scholarly journals Patient Risk Factor Profiles Associated With Timing of Goals-of-Care Consultation Before Death

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 831-832
Author(s):  
Lauren Starr ◽  
Connie Ulrich ◽  
Paul Junker ◽  
Liming Huang ◽  
Nina O’Connor ◽  
...  
Keyword(s):  
Risk Factor ◽  
Age Groups ◽  
Secondary Analysis ◽  
Regression Tree ◽  
Classification And Regression Tree ◽  
Goals Of Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Seriously Ill

Abstract Early palliative care consultation to discuss goals-of-care (“PCC”) benefits seriously ill patients. To identify risk factor profiles associated with inpatient PCC timing before death, we conducted a secondary analysis of seriously ill adults who had PCC at a high-acuity hospital and died 2014-2016. Of 1,141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15-60 days before death; 21% had PCC >60 days before death (median 13 days). Classification and Regression Tree modeling showed Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%) were most likely to have PCC close to death, with age <46 or >75 increasing probability (98%). Among age groups, the highest proportion of patients with PCC close to death was >75 years. Complex variable interactions associated with PCC timing suggests we need a systematic process for initiating PCC earlier and effective primary palliative training for providers across settings.

Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis

2020 ◽  
Vol 37 (10) ◽  
pp. 767-778
Author(s):  
Lauren T. Starr ◽  
Connie M. Ulrich ◽  
Paul Junker ◽  
Liming Huang ◽  
Nina R. O’Connor ◽  
...  
Keyword(s):  
Risk Factor ◽  
Intensive Care ◽  
Medical Center ◽  
Regression Tree ◽  
Illness Severity ◽  
Classification And Regression Tree ◽  
Goals Of Care ◽  
Intensive Care Patients ◽  
Care Consultation ◽  
Classification And Regression

Background: Early palliative care consultation (“PCC”) to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed. Objective: To identify risk factor patient profiles associated with PCC timing before death. Methods: Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables. Results: Of 1141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC >60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%), with age <46 or >75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity. Conclusions: A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed.

scholarly journals Goals-of-Care Consult and Future Costs, Acute Care and Hospice Use in Matched Cohorts of African Americans and Whites

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 521-521
Author(s):  
Lauren Starr ◽  
Connie Ulrich ◽  
Scott Appel ◽  
Paul Junker ◽  
Nina O’Connor ◽  
...  
Keyword(s):  
African Americans ◽  
End Of Life ◽  
Acute Care ◽  
Secondary Analysis ◽  
Care Utilization ◽  
Goals Of Care ◽  
Palliative Care Consultation ◽  
Significant Difference ◽  
Hospice Use ◽  
Care Costs

Abstract African Americans receive less hospice care and more aggressive end-of-life care than Whites. Little is known about how palliative care consultation to discuss goals-of-care (“PCC”) is associated with future acute care utilization and costs, or hospice use, by race. To compare future acute care costs and utilization and discharge to hospice between propensity-matched cohorts of African Americans with and without PCC, and Whites with and without PCC, we conducted a secondary analysis of 35,154 seriously-ill African American and White adults who had PCC at a high-acuity hospital and were discharged 2014-2016. We found no significant difference between African Americans with or without PCC in mean future acute care costs ($11,651 vs. $15,050, P=0.09), 30-day readmissions (P=0.58), future hospital days (P=0.34), future ICU admission (P=0.25), or future ICU days (P=0.30), but found greater discharge to hospice among African Americans with PCC (36.5% vs. 2.4%, P&lt;0.0001). We found significant differences between Whites with PCC vs. without PCC in mean future acute care costs ($8,095 vs. $16,799, P&lt;0.001), 30-day readmissions (10.2% vs. 16.7%, P&lt;0.0001), future days hospitalized (3.7 vs. 6.3 days, P&lt;0.0001), and discharge to hospice (42.7% vs. 3.0%, P&lt;0.0001). Results suggest PCC decreases future acute care costs and utilization in Whites and, directionally but not significantly, in African Americans; and increases discharge to hospice in both races (15-fold in African Americans, 14-fold in Whites). Research is needed to understand how PCC supports end-of-life decision-making and hospice use across races and how systems and policies can enable effective goals-of-care consultations across settings.

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.

scholarly journals Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients

2020 ◽  
Vol 60 (4) ◽  
pp. 801-810
Author(s):  
Lauren T. Starr ◽  
Connie M. Ulrich ◽  
Paul Junker ◽  
Scott M. Appel ◽  
Nina R. O'Connor ◽  
...  
Keyword(s):  
African American ◽  
Goals Of Care ◽  
Care Consultation ◽  
Seriously Ill ◽  
White Patients

The effect of early palliative care consultation for survival in patients with unresectable pancreatic cancer.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 131-131
Author(s):  
Kazuhiro Kosugi ◽  
Fumio Omata ◽  
Yoshiyuki Fujita ◽  
Akitoshi Hayashi
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Rank Test ◽  
Unresectable Pancreatic Cancer ◽  
Poor Prognostic Factor ◽  
Early Palliative Care ◽  
Ajcc Stage ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Basic Characteristics

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]

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