Behaviour patterns of health care utilization in terminal cancer patients: Korean perspective

This study was designed to test the hypothesis that health care professionals would differ in their evaluations of a patient contemplating suicide, in their acceptance of suicide for the patient, and in their projected behavioral response to the patient, as a function of their belief that the patient has cancer, a terminal illness, or terminal cancer, and as a function of the degree of their death anxiety. Health care professionals ( N = 138) across a variety of disciplines completed Templer's Death Anxiety Scale, read one of four randomly distributed written introductions, then viewed taped segments of counseling sessions with a woman who was contemplating suicide. Results demonstrated that health care professionals' evaluations, acceptance, and behavior in the case of a patient contemplating suicide are affected by their belief that the patient has cancer and/or is dying, and by the degree of death anxiety experienced by the practitioner. The importance of awareness regarding personal feelings about suicide among terminal cancer patients is discussed.

Download Full-text

Evaluating goals of care meetings for hospitialized cancer patients at risk for critical care.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.134 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 134-134

Author(s):

Colleen C. Apostol ◽

Julie Waldfogel ◽

Elizabeth Pfoh ◽

Donald C. List ◽

Lynn Billing ◽

...

Keyword(s):

Health Care ◽

At Risk ◽

Critical Care ◽

Health Care Utilization ◽

Cancer Patients ◽

Cancer Center ◽

Care Utilization ◽

Refractory Disease ◽

Comfort Care ◽

Goals Of Care

134 Background: Communication about care preferences is vital for care of cancer patients with advanced and refractory disease, particularly when they become ill enough to be at risk for critical care interventions potentially inconsistent with their preferences. It is vital to describe the use of goals of care discussions in patients with advanced/refractory cancer at risk for critical care and evaluate associations between these discussions and outcomes. Methods: Cohort study describing patient/families’ perceptions of goals of care meetings and comparing health care utilization outcomes of patients who did and who did not have discussions. Inpatient units of an academic cancer center included patients who had metastatic solid tumors or relapsed/refractory lymphoma or leukemia and were at risk for critical care (defined as requiring supplemental oxygen and/or a cardiac monitor). Results: Of 86 patients enrolled, 34 (39%) had a reported goals of care discussion. Patients/families reported their needs and goals were addressed moderately to quite a bit during the meetings. Patients with reported discussions were less likely to receive critical care (0% vs 22%, p=0.003) and more likely to be discharged to hospice (48% vs 30%, p=0.04). Only one patient with a goals of care discussion died during the index hospitalization (on comfort care) (3%) compared with 9% among those without discussions (p=0.08). Conclusions: Goals of care meetings should be incorporated into usual care for cancer patients with advanced or refractory disease at risk for critical care during a hospitalization, in order to improve concordance between care received and patient and family preferences. Goals of care meetings for advanced/refractory cancer inpatients at risk for critical care can address patient and family goals and needs and improve health care utilization outcomes. These meetings should be part of routine care in this patient population.

Download Full-text

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.488 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 488-488

Author(s):

Nizar Bhulani ◽

Ang Gao ◽

Arjun Gupta ◽

Jenny Jing Li ◽

Chad Guenther ◽

...

Keyword(s):

Health Care ◽

Pancreatic Cancer ◽

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Health Care Utilization ◽

End Of Life ◽

Cancer Patients ◽

Cost Of Care ◽

Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

Download Full-text