QOLP-36. PATTERN OF CARE OF BRAIN TUMOR PATIENTS IN THE LAST MONTHS OF LIFE: ANALYSIS OF A COHORT OF 3045 PATIENTS IN THE LAZIO REGION IN THE LAST 10 YEARS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi191-vi191
Author(s):  
Andrea Pace ◽  
Valeria Belleudi ◽  
Luigi Pinarelli ◽  
Veronica Villani ◽  
Francesca poggi ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Quality Of Care ◽  
End Of Life ◽  
Hospital Readmission ◽  
Improve Quality ◽  
Tumor Patients ◽  
Lazio Region ◽  
Study Results ◽  
Quality Of Death

Abstract The final days of life of Brain Tumor patients (BT) present special challenges and often palliative care approach is underutilyzed. Several studies reported that BT patients in the last months of life receive frequent hospital readmissions and ER accesses as result of bad quality of End of Life care. Early integration of pallative care has been demonstrated to improve quality of care in advanced stage of disease and quality of death in cancer patients. With the aim to evaluate pattern of treatment and the rate of hospital readmission in the last months of life, we retrospectively analyzed a consecutive serie of BT patients discharged after a diagnosis of BT. METHODS: Data regarding hospital readmission and treatment received in the last two months of life were collected from the Lazio Region Healthcare database. Adult patients discharged with diagnosis ICD-9 191.* between 1/1/2010 until 31/12/2019, were included in this study. RESULTS: 6672 patients were identified and 3045 death before 31/12/2019 were included (median age 67 y;M1700). In the last month of life 42.6% received hospital reamission (4.6% intensive care unit) and 37.9% had ER accesses. 24.5% received chemotherapy and 12.1% radiotherapy. In the last 30 days 33% were readmitted in hospital and 24.2% were admitted in ER. 11.7% were treated with chemotherapy and 6% with radiotherapy. CONCLUSION: Strategies to improve quality of care at the end of life and to decrease rehospitalization and futile treatments are becoming increasingly important to improve quality of death and to reduce costs of Healthcare System.

P14.56 Pattern of care of Brain Tumor patients in the last months of life: analysis of a cohort of 3045 patients in the Lazio region in the last 10 years

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii48-ii48
Author(s):  
A Pace ◽  
V Belleudi ◽  
L Pinarelli ◽  
V Villani ◽  
F Poggi ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Quality Of Care ◽  
End Of Life ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Improve Quality ◽  
Tumor Patients ◽  
Lazio Region ◽  
Quality Of Death

Abstract BACKGROUND The final days of life of Brain Tumor patients (BT) present special challenges and often palliative care approach is underutilyzed. Several studies reported that BT patients in the last months of life receive frequent hospital readmissions and ER accesses as result of bad quality of End of Life care. Early integration of pallative care has been demonstrated to improve quality of care in advanced stage of disease and quality of death in cancer patients. With the aim to evaluate pattern of treatment and the rate of hospital readmission in the last months of life, we retrospectively analyzed a consecutive serie of BT patients discharged after a diagnosis of BT. MATERIAL AND METHODS Data regarding hospital readmission and treatment received in the last two months of life were collected from the Lazio Region Healthcare database. Adult patients discharged with diagnosis ICD-9 191.* between 1/1/2010 until 31/12/2019, were included in this study. RESULTS 6672 patients were identified and 3045 who have died before 31/12/2019 were included (median age 67 y;M1700). In the last two month of life 42.6% received hospital reamission (4.6% intensive care unit) and 37.9% had ER accesses. 24.5% received chemotherapy and 12.1% radiotherapy. In the last 30 days 33% were readmitted in hospital and 24.2% were admitted in ER. 11.7% were treated with chemotherapy and 6% with radiotherapy. CONCLUSION Strategies to improve quality of care at the end of life and to decrease re-hospitalization and futile treatments are becoming increasingly important to improve quality of death and to reduce costs of Healthcare System.

scholarly journals Integration of palliative care into the neuro-oncology practice: patterns in the United States

2014 ◽  
Vol 1 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Tobias Walbert
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Brain Tumor ◽  
End Of Life ◽  
Symptom Control ◽  
Tumor Patients ◽  
Life Phase ◽  
Improve Symptom ◽  
Oncology Practice

Abstract Background Between 80%–85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life. Methods A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice. Results Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey. Conclusions Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.

scholarly journals Epilepsy in the end of life phase of brain tumor patients: a systematic review

2014 ◽  
Vol 1 (3) ◽  
pp. 134-140 ◽  
Author(s):  
Johan A.F. Koekkoek ◽  
Linda Dirven ◽  
Jaap C. Reijneveld ◽  
Tjeerd J. Postma ◽  
Robin Grant ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Tumor ◽  
End Of Life ◽  
Current Knowledge ◽  
Epileptic Seizures ◽  
High Grade Glioma ◽  
Malignant Brain Tumor ◽  
Tumor Patients ◽  
Swallowing Difficulties

Abstract Epileptic seizures are common in patients with primary or secondary malignant brain tumor. However, current knowledge on the occurrence of seizures during the end of life (EOL) phase of brain tumor patients is limited. Because symptom management with preservation of quality of life is of major importance for patients with a malignant brain tumor, particularly in the EOL, it is necessary to gain a deeper understanding of seizures and their management during this phase. We performed a systematic review of literature related to epilepsy in the EOL phase of brain tumor patients, based on the electronic resources PubMed, Embase, and Cinahl. The search yielded 442 unique records, of which 11 articles were eligible for further analysis after applying predefined inclusion criteria. Seizures occur relatively frequently in the EOL phase, particularly in patients with high-grade glioma. However, seizure management is often hampered by swallowing difficulties and impaired consciousness. Treatment decisions are largely dependent on expert opinion because a standardized approach for treating seizures in the terminal stage of brain tumor patients is still lacking.

End-of-life care in patients with primary malignant brain tumors: A systematic literature review and analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20703-e20703
Author(s):  
Tobias Walbert ◽  
Muhib Alam Khan
Keyword(s):  
Quality Of Life ◽  
Brain Tumor ◽  
Brain Tumors ◽  
End Of Life ◽  
End Of Life Care ◽  
Adult Brain ◽  
Life Care ◽  
Tumor Patients ◽  
Specific Patient

e20703 Background: 80–85% of all adult brain tumors are high-grade glioma (HGG). HGG are typically treated with maximal surgical resection, followed by radiotherapy with concurrent and adjuvant chemotherapy. The median survival for anaplastic glioma is estimated to be 2-5 years and 15 months for patients with glioblastoma. Quality of life (QoL) has become an increasing important outcome assessed in clinical trials as well as in the standard care of brain tumor patients. Despite the inevitable disease trajectory, not much is known about symptoms and needs of brain tumor patients and their caretakers at the end of life. There appears to be a lack of published literature on this important aspect of neuro-oncology. Methods: A systematic literature search was conducted in PubMed and Cochrane covering the years between 1946 through 2012. In total, 7146 article citations were found. After first review 942 abstracts were obtained. Based on content 82 articles were examined separately by both authors and it was agreed to eliminate 67 of them because they did not include a significant number of primary brain tumor patients or the focus was not on end of life care and symptoms. Results: Only 7 of the retained articles contained specific patient data and did not just reflect opinions of authors or reviews of the topic. Only one study was performed prospectively. Three studies assessed symptom management in inpatients, 2 in outpatients and 2 in a combined setting. Studies included between 29 and 169 patients. Drowsiness and loss of consciousness was the most common symptom (85%–90%). Poor communication (64% and 90%), focal deficits (29%– 62%), seizures (3%–67%), dysphagia (10%–85%), headache (4%–62%), and fatigue (25%–67%) were also frequent. Interventions included hydration (87%-93%), urinary catheter (89%), steroids (62%-80%), anti-epileptic drugs (45%-76%), oxygen (48%), tube feeding (13%) and palliative sedation (13%). Conclusions: There is 1 prospective study and only a total of 7 studies describing detailed end of life symptoms. None of the studies addressed caregiver quality of life. More research is needed to develop purposeful interventions to address end of life symptoms and QoL in patients with HGG.

Quality of Care and Rehospitalization Rate in the Last Stage of Disease in Brain Tumor Patients Assisted at Home: A Cost Effectiveness Study

2012 ◽  
Vol 15 (2) ◽  
pp. 225-227 ◽  
Author(s):  
Andrea Pace ◽  
Cherubino Di Lorenzo ◽  
Alessandra Capon ◽  
Veronica Villani ◽  
Dario Benincasa ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Quality Of Care ◽  
Cost Effectiveness ◽  
Effectiveness Study ◽  
Tumor Patients ◽  
Stage Of Disease ◽  
Rehospitalization Rate ◽  
Last Stage ◽  
Cost Effectiveness Study

scholarly journals Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Nataliya Brima ◽  
Nick Sevdalis ◽  
K. Daoh ◽  
B. Deen ◽  
T. B. Kamara ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Sierra Leone ◽  
Referral Hospital ◽  
Audit And Feedback ◽  
Health System Strengthening ◽  
Theory Of Change ◽  
Improve Quality ◽  
Nursing Documentation

Abstract Background There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone. Methods This project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory ‘Theory of Change’ process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases—(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention’s effectiveness For improving nursing in this pilot setting. Discussion We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone. Trial registration Protocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.

scholarly journals Physician beliefs about the impact of meaningful use of the EHR

2014 ◽  
Vol 05 (03) ◽  
pp. 789-801 ◽  
Author(s):  
D.Y. Ting ◽  
M. Healey ◽  
S.R. Lipsitz ◽  
A.S. Karson ◽  
J. S. Einbinder ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Primary Care Physicians ◽  
Meaningful Use ◽  
The United States ◽  
Improve Quality ◽  
Cross Sectional ◽  
Incentive Program ◽  
Physician Beliefs ◽  
The Impact

SummaryBackground: As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs.Objective: Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care.Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program.Results: Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items.Conclusions: Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.Citation: Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: A cross-sectional study. Appl Clin Inf 2014; 5: 789–801http://dx.doi.org/10.4338/ACI-2014-05-RA-0050

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