scholarly journals Cancer prevalence by phase of care: an indicator for assessing health service needs

2020 ◽  
pp. 030089162096183
Author(s):  
Anna Gigli ◽  
Silvia Francisci ◽  
Stefano Guzzinati ◽  
Aaron Hall ◽  
Mark Hachey ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
End Of Life ◽  
Population Aging ◽  
The United States ◽  
Similar Distribution ◽  
Service Needs ◽  
Cancer Type ◽  
Health Care Planning ◽  
Cancer Prevalence

Introduction: Cancer prevalence (people alive on a certain date in a population who previously had a cancer diagnosis) is expected to increase in the United States and Europe due to improvements in survival and population aging. Examination of prevalence by phase of care allows us to identify subgroups of patients according to their care trajectories, thus allowing us to improve health care planning, resource allocation, and calculation of costs. Methods: A new method to estimate prevalence by phase of care using grouped data is illustrated. Prevalence is divided into 3 mutually exclusive phases: initial, continuing, and end-of-life. An application to US and Italian data is applied to prevalent cases diagnosed with colon–rectum, stomach, lung, or breast cancer. Results: The distribution of phase of care prevalence estimated by cancer type and sex and results from the two datasets are very similar. Most survivors are in the continuing phase; the end-of-life phase is larger for cancers with worse prognosis. All phases prevalence is generally higher in the Italian than in the US dataset, except for lung cancer in women, where prevalence proportion in the Italian dataset is 30% lower than in the United States. Discussion: Incidence, survival, and population age structure are the main determinants of prevalence and they can affect differences in all phases of prevalence, as well as in discrete phases. Incidence is the most influential determinant. Ours is the first study that compares prevalence by phase of care between two populations in Italy and the United States. Despite great differences in health care management in the two countries, we found extremely similar distribution of survivors by phase of care for most cancer sites under study.

Transformative Advance Care Planning: The Honoring Choices Minnesota Experience

2013 ◽  
Vol 19 (4) ◽  
pp. 200-204 ◽  
Author(s):  
Barbara Greene
Keyword(s):  
United States ◽  
Health Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Medical Condition ◽  
Death And Dying ◽  
The United States ◽  
Care Planning ◽  
Advance Care ◽  
Voluntary Community

In the United States, discussing end-of-life wishes and preferences has been taboo ever since death and dying moved from a stage of life to a medical condition. This article describes the transformative nature of a Minnesota health care initiative, Honoring Choices Minnesota (HCM). As the world’s largest nongovernmental, voluntary community-centered initiative, HCM is changing the culture around speaking of death and dying, one conversation at a time.

Dying on Hospice in the Midst of an Opioid Crisis: What Should We Do Now?

2018 ◽  
Vol 36 (4) ◽  
pp. 273-281 ◽  
Author(s):  
Jennifer Gabbard ◽  
Allison Jordan ◽  
Julie Mitchell ◽  
Mark Corbett ◽  
Patrick White ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
The Past ◽  
Opioid Crisis ◽  
Prevalence Of Pain

The current opioid crisis in the United States is a major problem facing health-care providers, even at the end of life. Opioids continue to be the mainstay treatment for pain at the end of life, with the prevalence of pain reported in up to 80% of patients and tends to increase as one gets closer toward the end of life. In the past year, 20.2 million Americans had a substance use disorder (SUD) and SUDs are disabling disorders that largely go untreated. In addition, the coexistence of both a mental health and SUD is very common with the use of opioids often as a means of chemical coping. Most hospice programs do not have standardized SUD policies/guidelines in place despite the increasing concerns about substance abuse within the United States. The goal of this article is to review the literature on this topic and offer strategies on how to manage pain in patients who have active SUD or who are at risk for developing SUD in those dying on hospice.

scholarly journals Comparison of Health Care Utilization at the End of Life Among Patients With Cancer in Alberta, Canada, Versus Washington State

2020 ◽  
Vol 16 (12) ◽  
pp. e1543-e1552
Author(s):  
Ali Raza Khaki ◽  
Yuan Xu ◽  
Winson Y. Cheung ◽  
Li Li ◽  
Catherine Fedorenko ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
The United States ◽  
Washington State ◽  
Care Utilization ◽  
Patients With Cancer ◽  
Ed Visits ◽  
Eol Care

PURPOSE: Aggressive care at the end of life (EOL) can lead to unnecessary suffering and health care costs for patients with cancer. Despite geographic proximity and cultural similarities, we hypothesize that EOL care is more intense in the United States multipayer system versus the Canadian single-payer system. We compared health care utilization at EOL among patients with cancer in Alberta, Canada, with those in Washington state in the United States. METHODS: Adult patients with American Joint Committee on Cancer stage II to IV solid tumors who died between 2014 and 2016 in Alberta and between 2015 and 2017 in Washington were identified from regional population-based cancer registries linked to treatment and hospitalization records (Alberta) and health claims from major regional insurance plans (Washington). The proportion of patients receiving chemotherapy and having multiple emergency department (ED) visits, or intensive care unit (ICU) admissions in the last 30, 60, and 90 days of life (DOL) in Alberta and Washington were determined and compared using two-sample z-test and multivariable logistic regression (α = .006 after Bonferroni correction). RESULTS: Of patients, 11,177 in Alberta and 12,807 in Washington were included. Patients were similar in age (median, 71 v 72 year), with more patients in Washington with no comorbidities. More patients in Washington were treated with chemotherapy (12.6% v 6.6%; adjusted OR [aOR], 2.74), had multiple ED visits (16.2% v 12.1%; aOR, 1.40), and ICU admissions (23.7% v 3.9%; aOR, 14.27) in the last 30 DOL. Utilization was also higher in Washington in the last 60 and 90 DOL and among those with stage IV disease and those age 65 years and older. CONCLUSION: Utilization of chemotherapy, ED visits, and ICU admissions near EOL was higher in Washington versus Alberta. Future studies to characterize drivers of aggressive EOL care may help improve cancer care for patients in the United States and Canada.

Bhutanese Older Adult Refugees Recently Resettled in the United States: A Better Life With Little Sorrows

2017 ◽  
Vol 29 (2) ◽  
pp. 165-171 ◽  
Author(s):  
Ramraj Gautam ◽  
Barbara E. Mawn ◽  
Sarah Beehler
Keyword(s):  
United States ◽  
Health Care ◽  
Older Adult ◽  
Health Care Providers ◽  
Phenomenological Study ◽  
The United States ◽  
Adjustment Process ◽  
Service Needs ◽  
Care Providers ◽  
Cultural Tensions

Purpose: This study explores the experiences and adjustment process among older Bhutanese refugees resettled in the United States and identifies their unmet health and social service needs. Design: This phenomenological study design included the conduction of nine in-depth semistructured interviews in the respondents’ native language. The researchers adhered to the steps outlined by Moustakas for data analysis. Results: The five identified themes included the following: a better life but with little sorrows, cultural tensions related to adaptation, language as a barrier to success in the United States, isolation and loneliness, and worries about citizenship and its impact on the future. Discussion/Implications for Practice: Psychological adjustment to life in the United States can have profound impact on the health of Bhutanese older adults. Nurses and health care providers should integrate culturally congruent health care, raise awareness of the unique needs, and advocate for policy changes that will benefit this group of older adult refugees whose lives have frequently been upended.

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