Assessing Racial Disparity in Palliative Care Consultation and the Impact of Consultation on Hospice: A Multi-Hospital Analysis (TH321B)

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (<72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived >24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

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Palliative Care Consultation Affects How and Where Heart Failure Patients Die

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120963565 ◽

2020 ◽

pp. 104990912096356

Author(s):

Richard Pham ◽

Casey McQuade ◽

Alex Somerfeld ◽

Sandra Blakowski ◽

Gavin W. Hickey

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Chi Square ◽

Code Status ◽

Heart Failure Patients ◽

Palliative Care Consultation ◽

Care Consultation ◽

Dying At Home ◽

The Impact ◽

At Home

Objective: Determine the role of palliative care on terminal code status and setting of death for those with heart failure. Background: Although palliative care consultation (PCC) has increased for many conditions, PCC has not increased in those with cardiovascular disease. While it has been shown that the majority of those with heart failure die in medical facilities, the impact of PCC on terminal code status and setting of death requires further analysis. Methods: Patients admitted with heart failure between 2014-2015 at an academic VA Healthcare System were reviewed. Primary outcome was terminal code status. Secondary outcomes included setting of death, hospice utilization, and mortality scores. Student t-testing and Chi-square testing were performed where appropriate. Results: 334 patients were admitted with heart failure and had a median follow up time of 4.3 years. 196 patients died, with 122 (62%) receiving PCC and 74 (38%) without PCC. Patients were more likely to have terminal code statuses of comfort measures with PCC (OR = 4.6, p = 0.002), and less likely to be full code (OR = 0.09, p < 0.001). 146 patients had documented settings of death and were more likely to receive hospice services with PCC (OR 6.76, p < 0.001). A patient’s chance of dying at home was not increased with PCC (OR 0.49, p = 0.07), but they were more likely to die with inpatient hospice (OR = 17.03; p < 0.001). Conclusion: Heart failure patients who received PCC are more likely to die with more defined care preferences and with hospice services. This does not translate to dying at home.

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

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116650238 ◽

2016 ◽

Vol 34 (7) ◽

pp. 685-691 ◽

Cited By ~ 7

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.

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Evaluating the impact of early versus late inpatient palliative care consultation for cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6638 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6638-6638

Author(s):

Brian Cassel ◽

Patrick J. Coyne ◽

Nevena Skoro ◽

Kathleen Kerr ◽

Egidio Del Fabbro

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Palliative Care Team ◽

Care Team ◽

Care Hospital ◽

Palliative Care Consultation ◽

Social Security Death Index ◽

Hospital Deaths ◽

Care Consultation ◽

The Impact

6638 Background: Access to specialist palliative care (hospital-based or hospice) is a recognized measure of quality in cancer care. Most cancer centers do have palliative care consult services, although the availability of a comprehensive program that includes a palliative care unit and outpatient clinic (Hui 2010) is inconsistent. A simultaneous integrated model of palliative care that facilitates earlier access to a specialized palliative care team may improve clinical outcomes. Palliative care programs should measure the access, timing and impact of their clinical service. Methods: Hospital claims data were linked to Social Security Death Index (SSDI) data from the US Department of Commerce. 3,128 adult cancer patients died between January 2009 and July 2011 and had contact with our inpatient palliative care team in their last six months of life. We determined whether IPC earlier than 1 month prior to death had an impact on hospitalizations, in-hospital mortality and referral to hospice. Results: 27.5% of cancer decedents accessed IPC, median of 22 days before death. 13.2% were discharged to hospice, median of 13 days before death. Patients with IPC earlier than 1 month until death were more likely to have hospice and fewer in-hospital deaths but there was no association between early IPC and a 30-day mortality admission. Conclusions: Palliative care services are accessed by a minority of patients and typically in the last 2-3 weeks of life. Although in-hospital deaths were reduced by earlier palliative care consultation, 30 day mortality did not improve. Hospitals may need to implement other strategies including early integration of outpatient palliative care among cancer patients, to achieve an impact on 30-day mortality admissions. [Table: see text]

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The impact of palliative care consultation on overall survival and aggressive care at the end-of-life in unresectable pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e18729 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e18729-e18729

Author(s):

Caitlin Lees ◽

Swarna Weerasinghe ◽

Tallal Younis ◽

Nathan William Dana Lamond ◽

Ravi Ramjeesingh

Keyword(s):

Pancreatic Cancer ◽

Palliative Care ◽

Overall Survival ◽

End Of Life ◽

Unresectable Pancreatic Cancer ◽

Palliative Care Consultation ◽

Care Consultation ◽

Aggressive Care ◽

The Impact

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Timing of Palliative Care Consultation and the Impact on Thirty-Day Readmissions and Inpatient Mortality

Journal of Palliative Medicine ◽

10.1089/jpm.2018.0399 ◽

2019 ◽

Vol 22 (4) ◽

pp. 393-399 ◽

Cited By ~ 3

Author(s):

John E. Barkley ◽

Andrea McCall ◽

Andréa L. Maslow ◽

Beata A. Skudlarska ◽

Xu Chen

Keyword(s):

Palliative Care ◽

Inpatient Mortality ◽

Palliative Care Consultation ◽

Care Consultation ◽

The Impact

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Ethnicity, race, and advance directives in an inpatient palliative care consultation service

Palliative & Supportive Care ◽

10.1017/s1478951512000417 ◽

2012 ◽

Vol 11 (1) ◽

pp. 5-11 ◽

Cited By ~ 35

Author(s):

Glenn B. Zaide ◽

Renee Pekmezaris ◽

Christian N. Nouryan ◽

Tanveer P. Mir ◽

Cristina P. Sison ◽

...

Keyword(s):

Palliative Care ◽

African Americans ◽

Advance Directives ◽

Advance Directive ◽

Race And Ethnicity ◽

Primary Diagnosis ◽

Do Not Resuscitate ◽

Palliative Care Consultation ◽

Care Consultation ◽

The Impact

AbstractObjective:Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).Method:A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).Results:Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.Significance of results:This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.

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