The Impact of an Outpatient Palliative Care Consultation on Symptom Burden in Advanced Prostate Cancer Patients

2012 ◽  
Vol 15 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Bradley Atkinson ◽  
Jessica Masterson ◽  
David Hui ◽  
Diana Urbauer ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Prostate Cancer ◽  
Symptom Burden ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

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

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]

Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer

2021 ◽  
pp. 104990912098680
Author(s):  
Paige E. Sheridan ◽  
Wendi G. LeBrett ◽  
Daniel P. Triplett ◽  
Eric J. Roeland ◽  
Andrew R. Bruggeman ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Costs ◽  
Healthcare Expenditure ◽  
Advanced Cancer Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: There is inconsistent evidence that palliative care intervention decreases total healthcare expenditure at end-of-life for oncology patients. This inconsistent evidence may result from small sample sizes at single institution studies and disparate characterization of costs across studies. Comprehensive studies in population-based datasets are needed to fully understand the impact of palliative care on total healthcare costs. This study analyzed the impact of palliative care on total healthcare costs in a nationally representative sample of advanced cancer patients. Methods: We conducted a matched cohort study among Medicare patients with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation on factors related to both the receipt of palliative care and end of life costs. We compared direct costs between matched patients to determine the per-patient economic impact of a palliative care consultation. Results: Patients who received a palliative care consultation experienced an average per patient cost of $5,834 compared to $7,784 for usual care patients (25% decrease; p < 0.0001). Palliative care consultation within 7 days of death decreased healthcare costs by $451, while palliative care consultation more than 4 weeks from death decreased costs by $4,643. Conclusion: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditure among advanced cancer patients. Earlier palliative care consultation results in greater cost reductions than consultation in the last week of life.

scholarly journals Economic impact of palliative care among elderly cancer patients.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 91-91
Author(s):  
Wendi G. Lebrett ◽  
Eric Roeland ◽  
Andrew Bruggeman ◽  
Heidi Yeung ◽  
James Don Murphy
Keyword(s):  
Palliative Care ◽  
Economic Impact ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Costs ◽  
Advanced Cancer Patients ◽  
Care Intervention ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

91 Background: Randomized trials among advanced cancer patients demonstrate that early palliative care integration into usual oncology care reduces symptom burden, improves quality of life and caregiver outcomes, and may improve survival. The impact of palliative care on health economics remains poorly defined and reported cost savings are an unintentional consequence of providing care aligned with patient goals. This study determined the impact of palliative care on healthcare costs among elderly patients with advanced cancer. Methods: We conducted a matched case-control study among Medicare beneficiaries with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation. To determine the economic impact of a palliative care consultation we compared costs between cases and controls before and after the palliative care intervention. Costs included inpatient, outpatient, home health care, hospice, and medical equipment, and were adjusted to 2011 dollars. Results: Among the 2,576 patients in this study the total healthcare costs per patient in the 30 days before palliative care consultation was balanced between palliative care ($12,881) and non-palliative care control patients ($12,335). Palliative care intervention reduced total healthcare costs after the intervention. The total cost of care per patient in the 120 days after palliative care exposure was $6,880 compared to $9,604 for controls (28% decrease; p < 0.001). The economic effect of palliative care depended on timing of the consult. Palliative care consultation within 7 days of death decreased healthcare costs by $975, whereas palliative care consultation more than 4 weeks from death decreased costs by $5,362. Conclusions: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditures among advanced cancer patients. Furthermore, the cost reduction depends on timing of the palliative care consult.

Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

2021 ◽  
Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Quality Improvement Initiative ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

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 (&lt;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 &gt;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.

Palliative Care Consultation Affects How and Where Heart Failure Patients Die

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.

scholarly journals Characteristics of Hospitalized Cancer Patients Referred for Inpatient Palliative Care Consultation

2017 ◽  
Vol 20 (12) ◽  
pp. 1321-1326 ◽  
Author(s):  
Joan D. Penrod ◽  
Melissa M. Garrido ◽  
Karen McKendrick ◽  
Peter May ◽  
Melissa D. Aldridge ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Palliative Care Consultation ◽  
Care Consultation

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.

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