What happens during early outpatient palliative care consultations for persons with newly diagnosed advanced cancer? A qualitative analysis of provider documentation

2017 ◽  
Vol 32 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Gulcan Bagcivan ◽  
J Nicholas Dionne-Odom ◽  
Jennifer Frost ◽  
Margaret Plunkett ◽  
Lisa A Stephens ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Specific Treatment ◽  
Well Being ◽  
Treatment Recommendations ◽  
Newly Diagnosed ◽  
Advanced Cancer Patients ◽  
Marital Partner ◽  
Palliative Care Consultation

Background: Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters. Aim: Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations. Design: Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated. Setting/participants: Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US. Results: In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations—marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms—mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations—counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations—pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants. Conclusion: Outpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients’ needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom indicators versus reliance on oncologist referral.

Assessing hope at the end of life: Validation of an experience of hope scale in advanced cancer patients

2004 ◽  
Vol 2 (3) ◽  
pp. 243-253 ◽  
Author(s):  
CHERYL L. NEKOLAICHUK ◽  
EDUARDO BRUERA
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Well Being ◽  
Assessment System ◽  
Validity Evidence ◽  
Advanced Cancer Patients ◽  
Factor I ◽  
Factor Ii

Objective:The purpose of this study was to gather validity evidence for an innovative experience of hope scale, theHope Differential-Short (HDS), and evaluate its clinical utility for assessing hope in advanced cancer patients.Methods:A consecutive sampling approach was used to recruit 96 patients from an inpatient tertiary palliative care unit and three hospice settings. Each participant completed an in-person survey interview, consisting of the following measures: HDS (nine items), Herth Hope Index (HHI), hope visual analog scale (Hope-VAS) and Edmonton Symptom Assessment System (ESAS).Results:Using factor analytic procedures, a two-factor structure for the HDS was identified, consisting ofauthentic spirit(Factor I) andcomfort(Factor II). The HDS factors had good overall internal consistency (α = 0.83), with Factor I (α = 0.83) being higher than Factor II (α = 0.69). The two factors positively correlated with the HHI, Hope-VAS, and one of the ESAS visual analog scales, well-being (range: 0.38 to 0.64) and negatively correlated with depression and anxiety, as measured by the ESAS (range: −0.25 to −0.42).Significance of results:This is the first validation study of the HDS in advanced cancer patients. Its promising psychometric properties and brief patient-oriented nature provide a solid initial foundation for its future use as a clinical assessment measure in oncology and palliative care. Additional studies are warranted to gather further validity evidence for the HDS before its routine use in clinical practice.

Differences in performance status assessments between palliative care specialists, nurses, and oncologists.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 19-19
Author(s):  
YuJung Kim ◽  
Yi Zhang ◽  
Ji Chan Park ◽  
David Hui ◽  
Gary B. Chisholm ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Well Being ◽  
Assessment Tools ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale ◽  
Ecog Ps

19 Background: The Eastern Cooperative Oncology Group (ECOG) performance status (PS) is one of the most commonly used assessment tools among oncologists and palliative care specialists caring advanced cancer patients. However, the inter-observer difference between the oncologist and palliative care specialist has never been reported. Methods: We retrospectively reviewed the medical records of all patients who were first referred to an outpatient palliative care clinic in 2013 and identified 278 eligible patients. The ECOG PS assessments by palliative care specialists, nurses, and oncologists, and the symptom burden measured by Edmonton Symptom Assessment Scale (ESAS) were analyzed. Results: According to the pairwise comparisons using Sign tests, palliative care specialists rated the ECOG PS grade significantly higher than oncologists (median 0.5 grade, P<0.0001) and nurses also rated significantly higher (median 1.0 grade, P<0.0001). The assessments of palliative care specialists and nurses were not significantly different (P=0.10). Weighted kappa values for inter-observer agreement were 0.26 between palliative care specialists and oncologists, and 0.61 between palliative care specialists and nurses. Palliative care specialists’ assessments showed a moderate correlation with fatigue, dyspnea, anorexia, feeling of well-being, and symptom distress score measured by ESAS. The ECOG PS assessments by all three groups were significantly associated with survival (P<0.001), but the assessments by oncologists could not distinguish survival of patients with PS 2 from 3. Independent predictors of discordance in PS assessments between palliative care specialists and oncologists were the presence of an effective treatment option (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.09-5.23) and poor feeling of well-being (≥4) by ESAS (OR 2.38, 95% CI 1.34-4.21). Conclusions: ECOG PS assessments by the palliative care specialists and nurses were significantly different from the oncologists. Systematic efforts to increase regular interdisciplinary meetings and communications might be crucial to bridge the gap and establish a best care plan for each advanced cancer patients.

The ESCAPADE Study: Early supportive care for advanced cancer patients, assessing care delivery and provider engagement.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23142-e23142
Author(s):  
Oren Hannun Levine ◽  
Daryl Bainbridge ◽  
Gregory Russell Pond ◽  
Marissa Slaven ◽  
Sukhbinder K. Dhesy-Thind ◽  
...  
Keyword(s):  
Palliative Care ◽  
Disease Management ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Newly Diagnosed ◽  
Care Providers ◽  
Advanced Cancer Patients ◽  
Gi Cancer

e23142 Background: Advanced cancer patients benefit from early integration of palliative care (EIPC) with usual care. A proposed model of EIPC reserves specialized palliative care (SPC) for complex patients, while primary care providers (PCP) and oncologists oversee basic palliative care (PC). We studied the attitudes among patients and their healthcare providers regarding delivery of EIPC. Methods: A cross-sectional study at a tertiary cancer centre in Ontario. Patients with newly diagnosed incurable gastrointestinal (GI) cancer were surveyed using a study specific instrument for the outcomes of interest: importance of and preferences for accessing support across 8 domains of PC (disease management, physical, psychological, social, spiritual, practical, end of life care, loss and grief). Healthcare providers within the circle of care completed a parallel survey for each recruited patient. Primary analysis involved use of descriptive statistics to summarize survey results and concordance between patient and provider responses. Results: From Oct 2017 - Nov 2018, 67 patients were surveyed (median age 69, 34% female). 90% had an identified medical oncologist, and 19% had SPC. 97% had a PCP, but only 42% listed a PCP as part of the care team. Median time from first oncology assessment for advanced cancer to patient survey completion was 52.5 days. 85 providers responded (oncologist = 59, PCP = 20, SPC = 6; response rate 92%; 1-3 physician responses per patient). Disease management and physical concerns were most important to patients. In these domains, 67% and 81% of patients endorsed receiving care from the preferred provider, but concordance between patient and physician responses regarding most responsible provider was only 58% and 38%. For all other domains, 87 – 100% of patients attributed primary responsibility to self or family rather than any healthcare provider. Conclusions: Respondents did not assign responsibility to physicians early in the disease trajectory for many domains of PC. Our findings suggest that incorporating patient activation and empowerment into EIPC requires further study. PCPs appeared to have limited involvement in PC for newly diagnosed advanced GI cancer patients.

Spiritual well-being of Italian advanced cancer patients in the home palliative care setting

2017 ◽  
Vol 26 (4) ◽  
pp. e12677 ◽  
Author(s):  
A. A. Martoni ◽  
S. Varani ◽  
B. Peghetti ◽  
D. Roganti ◽  
E. Volpicella ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Care Setting ◽  
Well Being ◽  
Advanced Cancer Patients ◽  
Palliative Care Setting ◽  
Spiritual Well Being

scholarly journals Blood Transfusions and Palliative Care: Systematic Literature Review

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Marta Ibáñez ◽  
María Vicuña ◽  
Luis Málaga ◽  
Diana Vega
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Well Being ◽  
World Health ◽  
Blood Transfusions ◽  
Advanced Cancer Patients ◽  
Text Reading ◽  
Health Organization ◽  
Key Words Palliative Care ◽  
Main Effects

Anemia is an important condition related with symptoms in the later stages of disease; according to World Health Organization its prevalence is between 68-77% in patients with advanced cancer. There is no specific clinical guideline and we do not have clear evidence of the effect of blood transfusions in palliative care. Objective: Understand indicators and complications of the transfusions on advanced cancer patients. Methodology: In 2019 a systematic review on PubMed and Cochrane took place, using the key words: Palliative care AND Blood transfusion; analyzing: Type of study; sample size; Pathologies; transfusion criterion; Transfusions benefits; side effects; Survival; and amount of transfused concentrates. Results: 81 articles selected, adding 6 after a full text reading. For the most part, patients with solid tumors are described and some with no oncology pathology. The symptoms indicated by the transfusion are: Fatigue, dyspnea, asthenia, headache and/or brisk bleeding. Transfused unit’s average was 2 units. Only two studies present a post-transfusion recovery and less than half display information as to associated mortality. Conclusions: There is no consensus regarding the transfusion indication. The asthenia recovery, well-being, and quality of life based on subjective criteria, are the main effects described. More studies are required.

Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer

2021 ◽  
pp. 104990912098680
Author(s):  
Paige E. Sheridan ◽  
Wendi G. LeBrett ◽  
Daniel P. Triplett ◽  
Eric J. Roeland ◽  
Andrew R. Bruggeman ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Costs ◽  
Healthcare Expenditure ◽  
Advanced Cancer Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: There is inconsistent evidence that palliative care intervention decreases total healthcare expenditure at end-of-life for oncology patients. This inconsistent evidence may result from small sample sizes at single institution studies and disparate characterization of costs across studies. Comprehensive studies in population-based datasets are needed to fully understand the impact of palliative care on total healthcare costs. This study analyzed the impact of palliative care on total healthcare costs in a nationally representative sample of advanced cancer patients. Methods: We conducted a matched cohort study among Medicare patients with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation on factors related to both the receipt of palliative care and end of life costs. We compared direct costs between matched patients to determine the per-patient economic impact of a palliative care consultation. Results: Patients who received a palliative care consultation experienced an average per patient cost of $5,834 compared to $7,784 for usual care patients (25% decrease; p < 0.0001). Palliative care consultation within 7 days of death decreased healthcare costs by $451, while palliative care consultation more than 4 weeks from death decreased costs by $4,643. Conclusion: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditure among advanced cancer patients. Earlier palliative care consultation results in greater cost reductions than consultation in the last week of life.

Nurse-Led Palliative Care for Advanced Cancer Patients (DRAFT)

2018 ◽  
Author(s):  
Emily J. Martin ◽  
Eric J. Roeland
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Control Group ◽  
Advanced Cancer Patients ◽  
Intention To Treat ◽  
Symptom Intensity

This chapter summarizes the Bakitas et al. 2009 Project ENABLE II randomized controlled trial, which examined how a nurse-led palliative care intervention, provided concurrently with usual oncologic care, impacted quality of life, symptom intensity, mood, and resource use among advanced cancer patients. Longitudinal intention-to-treat analyses showed greater quality of life and less depressed mood in patients who received palliative care as compared with the control group. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

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