The ACS-TQIP palliative care guidelines at two level I trauma centres: a prospective study of patient and caregiver satisfaction

2020 ◽  
pp. bmjspcare-2020-002229
Author(s):  
Rebecca Vogel ◽  
Constance McGraw ◽  
Diane Redmond ◽  
Pamela Bourg (retired) ◽  
Chester Dreiman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Family Satisfaction ◽  
Trauma Patients ◽  
Do Not Resuscitate ◽  
Advanced Directives ◽  
Trauma Centres ◽  
Caregiver Satisfaction ◽  
Information Giving ◽  
Level I

ObjectivesTo measure trauma patient and caregiver satisfaction before and after implementation of standardised palliative care (PC) guidelines.MethodsProspective pre–post study at two level-I trauma centres. PC satisfaction surveys were administered prior to discharge for consented trauma patients (Family Satisfaction with Advanced Cancer Scale, Patient (FAMCARE-P13) survey)≥55 years, and their caregivers (FAMCARE survey), from 1 November 2016 to 30 November 2018. Standardised PC guidelines were implemented January 2018 and included consultations, prognostication assessments, identification of proxies, review of advanced directives and do not resuscitate orders within 24 hours of admission, while advanced goals of care, formal family meetings and spiritual care support were recommended within 72 hours of admission. Generalised linear models were used to determine whether differences in patient or caregiver satisfaction existed pre versus post implementation.ResultsThere were 572 patients (299 pre; 273 post) and 595 caregivers (334 pre; 261 post) included. Overall patient satisfaction significantly increased post implementation (82.0 vs 86.0, p=0.001). After adjustment, the implementation of the guidelines was an independent predictor of higher overall patient satisfaction (least squares mean (LSM= (83.8% (95%CI 81.2%-86.5%) vs 80.3% (77.7%-82.9%), p=0.003)). Compared with preimplementation, patient satisfaction was significantly higher post implementation in the following domains: information giving (80.9 vs 85.5, p=0.001), followed by physical care (82.2 vs 86.0, p=0.002), availability of care (83.4 vs 86.8, p=0.007) and psychosocial care (84.7 vs 87.6, p=0.04). No significant differences in caregiver satisfaction were found before or after adjustment (LSMpre: 83.1% (95%CI 80.9%-85.3%) vs. post: 82.4% (80.3%-84.5%), p=0.56))ConclusionsOur data suggest that the implementation of PC guidelines significantly improved patient satisfaction following traumatic injury, while maintaining robust caregiver satisfaction.

scholarly journals Is Preexisting Mental Illness Associated with Lower Patient Satisfaction for Older Trauma Patients? A Cross-sectional Descriptive Study

2020 ◽  
Author(s):  
Constance McGraw ◽  
Jennifer Pekarek ◽  
Diane Redmond ◽  
Rebecca Vogel ◽  
Allen Tanner ◽  
...  
Keyword(s):  
Mental Illness ◽  
Patient Satisfaction ◽  
Linear Models ◽  
Family Satisfaction ◽  
Patient Survey ◽  
Satisfaction With Care ◽  
Trauma Patients ◽  
Cross Sectional ◽  
The Family ◽  
Level I

Abstract Background The purpose of this study was to examine if satisfaction with care differs among older trauma patients with and without preexisting mental illness (PMI+/PMI-). Methods Data from two level I trauma centers were examined 11/2016-12/2017. Trauma patients ≥ 55 years were included and satisfaction of those who had a diagnosis of mental illness prior to the trauma admission (PMI+) to those without a diagnosis (PMI-) (n = 299; 62 PMI + and 237 PMI-) were compared. Enrolled patients completed the Family Satisfaction with Advanced Care Cancer Scale Patient Survey (FAMCARE-P13) prior to discharge. Associations between mental illness status and patient baseline characteristics, overall mean satisfaction, and mean satisfaction by question were compared. Generalized linear models adjusted for differences in patient satisfaction by mental illness status. Analyses were stratified by hospital to account for the interaction between hospital and mental illness status. Results Compared to PMI- patients, PMI + patients were more likely to be younger, female, have multiple comorbidities, and to report lower overall satisfaction with care. Among PMI + patients, the most common diagnoses were depression and anxiety. After adjustment, PMI + was associated with lower patient satisfaction at hospital 1; after examining individual questions lower satisfaction was associated with information provided on procedures and questions surrounding “Physical care.” Conversely, PMI + did not affect satisfaction at hospital 2 after adjustment. Conclusions At hospital 1, room for improvement was identified in providing information about prognosis and procedures, symptom management, and continuity of care. Reexamining practices for older PMI + trauma patients is warranted.

scholarly journals Is Preexisting Mental Illness Associated with Lower Patient Satisfaction for Older Trauma Patients? A Cross-sectional Descriptive Study

2020 ◽  
Author(s):  
Constance McGraw ◽  
Jennifer Pekarek ◽  
Diane Redmond ◽  
Rebecca Vogel ◽  
Allen Tanner ◽  
...  
Keyword(s):  
Mental Illness ◽  
Patient Satisfaction ◽  
Linear Models ◽  
Family Satisfaction ◽  
Patient Survey ◽  
Satisfaction With Care ◽  
Trauma Patients ◽  
Cross Sectional ◽  
The Family ◽  
Level I

Abstract Background: The purpose of this study was to examine if satisfaction with care differs among older trauma patients with and without preexisting mental illness (PMI+/PMI-).Methods: Data from two level I trauma centers were examined 11/2016-12/2017. Trauma patients ≥55 years were included and satisfaction of those who had a diagnosis of mental illness prior to the trauma admission (PMI+) to those without a diagnosis (PMI-) (n=299; 62 PMI+ and 237 PMI-) were compared. Enrolled patients completed the Family Satisfaction with Advanced Care Cancer Scale Patient Survey (FAMCARE-P13) prior to discharge. Associations between mental illness status and patient baseline characteristics, overall mean satisfaction, and mean satisfaction by question were compared. Generalized linear models adjusted for differences in patient satisfaction by mental illness status. Analyses were stratified by hospital to account for the interaction between hospital and mental illness status.Results: Compared to PMI- patients, PMI+ patients were more likely to be younger, female, have multiple comorbidities, and to report lower overall satisfaction with care. Among PMI+ patients, the most common diagnoses were depression and anxiety. After adjustment, PMI+ was associated with lower patient satisfaction at hospital 1; after examining individual questions lower satisfaction was associated with information provided on procedures and questions surrounding “Physical care.” Conversely, PMI+ did not affect satisfaction at hospital 2 after adjustment.Conclusions: At hospital 1, room for improvement was identified in providing information about prognosis and procedures, symptom management, and continuity of care. Reexamining practices for older PMI+ trauma patients is warranted.

scholarly journals Is Preexisting Mental Illness Associated with Lower Patient Satisfaction for Older Trauma Patients? A Cross-sectional Descriptive Study

2021 ◽  
Author(s):  
Constance McGraw ◽  
Jennifer Pekarek ◽  
Diane Redmond ◽  
Rebecca Vogel ◽  
Allen Tanner ◽  
...  
Keyword(s):  
Mental Illness ◽  
Patient Satisfaction ◽  
Linear Models ◽  
Family Satisfaction ◽  
Patient Survey ◽  
Satisfaction With Care ◽  
Trauma Patients ◽  
Cross Sectional ◽  
The Family ◽  
Level I

Abstract Background: The purpose of this study was to examine if satisfaction with care differs among older trauma patients with and without preexisting mental illness (PMI+/PMI-).Methods: Data from two level I trauma centers were examined from 11/2016 through 12/2017. Trauma patients ≥55 years were included and satisfaction of those who had a diagnosis of mental illness prior to the trauma admission (PMI+) to those without a diagnosis (PMI-) (n=299; 62 PMI+ and 237 PMI-) were compared. Enrolled patients completed the Family Satisfaction with Advanced Care Cancer Scale Patient Survey (FAMCARE-P13) prior to discharge. Associations between mental illness status and patient baseline characteristics, overall mean satisfaction, and mean satisfaction by question were compared. Generalized linear models adjusted for differences in patient satisfaction by mental illness status. Analyses were stratified by hospital to account for the interaction between hospital and mental illness status.Results: Compared to PMI- patients, PMI+ patients were more likely to be younger, female, have multiple comorbidities, and to report lower overall satisfaction with care. Among PMI+ patients, the most common diagnoses were depression and anxiety. After adjustment, PMI+ was associated with lower patient satisfaction at hospital 1; after examining individual questions lower satisfaction was associated with information provided on procedures and questions surrounding “Physical care.” Conversely, PMI+ did not affect satisfaction at hospital 2 after adjustment.Conclusions: At hospital 1, room for improvement was identified in providing information about prognosis and procedures, symptom management, and continuity of care. Reexamining practices for older PMI+ trauma patients is warranted.

scholarly journals Is preexisting mental illness associated with lower patient satisfaction for older trauma patients? A cross-sectional descriptive study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Constance McGraw ◽  
Jennifer Pekarek ◽  
Diane Redmond ◽  
Rebecca Vogel ◽  
Allen Tanner ◽  
...  
Keyword(s):  
Mental Illness ◽  
Patient Satisfaction ◽  
Linear Models ◽  
Family Satisfaction ◽  
Patient Survey ◽  
Satisfaction With Care ◽  
Trauma Patients ◽  
Cross Sectional ◽  
The Family ◽  
Level I

Abstract Background The purpose of this study was to examine if satisfaction with care differs among older trauma patients with and without preexisting mental illness (PMI+/PMI-). Methods Data from two level I trauma centers were examined from 11/2016 through 12/2017. Trauma patients ≥55 years were included and satisfaction of those who had a diagnosis of mental illness prior to the trauma admission (PMI+) to those without a diagnosis (PMI-) (n = 299; 62 PMI+ and 237 PMI-) were compared. Enrolled patients completed the Family Satisfaction with Advanced Care Cancer Scale Patient Survey (FAMCARE-P13) prior to discharge. Associations between mental illness status and patient baseline characteristics, overall mean satisfaction, and mean satisfaction by question were compared. Generalized linear models adjusted for differences in patient satisfaction by mental illness status. Analyses were stratified by hospital to account for the interaction between hospital and mental illness status. Results Compared to PMI- patients, PMI+ patients were more likely to be younger, female, have multiple comorbidities, and to report lower overall satisfaction with care. Among PMI+ patients, the most common diagnoses were depression and anxiety. After adjustment, PMI+ was associated with lower patient satisfaction at hospital 1; after examining individual questions lower satisfaction was associated with information provided on procedures and questions surrounding “Physical care.” Conversely, PMI+ did not affect satisfaction at hospital 2 after adjustment. Conclusions At hospital 1, room for improvement was identified in providing information about prognosis and procedures, symptom management, and continuity of care. Reexamining practices for older PMI+ trauma patients is warranted.

Phase II Study of an Outpatient Palliative Care Intervention in Patients With Metastatic Cancer

2009 ◽  
Vol 27 (2) ◽  
pp. 206-213 ◽  
Author(s):  
Matthew Follwell ◽  
Debika Burman ◽  
Lisa W. Le ◽  
Kristina Wakimoto ◽  
Dori Seccareccia ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Metastatic Cancer ◽  
Symptom Control ◽  
Family Satisfaction ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale ◽  
The Mean

Purpose Although there is increasing advocacy for timely symptom control in patients with cancer, few studies have assessed outpatient palliative care clinics. This study assessed prospectively the efficacy of an Oncology Palliative Care Clinic (OPCC) in improving patient symptom distress and satisfaction. Patients and Methods Eligible patients were new referrals to an OPCC, had metastatic cancer, were at least 18 years old, and were well enough and able to speak and read English sufficiently to provide informed consent and complete questionnaires. Patients received a consultation by a palliative care team. The primary end points of symptom control and patient satisfaction were assessed using the Edmonton Symptom Assessment Scale (ESAS) and patient-adapted Family Satisfaction with Advanced Cancer Care (FAMCARE) scale at baseline, 1 week, and 1 month. Initial and follow-up scores were compared using paired t tests. Results Of 150 patients enrolled, 123 completed 1-week assessments, and 88 completed 4-week assessments. At baseline, the mean ESAS Distress Score (EDS) was 39.5. The mean improvement in EDS was 8.8 points (P < .0001) at 1 week and 7.0 points (P < .0001) at 1 month. Statistically significant improvements were observed for pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, dyspnea, insomnia, and constipation at 1 week (all P ≤ .005) and 1 month (all P ≤ .05). The mean improvement in FAMCARE score was 6.1 points (P < .0001) at 1 week and 5.0 points (P < .0001) at 1 month. Conclusion This phase II study demonstrates efficacy of an OPCC for improvement of symptom control and patient satisfaction with care. Randomized controlled trials are indicated to further evaluate the effectiveness of specialized outpatient palliative care.

Nurses experience of communication with palliative patients in critical care unit: Saudi experience

2016 ◽  
Vol 5 (2) ◽  
pp. 102 ◽  
Author(s):  
Hanan Alshehri ◽  
Samantha Ismaile
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Do Not Resuscitate ◽  
Cross Sectional ◽  
Advanced Directives ◽  
Critical Care Units ◽  
Feeding Tubes ◽  
Common Causes ◽  
Cross Sectional Design ◽  
Palliative Patients

Communication is crucial regardless of a patient's condition in Critical Care Units (CCU). However; communication barriers are common in CCU. In recent years there has been a rapid growth within hospital settings in the provision of palliative care according to patient needs. The purpose of the research study was to investigate nurses’ experiences of communication with palliative patients in CCU. A cross sectional design was conducted using questionnaire. The study sample included nurses who were working in CCU. The total number of completed and submitted questionnaires were 61. The majority of respondents were females. The results show that 49% of respondents have experienced difficulties in palliative care tasks while 41% respondents have complications with communication in palliative care. Also, nurses who took part in this study reported difficultly in discussing decisions such as advanced directives, do not resuscitate orders, and feeding tubes. In conclusion, nurses experience difficulty with communication whilst carrying out palliative care tasks in critical care units. The common causes of communication difficulty are because of the complexity of palliative care tasks, language barriers, shortage of staff and feeling un-empowered. Moreover, there is a lack of education programs centered around enhancing communication difficulties between nurses and palliative patients.

Structured outpatient palliative care family conferences to enhance early integration of palliative care in advanced cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 36-36
Author(s):  
Cheruppolil R. Santhosh-Kumar ◽  
Deborah Gray ◽  
Stephanie Struve ◽  
Carol Huibregtse
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Direct Result ◽  
Do Not Resuscitate ◽  
Advanced Directives ◽  
Early Integration ◽  
Early Palliative Care ◽  
Family Conference ◽  
Nurse Navigator ◽  
Care Family

36 Background: Integrating early palliative care with cancer treatment improves quality of life and survival. Effective communication among physicians, patients and their loved ones is crucial to end-of-life, hospice and palliative care discussions. To address the inherent challenges in these discussions, we implemented a structured outpatient palliative care family conference (OFC) program at our community cancer clinic. Methods: A team comprising a hematologist/oncologist, cancer nurse navigator and social worker developed a toolkit for conducting an OFC, recognizing that each family conference is a unique adaptive challenge. New patients with advanced malignancies and limited life expectancy (<12 months) were offered a 90-minute structured OFC attended by the care team, patient and family members and or friends. Pre and post-conference patient satisfaction surveys and other data were collected prospectively. Results: From March 2014 through May 2015, fortyOFC were conducted (16 female and 24 male patients, median age: 67 years). Diagnoses were advanced gastrointestinal (14), lung (12), hematologic (6) and other (8) malignancies. As a direct result of the OFC program, 18 patients ordered do-not-resuscitate bracelets, 15 completed advanced directives, 7 submitted paperwork for disabled parking permits, 7 were referred to hospice and 4 for rehabilitation therapy. Further results are shown in the table. Conclusions: Structured outpatient palliative care family conferences improve satisfaction of end-of-life discussions and facilitate integration of palliative care options. Enhanced communication between providers, patients and loved ones eases the challenges of such discussions. The OFC approach could be a model for integrating palliative care in community cancer clinics. [Table: see text]

Embedding palliative care into care coordination.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 62-62
Author(s):  
Finly Zachariah ◽  
Mariela Gallo ◽  
Matthew Loscalzo ◽  
Laura E. Crocitto
Keyword(s):  
Palliative Care ◽  
Bladder Cancer ◽  
Cancer Patients ◽  
Care Coordination ◽  
Multidisciplinary Team ◽  
Average Length ◽  
Family Satisfaction ◽  
Cost Index ◽  
Average Case ◽  
Advanced Directives

62 Background: The Institute of Medicine (IOM) identified care coordination as a key strategy with potential to improve the safety and effectiveness of implemented care by deliberately organizing patient care activities and sharing information among all participants concerned. Palliative care maximizes quality of life for patient and family in serious illness and can be provided early and concurrently with curative therapies. At City of Hope National Medical Center (COH), we developed a pilot program for bladder cancer patients undergoing cystectomy to provide the benefits of care coordination and palliative care. Methods: 72 patients underwent cystectomy at COH from 2011-2013, the average case mix index was 3.51, the average length of stay (LOS) was 10.65 days, the LOS index was.92, Cost index 1.61, 30-day readmission rate 32.14%, and the most common causes for readmission were infection and dehydration. Based on comparative data, the urology service supported development of a novel pathway by a multidisciplinary team. The goals of the pathway are to facilitate navigation through the healthcare system, integrate tablet-based bio-psycho-social screening to proactively address patient and caregiver needs and goals, optimize medications to improve symptom management and recovery, empower patients with teach-back education, have anticipated interventions for likely readmission reasons, and develop effective collaboration amongst multidisciplinary providers across settings. The metrics include LOS, readmission rates, patient and family satisfaction, advanced directives on file, and cost index. Results: Hospital leadership and provider buy in was obtained, a daily rounding multidisciplinary team was created, change champions were identified, staff engagement increased, and COH and community agency staff were equipped with needed skills and support. Care model diagrams and clinical pathway orders were developed. Education materials were revised and updated. The pilot launched in April of 2014. Conclusions: We believe that a care coordination model with early integration of palliative care will improve the effectiveness of care delivered to our bladder cancer patients. A six-month retrospective review will be done to assess metric achievement.

scholarly journals Examining satisfaction of older adult patients and their caregivers following traumatic injury: a cross-sectional study of three level I trauma centres

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032374 ◽  
Author(s):  
Rebecca Vogel ◽  
Constance McGraw ◽  
Alessandro Orlando ◽  
Pamela Bourg ◽  
Chester Dreiman ◽  
...  
Keyword(s):  
Older Adult ◽  
Traumatic Injury ◽  
Primary Caregivers ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Trauma Centres ◽  
Caregiver Satisfaction ◽  
Level I

ObjectiveTo explore satisfaction of care received by older adult patients and their primary caregivers following traumatic injury.DesignProspective, cross-sectional study using the FAMCARE (Family Satisfaction with Advanced Cancer Care Scale) satisfaction surveys prior to discharge.SettingThree level I trauma centres in Colorado from November 2016 to December 2017.ParticipantsTrauma patients ≥55 years old and their primary caregivers.Outcome measuresOverall mean (SD) satisfaction, satisfaction <80% vs ≥80%, and mean satisfaction by survey conceptual structures.ResultsOf the 319 patients and 336 caregivers included, the overall mean (SD) patient satisfaction was 81.7% (15.0%) and for caregivers was 83.6% (13.4%). The area with the highest mean for patient and caregiver satisfaction was psychosocial care (85.4% and 86.9%, respectively). Information giving was the lowest for patients (80.4%) and caregivers (80.9%). When individual items were examined, patients were significantly more satisfied with ‘availability of nurses to answer questions’ (84.5 (15.3) vs 87.4 (14.8), p=0.02) and significantly less satisfied with ‘speed with which symptoms were treated’ (80.6 (17.9) vs 84.0 (17.0), p=0.03) compared with caregivers. Patients with a history of smoking (least squares mean difference: −0.096 (−0.18 to –0.07), p<0.001) and hospital discharge destination to an outside facility of care (adjusted OR: 1.6 (1.0 to 2.4), p=0.048) were identified as independent predictors of lower overall satisfaction in generalised linear and logistic models, respectively.ConclusionsOur data suggest that patients’ medical history was driving both patient and caregiver satisfaction. Patient characteristics and expectations need to be considered when tailoring healthcare interventions.

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