Integration and activity of hospital-based palliative care consultation teams: the INSIGHT multicentric cohort study

Background: Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. Aim: To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Design: Prospective multi-site cohort study (2007–2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Setting/participants: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Results: Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Conclusion: Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.

Download Full-text

Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study

BMC Palliative Care ◽

10.1186/s12904-021-00773-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Patcharaporn Prompantakorn ◽

Chaisiri Angkurawaranon ◽

Kanokporn Pinyopornpanish ◽

Lalita Chutarattanakul ◽

Chanchanok Aramrat ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Survival Time ◽

Cancer Patients ◽

Retrospective Cohort Study ◽

Median Survival Time ◽

Retrospective Cohort ◽

Palliative Care Consultation ◽

Care Consultation ◽

Performance Scale

Abstract Background Palliative Performance Scale (PPS) has been frequently used to estimate the survival time of palliative care patients. The objective was to determine the associations between the PPS and survival time among cancer and non-cancer patients in Thailand. Methods This is a retrospective cohort study. All in-patient adults who received a palliative care consultation at Chiang Mai University Hospital between 1 July 2018 to 31 July 2019 were included in the study and were followed-up until 26 June 2020. The Palliative Performance Scale was assessed using the validated Thai-Palliative Performance Scale for Adults. Survival analysis was used to determine the association between the Palliative Performance Scale and survival time among cancer and non-cancer patients. Results Out of 407 patients, 220 were male (54.1%). There were 307 cancer patients (75.4%) and 100 non-cancer patients (24.6%). The PPS and survival time in cancer patients were significantly correlated. Cancer patients with PPS 10, 20, 30, 40–60, and 70–80% had a median survival time of 2, 6, 13, 39, and 95 days, respectively. Non-cancer patients with PPS 10, 20, and 30% had a median survival time of 8, 6, and 24 days, respectively. Conclusions While useful for estimating survival time for cancer patients, other factors should be taken into account in estimating the survival time for non-cancer patients.

Download Full-text

Trends and Predictors of Palliative Care Consultation Among Patients Admitted for LVAD: A Retrospective Analysis From the Nationwide Inpatient Sample Database From 2006-2014

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211021837 ◽

2021 ◽

pp. 104990912110218

Author(s):

Karol Quelal ◽

Olankami Olagoke ◽

Anoj Shahi ◽

Andrea Torres ◽

Olisa Ezegwu ◽

...

Keyword(s):

Palliative Care ◽

Nationwide Inpatient Sample ◽

Metastatic Cancer ◽

The United States ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Incidence Trends ◽

Palliative Care Consultation ◽

Care Consultation

Background: Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation. Aim: This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014. Methods: We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis. Results: We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC. Conclusion: There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.

Download Full-text

Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit

The Neurohospitalist ◽

10.1177/1941874419869714 ◽

2019 ◽

Vol 10 (3) ◽

pp. 163-167

Author(s):

Jon Rosenberg ◽

Allie Massaro ◽

James Siegler ◽

Stacey Sloate ◽

Matthew Mendlik ◽

...

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Palliative Care ◽

High Grade ◽

Neurological Intensive Care Unit ◽

Code Status ◽

Neurological Intensive Care ◽

Palliative Care Consultation ◽

Care Consultation

Background: Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods: We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results: Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion: In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.

Download Full-text

“I Don't Have Time to Sit and Talk with Them”: Hospitalists’ Perspectives on Palliative Care Consultation for Patients with Dementia

Journal of the American Geriatrics Society ◽

10.1111/jgs.16712 ◽

2020 ◽

Vol 68 (10) ◽

pp. 2365-2372

Author(s):

Katherine R. Courtright ◽

Trishya L. Srinivasan ◽

Vanessa L. Madden ◽

Jason Karlawish ◽

Stephanie Szymanski ◽

...

Keyword(s):

Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation

Download Full-text

Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer

Current Oncology ◽

10.3747/co.26.4389 ◽

2019 ◽

Vol 26 (1) ◽

Cited By ~ 1

Author(s):

C. Lees ◽

S. Weerasinghe ◽

N. Lamond ◽

T. Younis ◽

Ravi Ramjeesingh

Keyword(s):

Pancreatic Cancer ◽

Palliative Care ◽

End Of Life ◽

Potential Effect ◽

Unresectable Pancreatic Cancer ◽

Palliative Care Consultation ◽

Integral Role ◽

Care Consultation ◽

Aggressive Care ◽

Key Indicators

Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.

Download Full-text