571 Palliative Care Utilization in Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S136-S136
Author(s):  
Marcus Geffre ◽  
Frederick W Endorf ◽  
Rachel M Nygaard
Keyword(s):  
Palliative Care ◽  
Inhalation Injury ◽  
Comfort Care ◽  
Code Status ◽  
Factors Associated ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Palliative Care Services ◽  
Care Consultation ◽  
Multiple Variables

Abstract Introduction The morbidity and mortality of the severely burned patient can be affected by multiple variables. Many of these variables are also associated with an increased likelihood of withdrawal of care. Palliative care services can aid families in difficult decision making during this time and improve the process of transition to comfort cares. Despite this, palliative care services may be underutilized. The aim of our study is to assess factors associated with palliative care consultation in the setting of severe burns. Methods We analyzed 191 patients with a burn TBSA of ≥30% at our institution from 2007 to 2019. Univariate and multivariate analysis was performed to identify factors associated with consultation to palliative care. Results 17 of the 191 (8.9%) patients received a palliative care consultation. The average time to consultation was 10.3 days. On univariate analysis, age, inhalation injury, multiple comorbid conditions, and code status were associated with consultation to palliative care. Independent predictors of palliative care consult included inhalation injury, non-white race, code status, and ventilator days. Conclusions Palliative care consultation appears to be seldomly requested at our facility. The presence of an inhalation injury and comorbidities increase the likelihood of consultation. These factors correspond to the same factors that increase likelihood of transition to comfort care. Consult to palliative care on patients with these factors can help improve patient and family care.

Perspectives on palliative care in a multisite oncology practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 52-52
Author(s):  
Kenneth D. Bishop ◽  
Angela Marie Taber
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Patients ◽  
Nurse Practitioners ◽  
Effective Means ◽  
Cancer Center ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Palliative Care Services ◽  
Care Consultation

52 Background: The Institute of Medicine reported that many cancer patients do not receive palliative care to manage symptoms. It is possible that practitioners do not identify palliative care as an important component of high-quality cancer care, or do not know how to most efficiently utilize available palliative care consultative services. Methods: An anonymous electronic survey was sent to physicians, nurses, nurse practitioners, physician assistants, and social workers (n=99) in our multi-site, single-institution Cancer Center. Results: Sixty-five responses were received (66% response rate). Eighty-three percent of respondents reported working primarily in the outpatient setting. Fifty-nine percent reported their patients ‘rarely use the ER for pain management’ while 16% reported their patients ‘frequently require ER visits for pain management’. Ninety-two percent considered palliative care ‘an integral part of a multidisciplinary team’ while 6% reported palliative care consultation to be ‘cumbersome to consult and coordinate with’. The most common reason for consultation was end-of-life discussions (38%) followed by chronic pain management (33%). Seventy-seven percent reported consulting between 1 and 5 times per month, 14% between 6-10 times per month, and 5% greater than 11 times per month. Thirteen percent reported that they were able to manage patient symptoms adequately themselves. The average rating for convenience of consulting palliative care was 3.8/5. Fifty-eight percent reported the most effective means of communication with palliative care consultants was through the medical record, whereas 42% reported that most effective communication took place in person. Sixty percent reported a preference for palliative care practitioners from within the division of hematology/oncology. Conclusions: Our survey suggests that the majority of oncology practitioners value palliative care consultation and are willing to incorporate palliative care services into patient management. It is possible that practitioners overestimate their utilization of palliative care services and that optimizing the convenience of consultation and communication would result in better integration of palliative care for cancer patients.

Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies

2020 ◽  
pp. 104990912092277
Author(s):  
Kimberley Lee ◽  
Faiz Gani ◽  
Joseph K. Canner ◽  
Fabian M. Johnston
Keyword(s):  
Palliative Care ◽  
Racial Disparities ◽  
Advanced Cancer ◽  
The United States ◽  
Patients With Cancer ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Black Patients ◽  
Palliative Care Services ◽  
Care Consultation

Background: There is increasing recognition of the importance of early incorporation of palliative care services in the care of patients with advanced cancers. Hospice-based palliative care remains underutilized for black patients with cancer, and there is limited literature on racial disparities in use of non-hospice-based palliative care services for patients with cancer. Objective: The primary objective of this study is to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Design: This retrospective cohort study analyzed 204 175 hospital admissions of patients with advanced cancers between 2012 and 2014. The cohort was identified through the National Inpatient Dataset. International Classification of Disease, Ninth Revision codes were used to identify receipt of a palliative care consultation. Results: Of this, 57.7% of those who died received IPCC compared to 10.5% who were discharged alive. In multivariable logistic regression models, black patients discharged from the hospital, were significantly less likely to receive a palliative care consult compared to white patients (odds ratio [OR] black: 0.69, 95% CI: 0.62-0.76). Conclusions: Death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There are significant racial disparities in the utilization of IPCC for patients with advanced cancer.

Prevalence of specialised palliative care consultation for eligible children within a paediatric cardiac ICU

2021 ◽  
pp. 1-7
Author(s):  
Claudia Delgado-Corcoran ◽  
Erin E. Bennett ◽  
Stephanie A. Bodily ◽  
Sarah E. Wawrzynski ◽  
Danielle Green ◽  
...  
Keyword(s):  
Palliative Care ◽  
Screening Criteria ◽  
Care Services ◽  
Lengths Of Stay ◽  
Paediatric Palliative Care ◽  
Icu Length Of Stay ◽  
Palliative Care Consultation ◽  
Risk Of Mortality ◽  
Palliative Care Services ◽  
Care Consultation

Abstract Objective: Retrospectively apply criteria from Center to Advance Palliative Care to a cohort of children treated in a cardiac ICU and compare children who received a palliative care consultation to those who were eligible for but did not receive one. Methods: Medical records of children admitted to a cardiac ICU between January 2014 and June 2017 were reviewed. Selected criteria include cardiac ICU length of stay >14 days and/or ≥ 3 hospitalisations within a 6-month period. Measurements and Results: A consultation occurred in 17% (n = 48) of 288 eligible children. Children who received a consult had longer cardiac ICU (27 days versus 17 days; p < 0.001) and hospital (91 days versus 35 days; p < 0.001) lengths of stay, more complex chronic conditions at the end of first hospitalisation (3 versus1; p < 0.001) and the end of the study (4 vs.2; p < 0.001), and higher mortality (42% versus 7%; p < 0.001) when compared with the non-consulted group. Of the 142 pre-natally diagnosed children, only one received a pre-natal consult and 23 received it post-natally. Children who received a consultation (n = 48) were almost 2 months of age at the time of the consult. Conclusions: Less than a quarter of eligible children received a consultation. The consultation usually occurred in the context of medical complexity, high risk of mortality, and at an older age, suggesting potential opportunities for more and earlier paediatric palliative care involvement in the cardiac ICU. Screening criteria to identify patients for a consultation may increase the use of palliative care services in the cardiac ICU.

scholarly journals End of Life, Withdrawal, and Palliative Care Utilization among Patients Receiving Maintenance Hemodialysis Therapy

2018 ◽  
Vol 13 (8) ◽  
pp. 1172-1179 ◽  
Author(s):  
Joy Chieh-Yu Chen ◽  
Bjorg Thorsteinsdottir ◽  
Lisa E. Vaughan ◽  
Molly A. Feely ◽  
Robert C. Albright ◽  
...  
Keyword(s):  
Palliative Care ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Maintenance Hemodialysis ◽  
Medical Complications ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Tertiary Center ◽  
Palliative Care Services ◽  
Care Consultation

Background and objectivesWithdrawal from maintenance hemodialysis before death has become more common because of high disease and treatment burden. The study objective was to identify patient factors and examine the terminal course associated with hemodialysis withdrawal, and assess patterns of palliative care involvement before death among patients on maintenance hemodialysis.Design, setting, participants, & measurementsWe designed an observational cohort study of adult patients on incident hemodialysis in a midwestern United States tertiary center, from January 2001 to November 2013, with death events through to November 2015. Logistic regression models evaluated associations between patient characteristics and withdrawal status and palliative care service utilization.ResultsAmong 1226 patients, 536 died and 262 (49% of 536) withdrew. A random sample (10%; 52 out of 536) review of Death Notification Forms revealed 73% sensitivity for withdrawal. Risk factors for withdrawal before death included older age, white race, palliative care consultation within 6 months, hospitalization within 30 days, cerebrovascular disease, and no coronary artery disease. Most withdrawal decisions were made by patients (60%) or a family member (33%; surrogates). The majority withdrew either because of acute medical complications (51%) or failure to thrive/frailty (22%). After withdrawal, median time to death was 7 days (interquartile range, 4–11). In-hospital deaths were less common in the withdrawal group (34% versus 46% nonwithdrawal, P=0.003). A third (34%; 90 out of 262) of those that withdrew received palliative care services. Palliative care consultation in the withdrawal group was associated with longer hemodialysis duration (odds ratio, 1.19 per year; 95% confidence interval, 1.10 to 1.3; P<0.001), hospitalization within 30 days of death (odds ratio, 5.78; 95% confidence interval, 2.62 to 12.73; P<0.001), and death in hospital (odds ratio, 1.92; 95% confidence interval, 1.13 to 3.27; P=0.02).ConclusionsIn this single-center study, the rate of hemodialysis withdrawals were twice the frequency previously described. Acute medical complications and frailty appeared to be driving factors. However, palliative care services were used in only a minority of patients.

scholarly journals Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists

2017 ◽  
Vol 13 (9) ◽  
pp. e703-e711 ◽  
Author(s):  
Alexandre Buckley de Meritens ◽  
Benjamin Margolis ◽  
Craig Blinderman ◽  
Holly G. Prigerson ◽  
Paul K. Maciejewski ◽  
...  
Keyword(s):  
Palliative Care ◽  
Practice Patterns ◽  
Medical Center ◽  
Symptom Control ◽  
Gynecologic Oncology ◽  
Academic Medical Center ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Palliative Care Services ◽  
Care Consultation

Purpose: We sought to describe practice patterns, attitudes, and barriers to the integration of palliative care services by gynecologic oncologists. Methods: Members of the Society of Gynecologic Oncology were electronically surveyed regarding their practice of incorporating palliative care services and to identify barriers for consultation. Descriptive statistics were used, and two-sample z-tests of proportions were performed to compare responses to related questions. Results: Of the 145 respondents, 71% were attending physicians and 58% worked at an academic medical center. The vast majority (92%) had palliative care services available for consultation at their hospital; 48% thought that palliative care services were appropriately used, 51% thought they were underused, and 1% thought they were overused. Thirty percent of respondents thought that palliative care services should be incorporated at first recurrence, whereas 42% thought palliative care should be incorporated when prognosis for life expectancy is ≤ 6 months. Most participants (75%) responded that palliative care consultation is reasonable for symptom control at any stage of disease. Respondents were most likely to consult palliative care services for pain control (53%) and other symptoms (63%). Eighty-three percent of respondents thought that communicating prognosis is the primary team’s responsibility, whereas the responsibilities for pain and symptom control, resuscitation status, and goals of care discussions were split between the primary team only and both teams. The main barrier for consulting palliative care services was the concern that patients and families would feel abandoned by the primary oncologist (73%). Ninety-seven percent of respondents answered that palliative care services are useful to improve patient care. Conclusion: The majority of gynecologic oncologists perceived palliative care as a useful collaboration that is underused. Fear of perceived abandonment by the patient and family members was identified as a significant barrier to palliative care consult.

Code status and outcomes in patients with cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) registry analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12035-12035
Author(s):  
Elizabeth Trice Loggers ◽  
Elizabeth Marie Wulff-Burchfield ◽  
Ishwaria Mohan Subbiah ◽  
Ali Raza Khaki ◽  
Pamela Egan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Factors Associated ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Ecog Ps

12035 Background: In-hospital mortality among patients with cancer (pts) and COVID-19 infection is high. The frequency of, and factors associated with, do-not-resuscitate (DNR) or do-not-intubate (DNI) orders at hospital admission (HA), and their correlation with care, has not been well studied. In November 2020, we began collecting this information for pts who were hospitalized at initial presentation in the CCC19 registry (NCT04354701). Methods: We investigated: 1. the frequency of, and factors associated with, DNR/DNI orders at HA; 2. change in code status during HA; and 3. the correlation between DNR/DNI orders and palliative care consultation (PC), mortality or length of stay (LOS). We included hospitalized, adult pts with cancer and COVID-19 from 57 participating sites. Reported characteristics include age, ECOG performance status (PS), and cancer status. Comparative statistics include 2-sided Wilcoxon rank sum and Fisher’s exact tests. Results: 744 pts had known baseline and/or changed code status (CS); most (79%) maintained their baseline CS (Table). Those with DNR±DNI orders at HA were older (median age 79 vs 69 yrs, p<0.001) and more likely to have: ECOG PS 2+ vs 0-1 (45% vs 22%, OR 3.95, p<0.001), metastatic disease (45% vs 35%, OR 1.72, p=0.005) and progressing cancer (32% vs 16%, OR 2.69, p<0.001), but equally likely to have received systemic anticancer therapy in the prior 3 months (38% vs 45%, p=0.15). N=192 pts with a change in CS from full to DNR±DNI were younger (median age 73), had better PS (37% ECOG PS 2+), and were less likely to have progressing cancer (23%) than those with DNR±DNI orders at baseline. However, their LOS was significantly longer, median 9 vs 6 days, p<0.001. Compared to those with DNR±DNI orders at HA, pts whose CS changed to DNR±DNI were more likely to die, OR 2.94, 95% CI 1.76-4.97, p<0.001. PC was obtained in 106 (14%) pts and associated with transition to DNR±DNI in 47 (44%), affirmation of admission CS in 58 (55%), and reversal in 1 (1%). Median LOS for pts receiving PC was 11 vs 6 days, p<0.001. Conclusions: In our sample, the majority of patients with cancer and COVID-19 were full code at hospital admission. DNR±DNI status, whether at baseline or assigned during the hospital course, was associated with worse prognosis. Longer length of stay for patients changing code status and/or receiving palliative care consultation was observed likely suggesting earlier palliative care consultation is an important, but likely underutilized component in the care of patients with cancer and COVID-19.[Table: see text]

scholarly journals Palliative care in critically ill COVID-19 patients: the early New York City experience

2020 ◽  
pp. bmjspcare-2020-002677
Author(s):  
Jacqueline Sheehan ◽  
Kam Sing Ho ◽  
Joseph Poon ◽  
Kimberly Sarosky ◽  
Jennifer Y Fung
Keyword(s):  
New York ◽  
Palliative Care ◽  
New York City ◽  
Critically Ill ◽  
York City ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Telemedicine Consultation ◽  
Palliative Care Services ◽  
Care Consultation

ObjectivesThe COVID-19 pandemic in the USA has been accompanied by high rates of mortality and an unprecedented need for palliative care delivery. Little is known about the use of palliative care services in intensive care unit (ICU) settings during the COVID-19 pandemic.MethodsThis is a retrospective cohort study of critically ill COVID-19 patients requiring ICU admission, between 7 March and 14 April 2020 to two academic teaching hospitals in New York City. Palliative care consultation included a one-time telemedicine consultation or continued telemedicine consultation and follow-up with multidisciplinary team involvement. Patient information was collected from the electronic health record and analyses were conducted with Stata V.15.1 (StataCorp) statistical software.ResultsA total of 151 critically ill patients with COVID-19 pneumonia requiring ICU admission were identified, of whom 59 (39.07%) received an inpatient palliative care consultation. More than half of patients died (n=85/151, 56.29%), with 57.65% (n=49/85) of these patients receiving palliative care services during their hospitalisation. Patients who received palliative care consultation were more likely to be older, sicker and receive mechanical ventilation than their counterparts. Patients who died and did not receive palliative care were younger and required non-invasive ventilation support.ConclusionThere is a lack of utilisation of palliative care in COVID-19 patients admitted to the ICU. Further research into predictors of poor outcomes in critically ill COVID-19 patients may help identify patients that would benefit from early palliative care involvement going forward.

scholarly journals Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit

2019 ◽  
Vol 10 (3) ◽  
pp. 163-167
Author(s):  
Jon Rosenberg ◽  
Allie Massaro ◽  
James Siegler ◽  
Stacey Sloate ◽  
Matthew Mendlik ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
High Grade ◽  
Neurological Intensive Care Unit ◽  
Code Status ◽  
Neurological Intensive Care ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods: We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results: Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion: In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.

Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts?

2020 ◽  
pp. 000313482097298
Author(s):  
Samuel J. Zolin ◽  
Jasmin K. Bhangu ◽  
Brian T. Young ◽  
Sarah E. Posillico ◽  
Husayn A. Ladhani ◽  
...  
Keyword(s):  
Critical Care ◽  
Trauma Patients ◽  
Family Meeting ◽  
Comfort Care ◽  
Code Status ◽  
Family Meetings ◽  
Dying Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Poor Outcomes

Background Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. Methods Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. Results Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). Conclusions Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.

scholarly journals Identifying Palliative Care Needs in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 788-788
Author(s):  
Daniel David ◽  
Abraham Brody ◽  
Tina Sadarangani ◽  
Bei Wu ◽  
Tara Cortez
Keyword(s):  
Palliative Care ◽  
Assisted Living ◽  
Unmet Needs ◽  
Care Needs ◽  
Code Status ◽  
Care Services ◽  
Palliative Care Services ◽  
Advance Care ◽  
Palliative Care Needs

Abstract Many residents of Assisted Living (AL) confront serious illness and therefore might benefit from greater access to Palliative Care Services to improve quality of life. We surveyed resident records and AL nursing staff to identify patients in need of Palliative Care. Preliminary findings showed that nurses predicted 23% would not be alive and 49% would no longer live in AL. A majority of residents were over the age of 90, yet 30% did not have a reported code status. These findings suggest that a substantial portion of AL residents may have unmet needs with respect to palliative care. Future interventions are needed to support advance care planning conversations and make palliative care more accessible to this population.

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