Patient-reported distress as an early warning sign of unmet palliative care needs and increased healthcare utilization in patients with advanced cancer

2022 ◽  
Author(s):  
Jordan D. Hildenbrand ◽  
Hee S. Park ◽  
David J. Casarett ◽  
Cheyenne Corbett ◽  
Alicia M. Ellis ◽  
...  
Keyword(s):  
Palliative Care ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Early Warning ◽  
Warning Sign ◽  
Care Needs ◽  
Early Warning Sign ◽  
Patient Reported ◽  
Palliative Care Needs

scholarly journals Integration of Oncology and Palliation Benefits Patients with Advanced Cancer and Unmet Needs: A Prospective Observational Study

2021 ◽  
Author(s):  
Asta Bye ◽  
Ellen Bjerkeset ◽  
Hanne Stensheim ◽  
Jon Håvard Loge ◽  
Marianne Jensen Hjermstad ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
Bone Metastases ◽  
Advanced Cancer ◽  
Intervention Group ◽  
Care Needs ◽  
Karnofsky Score ◽  
Patient Reported ◽  
Study Team ◽  
Palliative Care Needs

Abstract Background: Patients with advanced cancer and bone metastases may have unmet palliative care needs that go unnoticed during clinical oncological practice. This observational study describes palliative care needs and interventions identified because of participation in a clinical study. Methods: Patients with advanced cancer and painful bone metastases included in the Palliative Radiotherapy and Inflammation Study (PRAIS) aiming to predict the response of radiotherapy (RT) were eligible. All patients met with the palliative care (PC) study team prior to start of RT, after they had completed patient reported outcome measures (PROMs). Symptoms prompting interventions by the study team were documented in the patient charts and reviewed.Results: One hundred-and thirty-three patients were reviewed; 63% males, mean age 65 and mean Karnofsky score (KPS) 73. Interventions were initiated in 50% (n=67) of the patients. Most common were changed opioid management (69%), treatment of constipation (43%) and nausea (24%) and nutritional advices (21%). Patients receiving interventions had lower mean KPS (70 vs 77 p <0.001), shorter survival time after study inclusion (median 28 vs. 57.5 weeks p = 0.005) and were more often opioid naïve (12% vs 39% p <.001) compared with the non-intervention group. Conclusions: Adverse symptoms are often not identified in routine oncological consultations prior to RT for cancer pain. Special attention should be directed to frail patients. These findings call for an early and systematic integration of palliative care in patients with advanced cancer.Trial registration: ClinicalTrials.gov NCT02107664

Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

2021 ◽  
pp. 104990912110178
Author(s):  
Abigail Sy Chan ◽  
Amit Rout ◽  
Christopher R. D.’Adamo ◽  
Irina Lev ◽  
Amy Yu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Length Of Hospital Stay ◽  
Inpatient Setting ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Early Palliative Care ◽  
Code Status ◽  
Palliative Care Needs

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

scholarly journals Palliative Care Needs of Advanced Cancer Patients in the Emergency Department (S767)

2018 ◽  
Vol 55 (2) ◽  
pp. 693
Author(s):  
Isabelle Marcelin ◽  
Caroline McNaughton ◽  
Nicole Tang ◽  
Jeffrey Caterino ◽  
Corita Grudzen
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Palliative Care Needs

Palliative referrals in advanced cancer patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12102-12102
Author(s):  
Abigail Sy Chan ◽  
Amit Rout ◽  
Irina Lev ◽  
Amy Yu ◽  
Chris D'Adamo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Hospice Care ◽  
Inpatient Setting ◽  
Care Needs ◽  
Clinical Indicators ◽  
Code Status ◽  
Palliative Care Needs

12102 Backgroun1d: Timely identification of palliative care needs have the ability to reduce hospitalizations and improve QOL. The Supportive & Palliative Care Indicators Tool (SPICT) is used to identify patients with advanced stage medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting and has been validated to assess 24-hour mortality risk. We used SPICT and RI in cancer patients admitted to the hospital and evaluated their roles in recognizing early palliative care needs and 6-month mortality. Methods: Advanced/metastatic cancer patients admitted to our institution from Jan 1, 2019 to June 30, 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), comorbidities, palliative/hospice care referrals, vital status, initial RI score, and computed SPICT scores were obtained. Worse clinical indicators were defined as SPICT positive if it met > 2 clinical indicators or RI < 60. Univariate and bivariate analyses were performed. Results: A total of 227 patients were included, mean age 68, 34% Caucasians, 63% Blacks, 59% female, median comorbidities of 3, with majority having lung and GI malignancies. A total of 137 (60%) were SPICT +, 47 (21%) had RI < 60, and 38 (17%) concurrent SPICT + and RI < 60. SPICT + patients were more likely to have longer hospital stay, change in code status, more palliative/hospice referrals, and increased mortality. Those with RI < 60 had similar results (Table). SPICT + patients are more likely to have RI < 60 (p = 0.0013). Conclusions: SPICT and RI are valuable tools in predicting 6-month mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer. [Table: see text]

Dying Fit or Not—Physical Activity as Antidote to Death?

2020 ◽  
pp. 003022282091371
Author(s):  
Hanne Bess Boelsbjerg ◽  
Stinne Glasdam
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Palliative Care ◽  
Field Study ◽  
Advanced Cancer ◽  
Health Care Professionals ◽  
Care Needs ◽  
Palliative Care Needs ◽  
Empirical Material

Physical activity has increasingly gained attention within palliative care. This article aims to explore how the idea of physical activity influences patients with advanced cancer and health-care professionals’ interactions. The empirical material was gathered as part of an anthropological field study about palliative care needs among 16 patients with advanced cancer, consisting of observations and interviews with patients, relatives, and professionals. Two of the patient cases were analyzed, inspired by Goffman’s theory, showing how patients and health-care professionals interact in relation to physical activity. The findings show that patients played roles either embracing physical activity or distancing it by postponement. Professionals played expert roles of duty and attachment, stressing the importance of physical activity. Thus, they accepted a minimum of physical activity when patients were close to death. Professionals regarded patients’ absence of physical activity as a lack of desire to live; patients regard it as a way to live.

Identification of Patient-Reported Outcome Phenotypes Among Oncology Patients With Palliative Care Needs

2021 ◽  
pp. OP.20.00849
Author(s):  
Tara L. Kaufmann ◽  
Kelly D. Getz ◽  
Jesse Y. Hsu ◽  
Antonia V. Bennett ◽  
Samuel U. Takvorian ◽  
...  
Keyword(s):  
Palliative Care ◽  
Latent Profile Analysis ◽  
Clinical Care ◽  
Patient Reported Outcome ◽  
Assessment System ◽  
Moderate Pain ◽  
Care Needs ◽  
Oncology Patients ◽  
Patient Reported ◽  
Palliative Care Needs

PURPOSE: Despite evidence-based guidelines recommending early palliative care, it remains unclear how to identify and refer oncology patients, particularly in settings with constrained access to palliative care. We hypothesize that patient-reported outcome (PRO) data can be used to characterize patients with palliative care needs. To determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral. METHODS: We conducted a retrospective study of self-reported symptoms on the Edmonton Symptom Assessment System collected from solid tumor oncology patients (n = 745) referred to outpatient palliative care. Data were collected as part of routine clinical care from October 2012 to March 2018 at eight community and academic sites. We applied latent profile analysis to identify PRO phenotypes and examined the association of phenotypes with clinical and demographic characteristics using multinomial logistic regression. RESULTS: We identified four PRO phenotypes: (1) Low Symptoms (n = 295, 39.6%), (2) Moderate Pain/Fatigue + Mood (n = 180, 24.2%), (3) Moderate Pain/Fatigue + Appetite + Dyspnea (n = 201, 27.0%), and (4) High Symptoms (n = 69, 9.3%). In a secondary analysis of 421 patients, we found that two brief items assessing social and existential needs aligned with higher severity symptom and psychological distress phenotypes. CONCLUSION: Oncology patients referred to outpatient palliative care in a real-world setting can be differentiated into clinically meaningful phenotypes using brief, routinely collected PRO measures. Latent modeling provides a mechanism to use patient-reported data on a population level to identify distinct subgroups of patients with unmet palliative needs.

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