scholarly journals Factors related to specialized palliative care use and aggressive care at end of life in Japanese patients with advanced solid cancers: a cohort study

2021 ◽  
Author(s):  
Yusuke Hiratsuka ◽  
Takayuki Oishi ◽  
Mitsunori Miyashita ◽  
Tatsuya Morita ◽  
Jennifer W. Mack ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Japanese Patients ◽  
Specialized Palliative Care ◽  
Aggressive Care

scholarly journals Factors Related to Specialized Palliative Care Use and Aggressive Care at End of Life in Japanese Patients With Advanced Solid Cancers: A Cohort Study

2021 ◽  
Author(s):  
Yusuke Hiratsuka ◽  
Takayuki Oishi ◽  
Mitsunori Miyashita ◽  
Tatusya Morita ◽  
Jennifer W Mack ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Advanced Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Japanese Patients ◽  
University Hospital ◽  
Younger Age ◽  
Specialized Palliative Care ◽  
Aggressive Care

Abstract Purpose:This study aimed to identify factors associated with specialized palliative care (SPC) use and aggressive care at the end of life (EOL) among Japanese patients with advanced cancer. Methods:This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death.Results:We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20–59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30–12.91; p=0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07–17.37; p=0.04) were associated with chemotherapy in the last month before death.Conclusion:Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC.

Is specialized palliative cancer care associated with use of antineoplastic treatment at the end of life? A population-based cohort study

2018 ◽  
Vol 32 (9) ◽  
pp. 1509-1517 ◽  
Author(s):  
Kirstine Skov Benthien ◽  
Mathilde Adsersen ◽  
Morten Aagaard Petersen ◽  
Eva Soelberg Vadstrup ◽  
Per Sjøgren ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Female Gender ◽  
Population Based ◽  
Hospital Units ◽  
Hematological Cancers ◽  
Specialized Palliative Care ◽  
Antineoplastic Treatment ◽  
Breast And Prostate Cancer

Background: The use of chemotherapy in the last 14 days of life should be as low as possible. Aim: To study the factors related to the use of chemotherapy in the last 14 days of life and the factors related to concurrent antineoplastic treatment and specialized palliative care. Design: This was a population-based cohort study. The data were collected from the Danish Register of Causes of Death, the Danish National Patient Register, and the Danish Palliative Care Database. Analyses were descriptive and multivariate logistic regression. Setting/participants: Cancer decedents between 2010 and 2013 in the Capital Region of Denmark. Results: During the study period, 17,246 individuals died of cancer and 33% received specialized palliative care. In the last 14 days of life, 4.2% received chemotherapy. Younger patients and patients with hematological cancers were more likely to receive chemotherapy in the last 14 days of life. Receiving specialized palliative care was associated with a lower risk of receiving chemotherapy in the last 14 days of life—odds ratio 0.15 for hospices and 0.53 for palliative hospital units. A total of 8% of the population received concurrent antineoplastic treatment and specialized palliative care. Female gender, younger age, and breast and prostate cancer were significantly associated with this concurrent model. Conclusion: Overall, the incidence of antineoplastic treatment in the last 14 days of life was low compared to other studies. Patients in specialized palliative care had a reduced risk of receiving chemotherapy at the end of life.

scholarly journals Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
C. Lees ◽  
S. Weerasinghe ◽  
N. Lamond ◽  
T. Younis ◽  
Ravi Ramjeesingh
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Potential Effect ◽  
Unresectable Pancreatic Cancer ◽  
Palliative Care Consultation ◽  
Integral Role ◽  
Care Consultation ◽  
Aggressive Care ◽  
Key Indicators

Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.

Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

2020 ◽  
Vol 34 (10) ◽  
pp. 1393-1401
Author(s):  
Luke Mondor ◽  
Walter P Wodchis ◽  
Peter Tanuseputro
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Terminal Illness ◽  
Home Visits ◽  
Population Based ◽  
Relative Index ◽  
Deprived Neighbourhoods ◽  
Location Of Death ◽  
Index Of Inequality

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

Inequalities in end-of-life palliative care by country of birth in New South Wales, Australia: a cohort study

2020 ◽  
Author(s):  
Holger Möller ◽  
Hassan Assareh ◽  
Joanne M. Stubbs ◽  
Bin Jalaludin ◽  
Helen M. Achat
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
New South ◽  
New South Wales ◽  
Country Of Birth ◽  
South Wales

The influence of care place and diagnosis on care communication at the end of life: bereaved family members’ perspective

2021 ◽  
pp. 1-8
Author(s):  
Anna O'Sullivan ◽  
Anette Alvariza ◽  
Joakim Öhlén ◽  
Cecilia Larsdotter ex. Håkanson
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Nursing Home ◽  
End Of Life ◽  
Family Members ◽  
Palliative Care Unit ◽  
Deceased Person ◽  
Specialized Palliative Care ◽  
Bereaved Family ◽  
At Home

Abstract Objective To investigate the influence of care place and diagnosis on care communication during the last 3 months of life for people with advanced illness, from the bereaved family members’ perspective. Method A retrospective survey design using the VOICES(SF) questionnaire with a sample of 485 bereaved family members (aged: 20−90 years old, 70% women) of people who died in hospital was employed to meet the study aim. Results Of the deceased people, 79.2% had at some point received care at home, provided by general practitioners (GPs) (52%), district nurses (36.7%), or specialized palliative home care (17.9%), 27.4% were cared for in a nursing home and 15.7% in a specialized palliative care unit. The likelihood of bereaved family members reporting that the deceased person was treated with dignity and respect by the staff was lowest in nursing homes (OR: 0.21) and for GPs (OR: 0.37). A cancer diagnosis (OR: 2.36) or if cared for at home (OR: 2.17) increased the likelihood of bereaved family members reporting that the deceased person had been involved in decision making regarding care and less likely if cared for in a specialized palliative care unit (OR: 0.41). The likelihood of reports of unwanted decisions about the care was higher if cared for in a nursing home (OR: 1.85) or if the deceased person had a higher education (OR: 2.40). Significance of results This study confirms previous research about potential inequalities in care at the end of life. The place of care and diagnosis influenced the bereaved family members’ reports on whether the deceased person was treated with respect and dignity and how involved the deceased person was in decision making regarding care.

Aggressive care at the end of life: A study of practice based factors in patients with stage IV cancer.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 80-80
Author(s):  
Mohammad Omar Atiq ◽  
Rahul Ravilla ◽  
Ajay Kumar ◽  
Sajjad Haider ◽  
Ji-Ling Tang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Cancer Patients ◽  
Stage Iv ◽  
Goals Of Care ◽  
Significant Difference ◽  
Aggressive Care ◽  
Stage Iv Cancer ◽  
End Stage

80 Background: Numerous studies established that early utilization of palliative care-hospice services are beneficial to cancer patients. To reduce the incidence of aggressive care in terminal cancer patients, we conducted a quality improvement study to identify pertinent risk factors and develop interventions. Methods: Through chart review, we retrospectively identified patients with stage IV cancer that were followed by oncology clinic and were admitted to the University Hospital between 8/1/2015-10/31/15. For those patients who died during the last hospitalization or were discharged to hospice care, we obtained demographic, cancer related and practice related variables listed in Table. We used Mann Whitney U test and multivariable regression to find effects of factors related to length of stay (LOS) and cost of stay (COS). Results: Length of stay was significantly prolonged in those receiving chemotherapy within the past month (6 vs 3 p=0.035). Multivariate analyses found that patients with goals of care documented in the clinic had lower COS by 36.7% and LOS by 46.7%. On average, an ICU stay resulted in COS 2.2 times higher. No significant difference was seen in LOS based on a documented palliative care clinic visit or presence of an advanced directive. Conclusions: We identified practice based factors that need improvement including earlier goals of care conversations and less chemotherapy at the end of life. Identifying end stage patients in earlier admissions, collaborating with palliative care, and adding goals of care documentation to clinic note templates, are all interventions we are studying to improve care for end stage cancer patients. [Table: see text]

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