Abstract 68: Palliative Care Is Underutilized in Patients with Severe Intracerebral Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
April Sisson ◽  
Karen C Albright ◽  
Michelle Peck ◽  
Linh M Nguyen ◽  
Michael Lyerly ◽  
...  
Keyword(s):  
Palliative Care ◽  
Poor Prognosis ◽  
Care Service ◽  
Care Center ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Palliative Care Service ◽  
Code Status ◽  
Ich Score ◽  
Expected Mortality

Background and Purpose: Palliative care is an essential part of ICH care, particularly in patients with high ICH scores given their poor prognosis. Palliative care involves consultation by the Palliative Care Service and includes de-escalation of care, changing code status, and making pain and symptom relief the central goal of management. Methods: We performed a retrospective review of consecutive patients presenting to our tertiary care center from 2008-2013 with primary ICH. Demographic and clinical data were collected. Our sample included only patients who died or were transferred to hospice. We examined the proportion of patients that received an inpatient palliative care consult and compared this group to patients who did not receive an inpatient palliative care consult. Patients were categorized by ICH score. Results: Of the 99 ICH patients who died or were discharged to hospice, only 23% received a palliative care consult. Figure 1 displays death, predicted death, and palliative care consult proportions by ICH score. Patients that received a Palliative Care consult were older (mean age 65 vs. 73, p=0.018) and more frequently had evidence of infection (32% vs. 13%, p=0.038); no other significant differences were found between groups. Conclusions: In our sample of ICH patients, 23% of patients received a palliative care consult. In those with high ICH scores utilization was only 28%, despite 30 day expected mortality of 97% or greater. This raises concern that palliative care may be underutilized in patients who may benefit from it the most.

Evaluating a Palliative Care Program: Methodology and limitations

1996 ◽  
Vol 12 (2) ◽  
pp. 23-33 ◽  
Author(s):  
Hilary Jarvis ◽  
Frederick I. Burge ◽  
Chris A. Scott
Keyword(s):  
Palliative Care ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Palliative Care Service ◽  
Care Facility ◽  
Maslach Burnout Inventory ◽  
Symptom Distress ◽  
Community Resources ◽  
Tertiary Care Facility ◽  
Distress Scale

The article describes an evaluation of a palliative care service in a regional and tertiary care facility. The service components are described. The four outcomes chosen for evaluation were: (a) symptom relief; (b) satisfaction with care for patients/families; (c) utilization of community resources; (d) good nursing morale and low staff stress. Quality of life was measured using a symptom distress scale; satisfaction using an adapted Kristjanson FAMCARE scale; community resources with opinion and satisfaction surveys; and staff morale and stress with the Maslach Burnout Inventory and Latack's Coping Questionnaire. Results showed that overall symptom distress was reduced. Patients/families were generally satisfied, with some areas needing attention. Physicians were generally satisfied and believed patients/families benefited from the psychosocial support, respite, and education/information. Nurses felt they had the time, energy, resources and support to give quality care.

Quality matters: Patterns of palliative interventions in metastatic colorectal cancer (mCRC) patients.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 83-83
Author(s):  
Rebecca M. Prince ◽  
Shuyin Liang ◽  
Mantaj Brar ◽  
Stephanie Ramkumar ◽  
Adena Scheer ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Quality Care ◽  
Symptom Relief ◽  
Palliative Care Service ◽  
Palliative Surgery ◽  
Cancer Center ◽  
The Mean ◽  
Mean Time

83 Background: Increasing recognition that high-quality end of life care is essential has resulted in internationally endorsed metrics allowing assessment of interventions at the end of life. Median survival for mCRC patients has improved to more than 24 months resulting in increased opportunity to undergo interventions for symptom relief at the end of life. We explored patterns of palliative interventions (chemotherapy, radiotherapy, surgery, endoscopy, drainage procedures) and outcomes in mCRC patients. Methods: A retrospective review was undertaken of all mCRC patients referred to the palliative care service from 2000 to 2010 at a tertiary cancer center in Toronto, Canada. Descriptive statistics, survival analysis and regression were employed. Results: A total of 542 patients were included of whom 52.8% were male, mean age was 62.8 years and 44.6% had stage 4 disease at diagnosis. Over the course of their disease 93.9% had an intervention at any time after their diagnosis including 27.5% of patients undergoing palliative surgery, 77% of patients had an intervention in the last year of life and 19.1% had an intervention in the last 30 days of life. The percentage of patients receiving interventions within the last 14 days of life were 1.23% for chemotherapy, 4.6% for radiotherapy, 0.5% for surgery, 10.4% for endoscopy and 23% drainage procedures. The mean time between referral to palliative care and death was 7 months (SD 10.4). For patients who received chemotherapy, the mean time between last chemotherapy and death was 9.5 months (SD 14.9). Overall survival for patients who did not receive chemotherapy was 28 months (SD 33) compared with 40 months (SD 32) for those who received chemotherapy. Regression analysis for risks of dying within 30 days of chemotherapy was limited by a low event rate. Increasing age was significantly associated with a lower risk of dying within 30 days of chemotherapy. Conclusions: In their final months of life, palliative mCRC patients undergo a significant number of interventions aiming to improve quality of life. These require considerable multi-disciplinary input with ramifications for quality care, planning for service provision and funding.

scholarly journals The First Step to Initiate Pediatric Palliative Care: Identify Patient Needs and Cooperation of Medical Staff

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 127
Author(s):  
Su Hyun Bae ◽  
Yeo Hyang Kim
Keyword(s):  
Palliative Care ◽  
Medical Staff ◽  
Care Service ◽  
Care Center ◽  
Palliative Care Service ◽  
Disease Diagnosis ◽  
Pediatric Palliative Care ◽  
Number Of Patients ◽  
Palliative Care Services ◽  
Limiting Condition

Few Korean hospitals had experience in pediatric palliative care. Since the beginning of the national palliative care project, interest in pediatric palliative care has gradually increased, but the establishment of professional palliative care is still inadequate due to a lack of indicators. This study aimed to find considerations in the process of initiating palliative care services. The general and clinical characteristics of 181 patients aged less than 24 years who were registered at the pediatric palliative care center from January 2019 to August 2021 were evaluated. Life-limiting condition group 1 had the largest number of patients. The primary need for palliative care was psychological and emotional support, followed by information sharing and help in communication with the medical staff in decision-making processes. Seventy-two patients were technologically dependent, with one to four technical supports for each patient. The registration of patients with cancer increased with time, and the time from disease diagnosis to consultation for pediatric palliative care service was significantly reduced. In conclusion, before starting pediatric palliative care, it is necessary to understand the needs of patients and their families and to cooperate with medical staff.

scholarly journals Needs of Terminally ill Patients and their Families: An Experience with Fifty-three Patients Attending a Newly Organized Palliative Care Service in Bangladesh

2009 ◽  
pp. 38-43
Author(s):  
Nezamuddin Ahmad ◽  
Mustafa Kamal ◽  
AHM Mostak Anwar ◽  
AKM Shafiqur Rahman
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Symptom Relief ◽  
Terminally Ill ◽  
Palliative Care Service ◽  
Disease Status ◽  
Symptom Assessment ◽  
Cross Sectional ◽  
Terminally Ill Cancer Patients ◽  
Terminally Ill Patients

Objective: To identify the needed care of the terminally ill patients and their families in Bangladesh Design: Retrospective, descriptive cross-sectional study Setting: Out Patient Consultation, referred admitted patients and home care visits by the same palliative care team of Bangabandhu Sheikh Mujib Medical University (BSMMU) Participants: 53 terminally ill cancer patients registered with the palliative care service of BSMMU Results: Age range of 22 to 80 years, mostly from middle to poor class. Most of the patients needed relief from pain, anxiety, sleeplessness and constipation along with other symptom relief. Major concern of patients was financial whereas major concern of family members was not to inform the patient of the disease status.. Preferred site of care was at home when uncertainty about the disease status was reduced. Conclusion: even if a ‘good life' is not possible for all the people of Bangladesh, ‘a good death for most of the patients suffering from incurable diseases can be an affordable reality. Key words: need, symptom assessment, palliative care, Bangladesh   Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.38-43

The use of opioids in the last month of life in a tertiary cancer center in Jordan.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 54-54
Author(s):  
Omar M. Shamieh ◽  
Sewar S Salmany ◽  
Odai Khamash ◽  
Stella Dawood ◽  
Mustafa Alkhreisat ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Tertiary Care ◽  
Palliative Care Service ◽  
Cancer Center ◽  
Major Barrier ◽  
Survival Difference ◽  
Daily Dose ◽  
Higher Doses

54 Background: The low rates of utilization of opioids is a major barrier to optimal pain control in cancer patients in developing countries. The presence of a palliative care service may improve opioid utilization. In our study we assessed opioid utilization in the last month of life for patients admitted to our tertiary care cancer center in Jordan, and compared the use of opioids with and without palliative care involvement. Methods: We conducted a retrospective chart review to examine opioid use for all adult patients who died at King Hussein Cancer Center between January 1st, 2012 until December 31st, 2012. Patient demographics, cancer diagnosis, type of opioid and total daily dose of opioids in morphine oral equivalent (OME) were collected in the last 30 days of life while admitted to the hospital. Results: Among the 297 patients included, the median age was 58 years (range, 19- 95), 134 (45%) were males, and 186 (62.6%) died under the palliative care service. The median admission length was 7 days. The average daily doses of opioids were 187mg, 214mg, 222mg (OME) in the last 24 hours, 48 hours, and 30 days of life, respectively, In the last 24 and 48 hours before death, 140 (47%) and 228 (77%) patients were on opioids, respectively. Younger age was associated with higher doses of opioids (P= 0.0001). We found no significant differences in patient characteristics between palliative and non-palliative care patients; however, patients under palliative care received significantly higher doses of opioids compared to non-palliative care patients in the last 30 days of life, the average daily dose of opioids (OME) was 249.4mg vs. 11.2mg (P< 0.001). There was no survival difference between palliative and non-palliative patients (P= 0.2244), or between patients who were on opioids or patients who were not (p= 0.57). Conclusions: A large minority of patients did not receive opioids at the end-of-life. Palliative care service was associated with higher utilization of opioids. Palliative care service may assist in pain management at the end-of-life.

Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care service among gynecologic oncology patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11583-11583 ◽  
Author(s):  
Ashley Graul ◽  
Ashley Ford Haggerty ◽  
Carolyn Stickley ◽  
Pallavi Kumar ◽  
Knashawn Morales ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Palliative Care Service ◽  
Cancer Center ◽  
Educational Video ◽  
Oncology Patients ◽  
Care Services ◽  
Palliative Care Services

11583 Background: This was a randomized control trial to estimate the effect of an interventional video on improving palliative care knowledge and acceptability of outpatient services in gynecologic oncology patients. Methods: Women receiving active treatment for gynecologic malignancy (persistent or progressive disease despite primary treatment) were recruited at an academic tertiary care center from 2/2018 to 1/2019 and randomized to: palliative care educational video or non-directive cancer center informational video (control). The primary outcome was desire for referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy (FACT-G) and the Palliative Care Knowledge Scales. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher’s exact tests with significance level of α=0.05. Results: 111 women were enrolled. Demographic characteristics were equally distributed between groups (mean age 63.4 vs 65.4 years; 78% vs 82% Caucasian, 58% vs 68% stage III, 71% vs 64% ovarian cancer, 65% vs 72% platinum-sensitive). There was no statistical difference in knowledge scores or in desire for referral to palliative care (29% vs 27%; p=0.79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 29.7%; p=<0.001). Further, those that desired referral had significantly worse FACT-G scores at time of referral choice (table). Conclusions: Use of a palliative care educational video did not increase knowledge or acceptability of palliative care services within this RCT. However, the rate of patients seeking palliative care referral tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services. [Table: see text]

Role of emergent palliative radiation therapy in the care of patients with cancer.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 201-201 ◽  
Author(s):  
Lisa Singer ◽  
Michael Zhang ◽  
Steve E. Braunstein ◽  
Shannon E. Fogh
Keyword(s):  
Palliative Care ◽  
Radiation Therapy ◽  
Background Radiation ◽  
Care Service ◽  
Symptom Relief ◽  
Palliative Care Service ◽  
Cord Compression ◽  
Patients With Cancer ◽  
Palliative Radiation Therapy ◽  
Chief Complaints

201 Background: Radiation therapy (RT) provides an important role in the palliative care of patients with cancer. For patients with metastatic spinal cord compression not amenable to surgery, the value of timely palliative RT is well established; however, the value of the rapid application of RT for other chief complaints is less clear. The importance of palliative care service (PCS) involvement in patients treated with RT is becoming increasingly recognized and rapidly instituted RT could compromise this involvement. The purpose of this study was to assess the efficacy of emergent RT in alleviating symptoms in patients with cancer and to assess the extent of PCS in the management of patients treated with emergent RT. Methods: Patients treated with emergent RT were retrospectively identified through automated search of our institution’s radiation oncology electronic health record (EHR). Emergent RT was defined as treatment with RT in 48 hours or less from the time of simulation and flagged as emergent in the EHR by the radiotherapy team. Patients without a diagnosis of cancer were excluded from the study. For patients meeting inclusion criteria, data was collected regarding the chief complaint, completion of treatment, length of RT, and the primary outcomes of involvement of PCS and symptom relief. Results: From January to July 2015, 22 patients with cancer were treated with emergent RT. Prior to RT, 21 of 22 patients received other medical and/or procedural interventions. Sixty-four percent of patients were treated with 5 or fewer fractions and all but 2 patients completed RT. Symptoms improved in 73% of patients. PCS were involved in the care of 36% of patients. Conclusions: Emergent palliative RT provided symptom relief in the majority of patients; however, this study identified a lack of PCS involvement in the care of patients treated emergently. Study of long-term patient outcomes is needed. Future work should focus on developing clinical workflows that will better integrate involvement of PCS in the treatment of patients with palliative RT administered both emergently and non-emergently.

scholarly journals Cancer pain: facets of a problem

2018 ◽  
pp. 97-100 ◽  
Author(s):  
G. R. Abuzarova
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Russian Federation ◽  
Care Service ◽  
Care Center ◽  
Palliative Care Service ◽  
Human Suffering ◽  
Oncology Research ◽  
The Russian Federation ◽  
Safe Anaesthesia

Fighting against pain is a primary and very difficult task in palliative care case management. What are the best ways we can reduce human suffering? How to achieve effective and safe anaesthesia? What needs to be done to develop a palliative care service in our country? Read up on this in an interview with the Head of the Oncology Palliative Care Center of the Herzen Moscow Oncology Research Institute of the Ministry of Health of the Russian Federation, Guzel Rafailovna Abuzarova, MD.

scholarly journals 77 National Audit of Care At the End of Life (NACEL)—Round Two Findings

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
D Hibbert
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Palliative Care Service ◽  
Care Plan ◽  
Specialist Palliative Care ◽  
Experience Of Care ◽  
Outcomes Of Care ◽  
Specialist Palliative Care Service ◽  
The Right

Abstract   NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the final admission in acute and community hospitals in England and Wales. Mental health inpatient providers participated in the first round but excluded from the second round. NACEL round two, undertaken during 2019/20, comprised: Data was collected between June and October 2019. 175 trusts in England and 8 Welsh organisations took part in at least one element of NACEL (97% of eligible organisations). Key findings include Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases. The median time from recognition of dying to death was 41 hours (36 hours in the first round). Individual plan of care: 71% of patients, where it had been recognised that the patient was dying (Category 1 deaths), had an individualised end of life care plan. Of the patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: 80% of Quality Survey respondents rated the quality of care delivered to the patient as outstanding/excellent/good and 75% rated the care provided to families/others as outstanding/excellent/good. However, one-fifth of responses reported that the families’/others’ needs were not asked about. Individual plan of care: 80% of Quality Survey respondents believed that hospital was the “right” place to die; however, 20% reported there was a lack of peace and privacy. Workforce Most hospitals (99%) have access to a specialist palliative care service. 36% of hospitals have a face-to-face specialist palliative care service (doctor and/or nurse) available 8 hours a day, 7 days a week. NACEL round three will start in 2021.

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