comunicação, além das condições socioculturais, clínicas e cognitivas dessa etapa do adoecimento.
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Dittborn M, Turrillas P, Maddocks M, Leniz J. Attitudes and preferences towards palliative and end of life care in patients with advanced illness and their family caregivers in Latin America: A mixed studies systematic review. Palliat Med 2021; 35:1434-1451. [PMID: 34338052 DOI: 10.1177/02692163211029514] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Achieving universal access to palliative care is considered a global and equity priority. Understanding patients and caregivers' attitudes and preferences towards palliative and end-of-life care in Latin America is essential to develop person-centred services in the region. AIM To synthesize and appraise the evidence about patients with advanced illness and their caregivers' attitudes and preferences towards palliative and end-of-life care in Latin America. DESIGN Mixed studies systematic review with sequential exploratory synthesis (thematic and narrative synthesis). Quality was assessed using the Mixed-Methods Appraisal Tool. DATA SOURCES MEDLINE, Embase, PsychINFO, Lilacs, Web of Science, Scielo and Scopus to March 2021. Empirical studies examining patient or caregiver attitudes and/or preferences towards palliative and end-of-life care were included. RESULTS Of 3575 records screened, 45 articles were included, comprising 7 countries and a total of 1220 patients and 965 caregivers (26.8% non-cancer-related participants). Data were organized around seven themes: Symptom management and nutrition; End-of-life medical decisions; Communication patterns; Place of end-of-life care and death; God and religious community as source of hope and support; Caregiver's role; and Mixed understandings of palliative care. Main findings include; conflicted views around palliative care and pain relief; patients' preference to be informed about their condition contrasting with caregivers' reluctance to discuss this with patients; common preference for shared decision-making; and overburdened caregivers lacking professional home-care support. Methodological flaws were found in general. CONCLUSION Core themes provide context-specific evidence to inform the design of culturally sensitive palliative and end-of-life care services, models and public policies in Latin America.
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Affiliation(s)
- Mariana Dittborn
- Paediatric Bioethics Centre, Great Ormond Street Hospital for Children, London, UK.,Centro de Bioética, Facultad de Medicina CAS-UDD, Santiago, Chile.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Pamela Turrillas
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Silies KT, Köpke S, Schnakenberg R. Informal caregivers and advance care planning: systematic review with qualitative meta-synthesis. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003095. [PMID: 33952583 DOI: 10.1136/bmjspcare-2021-003095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advance care planning (ACP) is a communication process about a person's values, life goals and preferences for current and future treatment and care. It can improve end-of-life care experiences for care recipients as well as for family caregivers. Knowledge about caregivers' needs might support implementation of ACP interventions suitable to both care recipients and their caregivers. OBJECTIVE To explore the experiences and attitudes of informal family caregivers, and their knowledge, regarding ACP. METHODS A systematic literature search was conducted (participants: family caregivers; intervention: advance care planning; databases: MEDLINE, PsycINFO, CINAHL, Cochrane Library). Thematic synthesis was applied to qualitative and mixed methods studies; quantitative studies were described in relation to the themes of the meta-synthesis. RESULTS 57 studies were included, of these 51 in the meta-synthesis. Three themes emerged: (1) caregiver's individual conceptualisation of ACP, (2) caregiver's relationships and (3) ACP process. These themes were incorporated into a longitudinal perspective on the caregiver's ACP trajectory, encompassing the phases (A) life before, (B) ACP process, (C) utilisation of ACP and (D) life after. The implications for ACP activities are described according to each phase. CONCLUSION For the benefit of care recipients, healthcare professionals should carefully consider caregivers' conceptualisations of ACP as well as the relationships within the family. They need to be skilled communicators, sensitive to individual needs and equipped with sufficient time resources to tailor ACP interventions to their clients' unique situation. Thus, they will support decision-making according to care recipients' wishes, caregivers' end-of-life experience and their life after bereavement. PROSPERO REGISTRATION NUMBER CRD42018082492.
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Affiliation(s)
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rieke Schnakenberg
- Department for Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Gupta A, Bahl B, Rabadi S, Mebane A, Levey R, Vasudevan V. Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions. Am J Hosp Palliat Care 2020; 38:191-198. [PMID: 33021094 DOI: 10.1177/1049909120963698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs' potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.
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Affiliation(s)
- Amol Gupta
- 24508The Brooklyn Hospital Center, NY, USA
| | | | - Saher Rabadi
- 12340University of Texas Health Sciences Center, Houston, TX, USA
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Saioron I, Ramos FRS, Schneider DG, Silveira RSD, Silveira LR. Advance directives of will: nurses' perceptions of benefits and new demands. ESCOLA ANNA NERY 2017. [DOI: 10.1590/2177-9465-ean-2017-0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: Knowing the perception of nurses about benefits and new demands brought by the Advance Directives (AD) in their daily work. Methods: Qualitative and exploratory research with data collected in 2016 through semi-structured interviews with 19 nurses from a Hospital in southern Brazil. Data analysis was given by the Discursive Textual Analysis. Results: Three categories emerged: The benefits of using ADs in nurses' daily routine; New demands for professionals related to the AD; The AD relevance for patients and their families. Conclusion: It is significant that legal, cultural and structural changes take place in order to take advantage of the ADs' benefits. It is essential to extend the access to ADs' information as part of care quality promotion regarding the terminal patients.
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