scholarly journals Capturing what matters: A retrospective observational study of advance care planning documentation at an academic medical center during the COVID-19 pandemic

2021 ◽  
pp. 026921632110659
Author(s):  
Fangdi Sun ◽  
Raphaela Lipinsky DeGette ◽  
Elizabeth C Cummings ◽  
Lisa X Deng ◽  
Karen A Hauser ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Care Planning ◽  
Code Status ◽  
Palliative Care Consultation ◽  
Advance Care ◽  
Care Consultation

Background: Advance care planning allows patients to share their preferences for medical care with the aim of ensuring goal-concordant care in times of serious illness. The morbidity and mortality of the COVID-19 pandemic has increased the importance and public visibility of advance care planning. However, little is known about the frequency and quality of advance care planning documentation during the pandemic. Aim: This study examined the frequency, quality, and predictors of advance care planning documentation among hospitalized medical patients with and without COVID-19. Design: This retrospective cohort analysis used multivariate logistic regression to identify factors associated with advance care planning documentation. Setting/participants: This study included all adult patients tested for COVID-19 and admitted to a tertiary medical center in San Francisco, CA during March 2020. Results: Among 262 patients, 31 (11.8%) tested positive and 231 (88.2%) tested negative for SARS-CoV-2. The rate of advance care planning documentation was 38.7% in patients with COVID-19 and 46.8% in patients without COVID-19 ( p = 0.45). Documentation consistently addressed code status (100% and 94.4% for COVID-positive and COVID-negative, respectively), but less often named a surrogate decision maker, discussed prognosis, or elaborated on other wishes for care. Palliative care consultation was associated with increased advance care planning documentation (OR: 6.93, p = 0.004). Conclusion: This study found low rates of advance care planning documentation for patients both with and without COVID-19 during an evolving global pandemic. Advance care planning documentation was associated with palliative care consultation, highlighting the importance of such consultation to ensure timely, patient-centered advance care planning.

Patient perceptions of palliative care in the process of allogeneic hematopoietic cell transplantation.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24082-e24082
Author(s):  
Megan Elizabeth Melody ◽  
Chimere Bruning ◽  
Rachel Mack ◽  
Kimberley Parrott ◽  
Richard Taylor ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Palliative Medicine ◽  
Hematopoietic Cell Transplantation ◽  
Patient Perceptions ◽  
Comfort Level ◽  
Care Planning ◽  
Palliative Care Consultation ◽  
Advance Care ◽  
Care Consultation

e24082 Background: Allogeneic hematopoietic cell transplantation (allo-HCT) is associated with significant short- and long-term sequelae that affect patients’ overall quality of life (QoL) and their physical and psychological well-being. Studies have shown improvement in patient QoL and physician satisfaction with palliative care involvement in the allo-HCT process. However, patient and physician perceptions regarding palliative care often impact timely referral. We conducted a prospective study to examine patient perceptions of palliative care both before and after palliative care consultation during evaluation for allo-HCT. Methods: This is a prospective, single-center study, of patients > 18 years of age, who were referred for a palliative care consultation as part of standard evaluation for allo-HCT. Patients were administered a pre- and post-visit internally derived questionnaire to assess their understanding and comfort level with palliative care. The primary objective of this study was to examine patient perceptions of palliative care consultation during evaluation for allo-HCT. Primary end point was the change in patient pre- and post- questionnaire responses. Secondary endpoint was the completion of advance care planning documentation pre- and post- consultation. Results: We enrolled 32 patients (male = 14) undergoing evaluation for allo-HCT with a primary diagnosis of AML (n = 8), NHL (n = 8), MDS (n = 7), ALL (n = 2), and other (n = 7). Following consultation with palliative care there was a statistically significant increase in patient understanding of the reason for the appointment, p = 0.0006. There was also a significant increase in patient’s knowledge of palliative care, with only 28% describing their knowledge as “good” or “excellent” prior to consultation and 79.3% after consultation, p < 0.0001. There was an observed positive, non-statistically significant, trend in patient comfort level with palliative medicine with only 20.7% (n = 6) describing their comfort as “high” or “very high” prior to consultation and 51.7% (n = 15) after consultation, p = 0.60. There was a higher rate of completion of advance care planning documentation following consultation with palliative medicine 56.3% vs 71.4%, p = 0.042. Conclusions: Palliative care consultation prior to allo-HCT increases a patient’s understanding of the role of palliative medicine as part of their allo-HCT and improves advance care planning. These findings need to be validated in a larger, multicenter, patient cohort.

Access to Palliative Care Consultation and Advance Care Planning for Adults with High-Risk Leukemia

2018 ◽  
Vol 21 (2) ◽  
pp. 225-228 ◽  
Author(s):  
Ashley T. Freeman ◽  
William A. Wood ◽  
Alexandra Fox ◽  
Laura C. Hanson
Keyword(s):  
Palliative Care ◽  
High Risk ◽  
Advance Care Planning ◽  
Care Planning ◽  
Palliative Care Consultation ◽  
Advance Care ◽  
Care Consultation

Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation

2016 ◽  
Vol 34 (5) ◽  
pp. 461-465 ◽  
Author(s):  
Arif H. Kamal ◽  
Janet Bull ◽  
Steven P. Wolf ◽  
Diane Portman ◽  
Jacob Strand ◽  
...  
Keyword(s):  
Palliative Care ◽  
African Americans ◽  
Advance Care Planning ◽  
Care Quality ◽  
Care Planning ◽  
Racial Groups ◽  
Palliative Care Consultation ◽  
Patient Reported ◽  
Advance Care ◽  
Care Consultation

Context: Differences among patient populations that present to consultative palliative care are not known. Such an appreciation would inform health-care delivery tailored to unique populations. Objectives: We aimed to compare characteristics and palliative care needs of African Americans (AAs) and whites during initial palliative care consultation. Methods: We analyzed patient-reported, clinician-entered clinical encounter data from a large, multisite community-based, nonhospice palliative care collaborative. We included first specialty palliative care consultations from January 1, 2014, to July 2, 2015, across 15 sites within the Global Palliative Care Quality Alliance registry. Demographics, disease, performance status, advance care planning, and symptom prevalence/severity were compared. Results: Of 775 patients, 12.9% (N = 100) were AA. African Americans were younger (63 vs 75.4 years, P < .0001). A larger proportion of AAs had a diagnosis of cancer (45.0% vs 36.3%, P = .09) and in the hospital (71% vs 61.8%, P = .07). African Americans were more likely to have a Palliative Performance Score of 0 to 30 (35.6% vs 23.7%, P = .049). Around 50% in both racial groups were full code; slightly more than 40% had an advance directive. Nearly two-thirds in both racial groups reported 3 or more symptoms of any severity; one-third reported 3 or more moderate or severe symptoms. A larger proportion of Africans than whites reported pain of any severity (66.0% vs 56.1%, P = .06). Conclusion: All patients present to palliative care consultations with significant symptom and advance care planning needs. Further research is needed to identify how to deliver palliative care: earlier, in noncancer conditions, and improve pain management in AA populations.

scholarly journals Navigating Tensions: Integrating Palliative Care Consultation Services Into an Academic Medical Center Setting

2011 ◽  
Vol 42 (5) ◽  
pp. 680-690 ◽  
Author(s):  
Sally A. Norton ◽  
Bethel Ann Powers ◽  
Madeline H. Schmitt ◽  
Maureen Metzger ◽  
Eileen Fairbanks ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Palliative Care Consultation ◽  
Academic Medical ◽  
Care Consultation ◽  
Consultation Services

Outpatient palliative care at a tertiary cancer center: Perceptions, pathways, and pitfalls.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 28-28
Author(s):  
Kavitha Ramchandran ◽  
Sandy Trieu ◽  
Stephanie Harman ◽  
Judy Passaglia ◽  
Janet Rodriguez ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Cancer Center ◽  
Care Planning ◽  
Life Care ◽  
Code Status ◽  
Wide Range ◽  
Advance Care

28 Background: To describe an outpatient palliative care program at a quaternary cancer center- Stanford Cancer Institute. Outpatient palliative care (PC) programs are still in their nascency. Best practices are still being developed and key performance metrics are being delineated. This is a description of Stanford Cancer Institute outpatient PC program. Methods: Observational study of the first six months of encounters to the outpatient PC program. Description of potential barriers to launch and growth, as well as description of resources required for continued success. Data evaluated included program volume, referral patterns, advance care planning, symptom assessment and team structure as collected by the clinical team. Results: Initial barriers to program initiation included lack of funding and infrastructure. Additional barriers included coordination between teams, flow of care (patients late for next appointments), and cultural perceptions of palliative care as equal to end of life care. There are 32 referring practitioners to the program. Over the first six months the outpatient PC program has seen growth with volume increasing from 10 consults per month to 26 consults per month for a total of 60 patients. At the time of initial consult, 11 of the 60 patients seen had an advance directive. Only 1 patient had a physician order for life sustaining treatment (POLST). Code status was documented in 21 of the 60 patients. Conclusions: Our program had multiple barriers to launch: perceptions that palliative care equaled end of life care, lack of infrastructure and funding, and difficulty with coordination between teams. With administrative support the program secured funding, developed infrastructure with the assistance of IT, Cancer Center administration, and Care Coordination. Consults now come from a wide range of providers. Based on preliminary data indicating a very low percentage of completion of these tasks by patients on initial consult there is need for outpatient palliative care for advance care planning. Future growth will include continued penetration of the cancer center, increasing volume of consults, and additional assessments of patient satisfaction, symptom improvement, and hospital utilization.

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