scholarly journals The End-of-Life Experience of Patients with Cystic Fibrosis and the Role of Pediatric Palliative Care Consultation (S800)

2016 ◽  
Vol 51 (2) ◽  
pp. 463
Author(s):  
Elliot Rabinowitz ◽  
Gregory Sawicki ◽  
Christina Ullrich
Keyword(s):  
Cystic Fibrosis ◽  
Palliative Care ◽  
End Of Life ◽  
Life Experience ◽  
Pediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

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.

scholarly journals Effect of Palliative Care on Aggressiveness of End-of-Life Care Among Patients With Advanced Cancer

2017 ◽  
Vol 13 (9) ◽  
pp. e760-e769 ◽  
Author(s):  
Daniel P. Triplett ◽  
Wendi G. LeBrett ◽  
Alex K. Bryant ◽  
Andrew R. Bruggeman ◽  
Rayna K. Matsuno ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Health Care Use ◽  
Medicare Beneficiaries ◽  
Invasive Procedures ◽  
Chemotherapy Administration ◽  
Palliative Care Consultation ◽  
Care Consultation

Purpose: Palliative care’s role in oncology has expanded, but its effect on aggressiveness of care at the end of life has not been characterized at the population level. Methods: This matched retrospective cohort study examined the effect of an encounter with palliative care on health-care use at the end of life among 6,580 Medicare beneficiaries with advanced prostate, breast, lung, or colorectal cancer. We compared health-care use before and after palliative care consultation to a matched nonpalliative care cohort. Results: The palliative care cohort had higher rates of health-care use in the 30 days before palliative care consultation compared with the nonpalliative cohort, with higher rates of hospitalization (risk ratio [RR], 3.33; 95% CI, 2.87 to 3.85), invasive procedures (RR, 1.75; 95% CI, 1.62 to 1.88), and chemotherapy administration (RR, 1.61; 95% CI, 1.45 to 1.78). The opposite pattern emerged in the interval from palliative care consultation through death, where the palliative care cohort had lower rates of hospitalization (RR, 0.53; 95% CI, 0.44-0.65), invasive procedures (RR, 0.52; 95% CI, 0.45 to 0.59), and chemotherapy administration (RR, 0.46; 95% CI, 0.39 to 0.53). Patients with earlier palliative care consultation in their disease course had larger absolute reductions in health-care use compared with those with palliative care consultation closer to the end of life. Conclusion: This population-based study found that palliative care substantially decreased health-care use among Medicare beneficiaries with advanced cancer. Given the increasing number of elderly patients with advanced cancer, this study emphasizes the importance of early integration of palliative care alongside standard oncologic care.

mHOMR: a feasibility study of an automated system for identifying inpatients having an elevated risk of 1-year mortality

2019 ◽  
pp. bmjqs-2018-009285 ◽  
Author(s):  
Pete Wegier ◽  
Ellen Koo ◽  
Shahin Ansari ◽  
Daniel Kobewka ◽  
Erin O'Connor ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Feasibility Study ◽  
Mortality Risk ◽  
End Of Life Care ◽  
Elevated Risk ◽  
Life Care ◽  
Risk Of Death ◽  
Palliative Care Consultation ◽  
Care Consultation

ObjectiveThe need for clinical staff to reliably identify patients with a shortened life expectancy is an obstacle to improving palliative and end-of-life care. We developed and evaluated the feasibility of an automated tool to identify patients with a high risk of death in the next year to prompt treating physicians to consider a palliative approach and reduce the identification burden faced by clinical staff.MethodsTwo-phase feasibility study conducted at two quaternary healthcare facilities in Toronto, Canada. We modified the Hospitalised-patient One-year Mortality Risk (HOMR) score, which identifies patients having an elevated 1-year mortality risk, to use only data available at the time of admission. An application prompted the admitting team when patients had an elevated mortality risk and suggested a palliative approach. The incidences of goals of care discussions and/or palliative care consultation were abstracted from medical records.ResultsOur model (C-statistic=0.89) was found to be similarly accurate to the original HOMR score and identified 15.8% and 12.2% of admitted patients at Sites 1 and 2, respectively. Of 400 patients included, the most common indications for admission included a frailty condition (219, 55%), chronic organ failure (91, 23%) and cancer (78, 20%). At Site 1 (integrated notification), patients with the notification were significantly more likely to have a discussion about goals of care and/or palliative care consultation (35% vs 20%, p = 0.016). At Site 2 (electronic mail), there was no significant difference (45% vs 53%, p = 0.322).ConclusionsOur application is an accurate, feasible and timely identification tool for patients at elevated risk of death in the next year and may be effective for improving palliative and end-of-life care.

Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database

2016 ◽  
Vol 34 (7) ◽  
pp. 685-691 ◽  
Author(s):  
Motoko Sano ◽  
Kiyohide Fushimi
Keyword(s):  
Palliative Care ◽  
Elderly Patients ◽  
End Of Life ◽  
Hospital Setting ◽  
Geriatric Oncology ◽  
National Database ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern. Objective: To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database. Methods: We conducted a multicenter cohort study of patients aged ≥65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage ≥3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using χ2 and logistic regression analyses. Results: We included 26 012 patients in this analysis. The mean age was 75.74 ± 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young–old, and patients with primary cancer. Conclusion: Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.

scholarly journals Components and Principles of a Pediatric Palliative Care Consultation: Results of a Delphi Study

2014 ◽  
Vol 17 (11) ◽  
pp. 1206-1213 ◽  
Author(s):  
Natalie Bradford ◽  
Anthony Herbert ◽  
Christine Mott ◽  
Nigel Armfield ◽  
Jeanine Young ◽  
...  
Keyword(s):  
Palliative Care ◽  
Delphi Study ◽  
Pediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

The Optimal Delivery of Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Jaclyn Yoong ◽  
Peter Poon
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Models Of Care ◽  
Global Rating ◽  
Life Care ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Excellent Care ◽  
Veterans Affairs Medical Centers

This study aimed to compare the effect of palliative care consultation teams with that of dedicated palliative care units on the quality of end-of-life care. This was a telephone-base survey conducted in 77 Veterans Affairs medical centers that had provided both models of care. Deceased patients from July 2008 to December 2009 were identified. A family member of the decedent was invited to participate in the survey which consisted of one global rating item and nine core items pertaining to patient’s end-of-life care. Families of patients who received care in a palliative care unit were more likely to report “excellent” care compared to families of those who received at least one palliative care consultation; families of those who received at least one palliative care consultation in turn where more likely to report “excellent” care compared to families of those who received usual care.

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