The Use of Healthcare Services by Prostate Cancer Patients in the Last 12 Months of Life: How Do We Improve the Quality of Care During This Period?

2020 ◽  
pp. 082585972097594
Author(s):  
Tony Tien ◽  
Evangelos Gkougkousis ◽  
Paula Allchorne ◽  
James S. A. Green
Keyword(s):  
Prostate Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Quality Care ◽  
Cost Effective ◽  
Healthcare Services ◽  
Care Needs ◽  
Prostate Cancer Survivors ◽  
New Treatments

Introduction: Current research on prostate cancer is heavily focused on early detection and new treatments. There is a lack of research on the overall morbidity prostate cancer survivors face and the amount of healthcare treatment they receive toward the end of their lives. Identifying these care needs will allow appropriate healthcare modeling, resource allocation and service re-design to ensure higher quality care toward the end of life. The aim of this study is to quantify and analyze the use of healthcare services by patients dying with but not necessarily of prostate cancer. Methods: All patients who died with a diagnosis of prostate cancer during a 2-year period at a single hospital were included. Data on outpatient attendances, elective and emergency admissions and palliative care involvement in the 12 months prior to death were collected. Results: A total of 77 patients were included and of these, 60 (78.0%) had 545 scheduled appointments with 473 (86.8%) attendances. More non-attendances occurred in the last 6 months of life; 56 vs 16, p < 0.001. Nurse led clinics doubled in the last 6 months of life, 117 vs 66. There were 173 admissions from 63 (81.8%) patients resulting in 1816 days inpatient stay. This averaged to 2.7 admissions per patient for 10.5 days per episode. 32 (41.6%) patients were seen by palliative care resulting in 192 visits in total. 78 (40.6%) were inpatient and 114 (59.4%) were community reviews. Conclusions: In the last year of life, prostate cancer patients use a considerable amount of healthcare resources. Understanding this clinical and economical burden is important for healthcare remodeling to provide better quality care that is cost effective.

Disparities among GU cancer patients referred to palliative care.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 114-114
Author(s):  
Saad Omar Atiq ◽  
James Helzberg ◽  
Nathan Hirshman ◽  
Zainab Atiq ◽  
Daniel J. George ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
The United States ◽  
Quality Data ◽  
Black Patients ◽  
Quality Of Life Scale

114 Background: The role of palliative care in genitourinary (GU) malignancies has been understudied. Despite representing nearly 25% of new cancer diagnoses, with over 350,000 new cases diagnosed each year, few GU patients have been included in palliative care trials under the theory that symptoms are less severe for GU patients than other solid tumors. Early involvement of palliative care services improves the patient care experience, decreases healthcare utilization, is associated with survival benefit, and results in improved quality of life and mood. To further elucidate the role of palliative care in oncology, we must study its utility in subsets of malignancy like GU cancers, as needs for patients may differ by malignancy type. Methods: A retrospective cross-sectional analysis of initial outpatient palliative care visits was performed using data from the Quality Data Collection Tool for Palliative Care (QDACT-PC) database from 2014-2020. QDACT-PC is a web-based, point-of-care registry used by physicians across the United States to track quality metrics associated with patient consultations. Data was collected and analyzed from patients' initial visits including pain scale, dyspnea scale, feeling of well-being (Quality of Life scale), fatigue scale, constipation scale, palliative performance status (PPS), and preference for resuscitation status. Scales for these variables were 0-10, with the exception of a scale of 0-100% for PPS. Patients less than 18 and greater than 90 years old were excluded. Chi-squared and Student’s t-tests were used to compare categorical and continuous variables, respectively. Results: 824 GU oncology patients (358 prostate cancer patients, 251 bladder cancer patients, 215 renal cancer patients) were compared against all patients with non-GU cancers (7807 patients). Notably, non-GU patients reported higher rates of fatigue (4.50 vs. 4.13, p = 0.0013) and dyspnea (1.63 vs. 1.11, p < 0.0001) than GU patients. GU malignancies had non-significant higher reported pain (3.73 vs. 3.60, p = 0.3109) and constipation (1.96 vs. 1.83, p = 0.2319) and lower PPS (4.95 vs. 4.96, p = 0.8555) and QOL (4.55 vs. 4.73, p = 0.0962). Preference for resuscitation at the time of referral was similar between the two groups (p = 0.6339). Only 16.5% of prostate cancer patients referred to palliative care in this database were black, while black patients are often estimated to represent 30% of new prostate cancer diagnoses each year. Conclusions: GU patients represent 9.54% of cancer patients seen by palliative care while the incidence is nearly 25%. Traditionally, GU patients were underrepresented in palliative care trials under the notion of less severe symptoms; however, this study demonstrates that GU patients have as severe symptoms as non-GU patients, highlighting a disparity in referral to palliative care. Furthermore, the lack of representation of black patients suggests potential inequity and warrants further investigation.

Palliative care needs: Symptom reporting during geriatric oncology evaluation.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 184-184
Author(s):  
Marie Anne Flannery ◽  
Chintan Pandya ◽  
Mohamedtaki Abdulaziz Tejani ◽  
Charles Stewart Kamen ◽  
Allison Magnuson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Geriatric Oncology ◽  
Older Individuals ◽  
Symptom Experience ◽  
Care Needs ◽  
Older Cancer Patients ◽  
Palliative Care Needs

184 Background: Although extensive descriptive work has been conducted on the symptom experience in cancer, relatively little is known about the specific palliative care needs for geriatric oncology populations. When all age groups are studied older individuals report less symptoms and the symptom experience of older cancer patients is minimized. Utilizing data collected from two geriatric oncology referral clinics the primary aim of this study was to identify geriatric oncology patients’ symptom reports, the number of symptoms experienced, and interference reported from symptoms. Methods: Patients referred to a geriatric oncology consult clinic were asked to complete the MD Anderson Symptom Inventory (MDASI) total of 13 items. In addition all patients underwent comprehensive geriatric assessment with a battery of tests. Results: 192 patients completed the symptom inventory with a median age of 81 years (range 65-95). 94% of patients reported at least one symptom, >45% reported experiencing 10 of the 13 symptoms (mean number of symptoms =5.7, SD= 3.7). Most frequently reported symptoms were in order: drowsiness, trouble remembering, dry mouth, disturbed sleep, pain, distress, decreased appetitive, dyspnea, and sadness. Severity ratings for individual symptoms M’s= 0.3-2.5, although the complete range of 0-10 was reported. 67% of patients reported that symptoms were interfering with their quality of life, general activity level and walking ability. Conclusions: In contrast to the myth that older cancer patients have minimal symptoms, at time of referral to a geriatric oncology consultation patients report on average experiencing six symptoms which interfere with their quality of life. There is an intersection between geriatric oncology and palliative care and these descriptive findings highlight the importance of systematic symptom assessment for older individuals with cancer to identify needed symptom relief strategies.

scholarly journals Application Application Of Problems And Needs In Palliative Care Instrument - Short Version (PNPC-Sv) For Assessing The Paliative Care Needs For Cancer Patients

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Ratih Ayuningtyas Pocerattu ◽  
Anggorowati ◽  
Chandra Bagus
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Information Needs ◽  
Physical Symptoms ◽  
Short Version ◽  
Care Needs ◽  
Study Approach ◽  
The Right

Background: Assessment of the needs of palliative care is the first step to know about the picture quality of life and determine interventions to solve problems experienced by patients with chronic conditions and terminal. One of the instruments that can be used is the PROBLEMS AND NEEDS IN PALLIATIVE CARE INSTRUMENT - SHORT VERSION (PNPC-sv). Instrument PNPC-sv examines the 8 dimensions of activity and excersice, physical symptoms, autonomy, psychological, spiritual, financial, and information needs. Methods: This research uses qualitative method with case study approach. Data collection was conducted by means of questionnaires filled in the assessment of the needs of palliative care (PNPC-SV),  then performed in-depth interviews in accordance with the results of the assessment and observation on the 6 participants in the space of oncology in one of hospital in Semarang. Result: The theme results of this research are: (1) Self-acceptance as well as support to the family of the condition of the patient, (2) Influence the patient's psychological to the social environment, (3) the right education to improve the quality of life and (4) The basic components assessment  of the needs palliative care should be assessed by the nurse. Conclusion: The assessment which done in a holistic manner can help the nurse to provide nursing care in accordance with the needs of the patient to face the condition of the disease. The needs of the patient in physical, psychological, social and spiritual is very necessary to maintain the balance of her consistency and integrity in the ability to remain accepted, loved and appreciated by others. Keywords: The need for palliative care, PNPC-SV, cancer patients.

scholarly journals Quality of life among advanced cancer patients in Vietnam: a multicenter cross-sectional study

2021 ◽  
Author(s):  
Bui Thanh Huyen ◽  
Pham Thi Van Anh ◽  
Le Dai Duong ◽  
Than Ha Ngoc The ◽  
Ping Guo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Discriminant Validity ◽  
Correct Prediction ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Chi Square

Abstract Purpose Cancer is a leading cause of death in Vietnam. To maximize quality of life (QOL) at the end of life, valid and clinically useful instruments are needed to assess palliative care needs and the effectiveness of palliative care interventions. Methods We aimed to (i) determine psychometric properties of the Vietnamese version of the WHO abbreviated quality of life scale (WHOQOL-BREFVN) among advanced cancer patients, (ii) measure HR-QOL, and (iii) identify predictors of HR-QOL. We collected demographic, clinical, and HR-QOL data from stage III/IV adult cancer patients at two major Vietnamese cancer centers. We determined the internal consistency (Cronbach’s alpha), construct validity (confirmatory factor analysis (CFA)), and discriminant validity (known-groups comparison) of the Vietnamese instrument. HR-QOL was analyzed descriptively. Multinomial logistic regressions identified predictors of HR-QOL. Results A total of 825 patients participated. Missing data were completely at random (MCAR) (chi-square = 14.270, df = 14, p = 0.430). Cronbach’s alpha for all items was 0.904. CFA loadings of physical, psychological, social relationship, and environment domains onto HR-QOL were 0.81, 0.82, 0.34, and 0.75, respectively. Prediction of scores differed significantly by functional status (Wilks’ lambda = 0.784, chi-square = 197.546, df = 4, p < 0.01, correct prediction = 74.6%). HR-QOL was reported as very bad/bad by n = 188 patients (22.8%) and general health as very bad/bad by n = 430 (52.1%). Multinomial logistic regression (likelihood ratio test: chi-square = 35.494, df = 24, p = 0.061, correct prediction = 62.2%) and the Pearson correlations revealed worse HR-QOL was associated with inpatient status, high ECOG score, and having dependent children. Conclusion The Vietnamese version of the WHOQOL-BREF has excellent internal consistency reliability and sound construct and discriminant validity in advanced cancer patients. Advanced cancer inpatients, those with dependent children, and those with poorer physical function appear to have the greatest palliative care needs.

Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

2021 ◽  
pp. 104990912110178
Author(s):  
Abigail Sy Chan ◽  
Amit Rout ◽  
Christopher R. D.’Adamo ◽  
Irina Lev ◽  
Amy Yu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Length Of Hospital Stay ◽  
Inpatient Setting ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Early Palliative Care ◽  
Code Status ◽  
Palliative Care Needs

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

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