scholarly journals Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association With End-of-Life Care

2019 ◽  
Vol 57 (2) ◽  
pp. 233-240 ◽  
Author(s):  
Robert Gramling ◽  
Elizabeth Gajary-Coots ◽  
Jenica Cimino ◽  
Kevin Fiscella ◽  
Ronald Epstein ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Cancer Disparities ◽  
Life Care

Physician orders for scope of treatment (POST) forms in metastatic cancer patients: A 3-year single-university–institution retrospective review.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 133-133
Author(s):  
Brendan F. Curley ◽  
Farhad Khimani ◽  
Alvin Howard Moss
Keyword(s):  
Palliative Care ◽  
West Virginia ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Metastatic Cancer ◽  
X Rays ◽  
Life Care ◽  
West Virginia University

133 Background: Physician orders for dcope of treatment (POST) forms are standardized forms for patient preferences for end-of-life care. These forms contain orders by a physician who has identified a patient who is seriously ill with life-limiting progressive, advanced illness. Utilization of the POST form in advanced and metastatic cancer patients has not yet been evaluated. Methods: At West Virginia University/Mary Babb Randolph Cancer Center, we performed an IRB approved retrospective chart review of all patients who died of metastatic or advanced malignancies from 2010-2012. Statistical analysis was performed with SPSS Version 20. Results: 139 patients were identified who were diagnosed with metastatic cancer and treated at West Virginia University who died from 2010-2012. Of those 139 patients, 26 (18.7%) completed POST forms. 51 (36.7%) patients received systemic oncologic treatment in their last thirty days of life. In the last ninety days of life, patients averaged 16.2 days hospitalized. 123 (88.4%) patients had at least one hospital stay in their last three months of life, with 82 (58.7%) having two or more stays. 65 (46.8%) patients had a hospital readmission within thirty days. 39 (28.1%) patients had an ICU stay with an average duration of 2.6 days. Almost half of all patients reviewed (67, 48.2%) died in the hospital. Patients averaged 2.9 CT scans and 5.2 X-rays over the last ninety days of their life. 116 (83.5%) patients had an end-of-life discussion, with an average time from discussion to date of death of 24.5 days. Only 60 (43.2%) were identified as having a palliative care consult completed. Conclusions: The American Society of Clinical Oncology (ASCO) recommends implementation of Palliative Care at the time of diagnosis of advanced cancer. POST forms appear to have a positive impact on end-of-life care in this population of advanced cancer patients. Increasing their implementation in metastatic oncology patients will likely improve end-of-life care. [Table: see text]

Measure Scan and Synthesis of Palliative and End-of-Life Process Quality Measures for Advanced Cancer

2020 ◽  
pp. OP.20.00240
Author(s):  
Claire E. O’Hanlon ◽  
Charlotta Lindvall ◽  
Karl A. Lorenz ◽  
Karleen F. Giannitrapani ◽  
Melissa Garrido ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Quality Measures ◽  
Process Quality ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

PURPOSE: Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer. METHODS: We reviewed MEDLINE/PubMed-indexed articles for process quality measures related to palliative and end-of-life care for patients with advanced cancer, supplemented by expert input. Measures were inductively grouped into “measure concepts” and higher-level groups. RESULTS: Literature review identified 226 unique measures from 23 measure sources, which we grouped into 64 measure concepts within 12 groups. Groups were advance care planning (11 measure concepts), pain (7), dyspnea (9), palliative care–specific issues (6), other specific symptoms (17), comprehensive assessment (2), symptom assessment (1), hospice/palliative care referral (1), spiritual care (2), mental health (5), information provision (2), and culturally appropriate care (1). CONCLUSION: Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.

Exploring the palliative care needs of Hispanic immigrant mothers with advanced cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 135-135
Author(s):  
Rafael Alonso Saldana ◽  
Eliza Park ◽  
Devon Check ◽  
Katherine Elizabeth Reeder-Hayes ◽  
Deborah Mayer
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Life Care ◽  
Spanish Speaking ◽  
Demographic Group

135 Background: Hispanics are the fastest growing demographic group in the United States and cancer is the leading cause of death in this population. Hispanic immigrants encounter a number of challenges when confronting end-of-life care: geographical and cultural separation from families; language and educational barriers; fear of discrimination; and in the case of undocumented immigrants, fear of deportation. The experiences of Hispanic patients with advanced cancer who are parents of dependent-age children are essentially unknown. Therefore, we used qualitative methods to identify the palliative care and end-of-life needs of this unique population. Methods: We recruited five Spanish-speaking, Hispanic mothers with metastatic cancer to complete a semi-structured interview about their experiences. The interviews addressed coping with advanced illness, sources of distress, parenting changes, medical decision-making strategies, and communication about illness. Data were analyzed using traditional content analysis techniques. Results: Participants were all female, ages 34-43 year old. On average, they had 3.4 children and 8.2 years of education. Common themes were: (1) the financial burden of cancer; (2) low social support for parenting and household responsibilities; (3) lack of perceived role in medical decision-making; (4) and religion as primary source of coping and hope. We also identified several communication barriers in conducting a palliative care study with this population. Conclusions: Future palliative care studies can improve Spanish-speaking Hispanics’ comprehension by incorporating Spanish vocabulary into the interviews and providing greater explanation of concepts such as shared decision-making, cancer staging, palliative care, and hospice. Greater awareness of financial concerns and insufficient social support may help oncology providers and researchers develop interventions to help Hispanic parents with advanced cancer. Further studies are needed to learn more about the unmet needs of end-of-life care for this demographic group.

Spiritual care provided by oncology physicians and nurses to advanced cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9116-9116
Author(s):  
Zachary Epstein-Peterson ◽  
Adam Sullivan ◽  
Andrea C. Phelps ◽  
Michael J. Balboni ◽  
Tyler J. Vanderweele ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Spiritual Care ◽  
Cancer Care ◽  
End Of Life Care ◽  
Life Care ◽  
Advanced Cancer Patients ◽  
Care Guidelines

9116 Background: For many patients facing a diagnosis of advanced cancer, religion and/or spirituality (R/S) play an important role in coping with illness. Data suggest that cancer patients receiving spiritual care (SC) have better quality of life and receive less futile, aggressive interventions at the end of life. National palliative care guidelines include SC as a key component of end-of-life care. However, current SC practices and the role clinicians should play in SC provision remain unclear. Methods: The Religion and Spirituality in Cancer Care (RSCC) study is a survey-based, cross-sectional study of oncology physicians and nurses and advanced cancer patients from five Boston-area institutions. The survey elicited respondents’ R/S beliefs/practices, their views on the appropriateness of SC in the advanced cancer care setting, and their experiences in giving or receiving SC (e.g., spiritual history, referrals to chaplains). In total, 68 patients, 204 physicians, and 114 nurses responded (response rates: patients = 73%; clinicians = 63%). Multivariable analyses (MVAs) were performed to determine predictors (e.g., clinician demographics, R/S, spiritual care training) of SC provision by clinicians. Results: All respondents reported a low frequency of SC provision, with only 9% of patients receiving SC from physicians, 20% from nurses, and physicians reporting performing SC during only 8% of interactions, nurses during 12% of interactions. In MVAs, prior training in spiritual care was significantly associated with SC provision (OR physicians 5.89, CI 2.14-16.22; OR nurses 10.42, CI 1.30-89.19), as was the provider identifying as being spiritual (OR 3.85 physicians CI, 2.12-6.98; OR 2.92 nurses CI, 1.15-7.42). Conclusions: These data highlight the current inadequacies of SC provision by clinicians, despite national palliative care guidelines, and underscore the central role of SC training for doctors and nurses, as this was the strongest predictor of SC provision. Given the important role that SC has in end-of-life care and the paucity of data guiding its provision, we hope this research will advance the understanding of how to integrate SC into end-of-life care, and ultimately improve patient outcomes at the end-of-life.

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