scholarly journals Palliative and end-of-life care in glioblastoma: defining and measuring opportunities to improve care

2016 ◽  
Vol 4 (3) ◽  
pp. 182-188 ◽  
Author(s):  
Lauryn E Hemminger ◽  
Christine A Pittman ◽  
David N Korones ◽  
Jennifer N Serventi ◽  
Susan Ladwig ◽  
...  
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
End Of Life ◽  
Patient Outcomes ◽  
Advance Directives ◽  
Advance Directive ◽  
Quality Measures ◽  
Care Quality ◽  
Home Setting ◽  
Palliative Care Consultation

Abstract Background American Society for Clinical Oncology (ASCO) quality measures for terminal cancers recommend early advance care planning and hospice at the end of life. We sought to evaluate adherence to 5 palliative care quality measures and explore associations with patient outcomes in glioblastoma. Methods This is a retrospective analysis of 117 deceased glioblastoma patients over 5 years. Records were reviewed to describe adherence to palliative care quality measures and patient outcomes. Data regarding emotional assessments, advance directives, palliative care consultation, chemotherapy administration, hospice, location of death, and overall survival were collected. Results Median overall survival was 12.9 months. By the second oncology visit, 22.2% (26/117) had an emotional assessment completed. Advance directives were documented for 52.1% (61/117) by the third neuro-oncology visit (30/61 health care proxy), yet 26.5% (31/117) did not have any advance directive before the last month of life. With regard to other ASCO quality measures, 36.8% (43/117) had a palliative care consult; 94.0% (110/117) did not receive chemotherapy in the last 14 days of life; 59.8% (70/117) enrolled in hospice >7 days before death; and 56.4% (66/117) died in a home setting. Patients who enrolled in hospice >7 days before death were 3.56 times more likely to die in a home setting than patients enrolled <7 days before death or with no hospice enrollment (P = .002, [OR 3.56; 95% CI, 1.57–8.04]). Conclusions Late advance directive documentation, minimal early palliative care involvement, and the association of early hospice enrollment with death in a home setting underscore the need to improve care and better define palliative care quality measures in glioblastoma.

In-hospital cancer care: Are we missing an opportunity for end of life care?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9039-9039
Author(s):  
Gabrielle Betty Rocque ◽  
Anne Elizabeth Barnett ◽  
Lisa Illig ◽  
Howard Harry Bailey ◽  
Toby Christopher Campbell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
Hospital Admission ◽  
End Of Life ◽  
Poor Prognosis ◽  
Metastatic Cancer ◽  
Academic Medical Center ◽  
Imaging Studies ◽  
Improvement Project ◽  
Palliative Care Consultation

9039 Background: Little data exists on the estimated survival of patients with metastatic cancer after hospitalization. As part of a prospective quality improvement project, we characterized the population of patients admitted to an inpatient oncology service in an academic medical center with emphasis on the disposition at discharge and overall survival. Methods: We collected data over a 4 month period (9/1/10-12/23/10) representing 149 admissions of 119 unique patients. We measured patient characteristics, disease evaluation, procedures, consults, imaging studies performed, disposition, length of stay, and overall survival. These data were compared to a similar study conducted in our center in 2000. Results: Uncontrolled symptoms were the most common reason for admission (pain 28%, dyspnea 9%, nausea 9%). Imaging studies were more common than in 2000 (415 vs. 196 total procedures). Eighty-five percent of patients had progressive disease. Seventy percent of patients were discharged home without additional services such as home health or hospice. The overall median survival was poor in 2000 and in 2010, 100 days and 60 days from discharge, respectively. Despite an overall poor prognosis, palliative care consultation was obtained only 13 times (8% of admissions) and 18% of patients were enrolled in hospice at discharge. Conclusions: An unscheduled hospital admission portends a poor prognosis. Cancer patients in the hospital are nearing the end-of-life with a median life expectancy of approximately 3 months and could be considered hospice-eligible and appropriate for a palliative care consult. We believe that hospital admission represents a missed opportunity to provide palliative care services and end-of-life counseling to this patient population.

498: PALLIATIVE CARE CONSULTATION IS ASSOCIATED WITH ADHERENCE TO ICU PALLIATIVE CARE QUALITY MEASURES

2018 ◽  
Vol 46 (1) ◽  
pp. 234-234
Author(s):  
Joshua Lee ◽  
Nicholas Wysham ◽  
Steven Wolf ◽  
Mary-Ruth Pupa ◽  
Arif Kamal
Keyword(s):  
Palliative Care ◽  
Quality Measures ◽  
Care Quality ◽  
Palliative Care Consultation ◽  
Care Consultation

Ethnicity, race, and advance directives in an inpatient palliative care consultation service

2012 ◽  
Vol 11 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Glenn B. Zaide ◽  
Renee Pekmezaris ◽  
Christian N. Nouryan ◽  
Tanveer P. Mir ◽  
Cristina P. Sison ◽  
...  
Keyword(s):  
Palliative Care ◽  
African Americans ◽  
Advance Directives ◽  
Advance Directive ◽  
Race And Ethnicity ◽  
Primary Diagnosis ◽  
Do Not Resuscitate ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

AbstractObjective:Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).Method:A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).Results:Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.Significance of results:This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.

scholarly journals Conformance With Supportive Care Quality Measures Is Associated With Better Quality of Life in Patients With Cancer Receiving Palliative Care

2013 ◽  
Vol 9 (3) ◽  
pp. e73-e76 ◽  
Author(s):  
Arif H. Kamal ◽  
Janet Bull ◽  
Charles S. Stinson ◽  
Debra L. Blue ◽  
Amy P. Abernethy
Keyword(s):  
Palliative Care ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Quality Measures ◽  
Care Quality ◽  
Quality Data ◽  
Patients With Cancer ◽  
Data Assessment ◽  
The Relationship

The authors used a quality data assessment tool to examine the relationship between conformance with palliative care quality measures and patient outcomes.

Voluntarily Stopping Eating and Drinking: A Normative Comparison with Refusing Lifesaving Treatment and Advance Directives

2017 ◽  
Vol 45 (4) ◽  
pp. 634-646 ◽  
Author(s):  
Paul T. Menzel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Legal Basis ◽  
Proper Place ◽  
Manner Of Death ◽  
Normative Comparison

Refusal of lifesaving treatment, and such refusal by advance directive, are widely recognized as ethically and legally permissible. Voluntarily stopping eating and drinking (VSED) is not. Ethically and legally, how does VSED compare with these two more established ways for patients to control the end of life? Is it more questionable because with VSED the patient intends to cause her death, or because those who assist it with palliative care could be assisting a suicide?In fact the ethical and legal basis for VSED is virtually as strong as for refusing lifesaving treatment and less problematic than the basis for refusing treatment by advance directive. VSED should take its proper place among the accepted, permissible ways by which people can control the time and manner of death.

scholarly journals A Longitudinal Study of Retirement Transition and Advance Directive Completion

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 441-441
Author(s):  
Catheryn Koss
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Multinomial Logistic Regression ◽  
Statistical Significance ◽  
Optimal Time ◽  
Retirement Transition ◽  
Multistep Process ◽  
Study Participants ◽  
Retirement Study

Abstract Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of-life care. According to normative life course theory, retirement is a significant role change that signals a transition into the third age and its socially prescribed activities. To the extent that ACP is viewed as something to do when one reaches a more advanced stage in life, retirement may spark recognition that planning for incapacity and the end of life is now personally relevant and appropriate. This study tested whether transitioning from work to retirement prompted AD completion. The sample included Health and Retirement Study participants 65 and older who, in 2012, had no ADs and were not completely retired (N = 919). Retirement was operationalized as both a categorical status and as a multistep process. Three waves of data were analyzed using multinomial logistic regression to test associations between retirement transition and advance directive completion. By 2014, 21% had completed ADs and another 17% completed them by 2016. Those who completely retired between 2012 and 2014 were almost twice as likely to complete ADs between 2014 and 2016. Graduated increase in level of retirement between 2012 and 2014 was associated with higher odds of new AD possession in 2016, but did not reach statistical significance at p &lt; .05. These results suggest the period following retirement may be an optimal time to encourage patients and clients who have not already done so to complete advance directives.

scholarly journals Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
C. Lees ◽  
S. Weerasinghe ◽  
N. Lamond ◽  
T. Younis ◽  
Ravi Ramjeesingh
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Potential Effect ◽  
Unresectable Pancreatic Cancer ◽  
Palliative Care Consultation ◽  
Integral Role ◽  
Care Consultation ◽  
Aggressive Care ◽  
Key Indicators

Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.

Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer

2021 ◽  
Author(s):  
Prasanna Ananth ◽  
Sophia Mun ◽  
Noora Reffat ◽  
Soo Jung Kang ◽  
Sarah Pitafi ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Quality ◽  
Life Care ◽  
Children With Cancer ◽  
Symptom Screening ◽  
Palliative Care Consultation ◽  
Patient Reported

PURPOSE: There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS: We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS: Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION: Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.

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