TRENDS IN UTILIZATION OF INPATIENT PALLIATIVE CARE SERVICES AND RACIAL DISPARITY OF DISPOSITION TO HOSPICE CARE AMONG PATIENTS WITH HEART FAILURE IN THE UNITED STATES BETWEEN 2003 AND 2012

Background: Heart failure is highly prevalent with poor outcomes, yet only a small proportion of patients receive specialist palliative care services. Aim: To explore if a programme focusing on support and symptom management of people with heart failure in a hospice environment would be acceptable and of benefit to patients. Methods: A pre/post intervention study design using mixed methods was used to evaluate the programme. The programme was delivered in 2-hour time slots over a period of 8 weeks. Participants completed three questionnaires pre- and post- and were interviewed within 1 week of completion. The study was conducted between June 2014 and January 2015. Findings: A response rate of 51.7% (n=15) was narrowed to a final sample size of 12 patients. The questionnaire results showed a positive impact on participants' wellbeing and views regarding the use of a hospice, but a desire for greater focus on emotional support. Four key themes emerged from inductive qualitative analysis: demystifying perceptions about hospice care; positivity about wellbeing; learning together; and consideration of end-of-life preparation. Conclusion: This adapted programme provides a useful model for the increased integration of palliative care into provision for those living with advancing heart failure.

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Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States

Palliative Medicine ◽

10.1177/0269216319896745 ◽

2020 ◽

Vol 34 (4) ◽

pp. 513-523 ◽

Cited By ~ 1

Author(s):

Deokhee Yi ◽

Bridget M Johnston ◽

Karen Ryan ◽

Barbara A Daveson ◽

Diane E Meier ◽

...

Keyword(s):

United States ◽

Palliative Care ◽

Home Care ◽

Service Use ◽

The United States ◽

Care Services ◽

Health And Social Care ◽

Total Care ◽

Palliative Care Services ◽

Care Costs

Background: Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. Aim: The aim of this study was to compare health and social care costs, quality and their drivers in the last 3 months of life for older adults across countries. Null hypothesis: no difference between countries. Design: Mortality follow-back survey. Costs were calculated from carers’ reported service use and unit costs. Setting: Palliative care services in England (London), Ireland (Dublin) and the United States (New York, San Francisco). Participants: Informal carers of decedents who had received palliative care participated in the study. Results: A total of 767 questionnaires were returned: 245 in England, 282 in Ireland and 240 in the United States. Mean care costs per person with cancer/non-cancer were US$37,250/US$37,376 (the United States), US$29,065/US$29,411 (Ireland), US$15,347/US$16,631 (England) and differed significantly ( F = 25.79/14.27, p < 0.000). Cost distributions differed and were most homogeneous in England. In all countries, hospital care accounted for > 80% of total care costs; community care 6%–16%, palliative care 1%–15%; 10% of decedents used ~30% of total care costs. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction. Conclusion: Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the United States were high and highly variable, suggesting that high-cost low-value care may be prevalent.

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Microethical & Relational Insights from Pediatric Palliative Care

VIMS Health Science Journal ◽

10.46858/vimshsj.7401 ◽

2020 ◽

Vol 7 (4) ◽

pp. 94-96

Author(s):

Dr. Abhijit Shinde ◽

Dr. Sunil Natha Mhaske ◽

Dr. Ramesh Kothari ◽

Dr. Sonal Shinde

Keyword(s):

United States ◽

Palliative Care ◽

End Of Life ◽

The United States ◽

Pediatric Palliative Care ◽

Live Births ◽

Care Services ◽

Palliative Care Services ◽

Life Threatening ◽

Developed World

In the India, more than 30 per 1000 live births of infants die each year before, during, or after birth as do many children with life- limiting conditions. In most countries in the developed world including the United States, the vast majority of infants, children and teenagers at end of life do not have access to multidisciplinary pediatric palliative care services in their community or at a children’shospital. Pediatric palliative care is for children and teenagers suffering from life- threatening or life-limiting conditions in which survival into adulthood is or may be jeopardized if curative treatments fail. As a result, pediatric palliative care may last over many years.

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Palliative care for patients with heart failure: description of a service

Palliative Medicine ◽

10.1191/0269216306pm1120oa ◽

2006 ◽

Vol 20 (3) ◽

pp. 211-214 ◽

Cited By ~ 35

Author(s):

MJ Johnson ◽

T Houghton

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Care Physician ◽

Heart Failure Patients ◽

Care Services ◽

Patients With Heart Failure ◽

Palliative Care Services ◽

Increasing Demand ◽

Set Up ◽

Palliative Care Physician

Over the past 10 years, there has been an increasing demand for heart failure patients to have access to palliative care services. The concerns of this group have been highlighted and there is growing recognition in national palliative care and cardiology bodies that these concerns should be addressed. In spite of this, there is little improvement. There are concerns about the acceptability of hospice services to heart failure patients, worries about service overload, lack of appropriate knowledge and skills and difficulty in knowing when to refer a heart failure patient for palliative care. In Scarborough, a joint approach by a cardiologist and palliative care physician was set up in September 2000. This paper describes the service so far in an attempt to address some of the above reservations and to provide a catalyst and encouragement to others beginning a similar venture.

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Marketing Palliative Care

10.1093/oxfordhb/9780199974412.013.27 ◽

2015 ◽

Author(s):

Rolfe Sean Morrison ◽

Bridget Tracy

Keyword(s):

Palliative Care ◽

Social Marketing ◽

Health Care Professionals ◽

Hospice Care ◽

Public Support ◽

The United States ◽

Historical Background ◽

Audience Research ◽

Care Services ◽

Palliative Care Services

This article examines why palliative care remains inaccessible to most persons with serious illness, citing the lack of a successful social marketing platform directed to consumers as a primary reason. It argues that the growth of palliative care has been hindered by the failure of palliative care professionals to consider the basic principles of social marketing in early language and messaging. The article first provides a historical background on the development of modern hospice care and of palliative care before turning to a discussion of how palliative care has failed to generate widespread public support and engagement. It then considers how early messaging by palliative care professionals hindered referrals to palliative care by other health-care professionals and concludes by explaining how recent attempts to use principles of audience research and targeted social marketing have led to the rapid spread and uptake of palliative care services in the United States.

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Ten-Year Trends of Utilization of Palliative Care Services and Life-Sustaining Treatments and Hospital Costs Associated With Patients With Terminally Ill Lung Cancer in the United States From 2005 to 2014

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119852082 ◽

2019 ◽

Vol 36 (12) ◽

pp. 1105-1113 ◽

Cited By ~ 2

Author(s):

Jinwook Hwang ◽

Jay Shen ◽

Sun Jung Kim ◽

Sung-Youn Chun ◽

Mutsumi Kioka ◽

...

Keyword(s):

United States ◽

Lung Cancer ◽

Palliative Care ◽

Hospital Cost ◽

Statistical Significance ◽

Hospital Costs ◽

The United States ◽

Care Services ◽

Dying Patients ◽

Palliative Care Services

Background: Palliative care services and life-sustaining treatments are provided to dying patients with lung cancer in the United States. However, data on the utilization trends of palliative care services and life-sustaining treatments of dying patients with lung cancer are not available. Methods: This study was a retrospective analysis of the National Inpatient Sample data (2005-2014) and included patients with lung cancer, aged ≥ 18 years, who died in the hospitals. Claims data of palliative care services and life-sustaining treatments that contained systemic procedures, local procedures, or surgeries were extracted. Compound annual growth rates (CAGRs) using Rao-Scott correction for χ2 tests were used to determine the statistical significance of temporal utilization trends of palliative care services and life-sustaining treatments and their hospital costs. Multilevel multivariate regressions were performed to identify factors associated with hospital costs. Results: A total of 120 144 weighted patients with lung cancer died in the hospitals and 41.9% of them received palliative care services. The CAGRs of systemic procedures, local procedures, surgeries, palliative care services, and hospital cost were 3.42%, 3.48%, 6.08%, 18.5%, and 5.0% (all P < .001), respectively. Increased hospital cost was attributed to systemic procedures (50.6%), local procedures (74.4%), and surgeries (68.5%; all P < .001), respectively. Palliative care services were related to decreasing hospital costs by 28.6% ( P < .001). Conclusion: The temporal trends of palliative care services indicate that their utilization has increased gradually. Palliative care services were associated with reduced hospital costs. However, life-sustaining treatments were associated with increased hospital costs.

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