scholarly journals Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ellinor Christin Haukland ◽  
Christian von Plessen ◽  
Carsten Nieder ◽  
Barthold Vonen
Keyword(s):  
Adverse Events ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Quality And Safety

scholarly journals Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

2020 ◽  
Author(s):  
Ellinor Christin Haukland ◽  
Christian von Plessen ◽  
Carsten Nieder ◽  
Barthold Vonen
Keyword(s):  
Palliative Care ◽  
Adverse Events ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Quality And Safety ◽  
Negative Consequences ◽  
Specialist Palliative Care ◽  
Early Integration ◽  
Anticancer Treatment

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care Methods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96). Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

scholarly journals Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

2020 ◽  
Author(s):  
Ellinor Christin Haukland ◽  
Christian von Plessen ◽  
Carsten Nieder ◽  
Barthold Vonen
Keyword(s):  
Palliative Care ◽  
Adverse Events ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Quality And Safety ◽  
Negative Consequences ◽  
Specialist Palliative Care ◽  
Early Integration ◽  
Anticancer Treatment

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer careMethods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life.Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96).Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

scholarly journals Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

2019 ◽  
Author(s):  
Ellinor Christin Haukland ◽  
Christian von Plessen ◽  
Carsten Nieder ◽  
Barthold Vonen
Keyword(s):  
Adverse Events ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Binary Logistic Regression ◽  
Quality And Safety ◽  
Negative Consequences ◽  
Anticancer Treatment ◽  
Global Trigger Tool

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and see if adverse events can be used as a measure of quality and safety in end-of-life cancer care Methods: Retrospective cohort study of deceased hospitalised cancer patients using the Global Trigger Tool to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.03, OR 2.10 (1.09 – 4.01). Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Identifying these adverse events is clearly warranted to improve clinical practice and avoid overtreatment in end-of life cancer care.

Patterns and costs of hospital-based cancer care in the last year of life: A national data linkage study in England.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18769-e18769
Author(s):  
Xhyljeta Luta ◽  
Katharina Diernberger ◽  
Joanna Bowden ◽  
Joanne Droney ◽  
Peter S Hall ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Health Care Utilisation ◽  
Cost Of Care ◽  
Hospital Episode Statistics ◽  
Hospital Episode ◽  
Care Utilisation

e18769 Background: Delivery of high quality cancer care is associated with rising costs, both in earlier stages of the illness trajectory and at the end of life. A significant portion of the costs and health care utilisation occurs in the last year of life. Most publications to date have focused on costs in hospital. Little is known about the costs of care for cancer patients across the entire health service. The aim was to examine primary, secondary and acute health care utilisation and cost in the last 12 months of life and how these differ by cancer diagnosis and other patient characteristics among decedent patients aged 60 and over. Methods: We conducted a retrospective cohort study of people aged 60 years and over (N=26,077) who died in England between 2010 and 2017. We used routinely collected and linked data from primary care (Clinical Practice Research Datalink (CPRD) secondary and acute care, (Hospital Episode Statistics (HES), and death data (Office for National Statistics (ONS)). This provided a nationally representative sample of the English population. We analysed of healthcare utilisation and resource use amongst decedents by gender, primary cause of death, age, geography, socio-economic status and comorbidities. Results: Overall, 90.2 % of the cancer decedents were admitted in the hospital at least once in the last 12 months of life. About 50% of patients we admitted to hospital in the last month of life with 37.6 being admitted to the hospital more than once in the last month of life. The health care utilisation and costs increased sharply in the last month of life. life. The mean number of hospital admissions in the last year of life was 3.7 (SD, 5.8). Those dying of haematological cancers (N=2093) had highest number of hospital admissions (mean:7.2, SD:10.8) and longer average hospital stay (mean:36.7, SD:33.0) (mean:12.0, SD:14.4). Use of outpatient services was highest in the group dying of haematological cancers (mean:12.0, SD:14.4) whereas those dying of prostate cancer (N= 2197) had higher number of emergency (mean:2.0, SD: 1.9) and GP visits (mean:30.8, SD: 20.7). Healthcare costs were highest among haematological cancers and lowest among those dying of breast cancer. Proximity to death and comorbidities were the main contributors of end-of-life care health care utilisation and costs. Conclusions: This study uses large linked datasets (linked to the whole spectrum of hospital episode statistics) providing a comprehensive picture of healthcare services accessed by cancer patients at end of life in England. There is significant variation in use and cost of care for cancer patients in the last year and month of life. Further analysis of variation according to hospice, palliative, and social care service provision may identify strategies to address this variation.

Trends in the cost of the futile cancer care near the end of life.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 126-126 ◽  
Author(s):  
Wender Lin ◽  
Chi-Jeng Hsieh
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Health Care Providers ◽  
Cancer Care ◽  
Health Resources ◽  
Claim Data ◽  
Care Providers ◽  
Aggressive Cancer ◽  
Futile Treatment ◽  
The Cost

126 Background: Aggressive cancer care near the end of life may not only represent a quality-of-care issue, but also a futility issue. Under the constraint of health resources, it is of interest to know the cost trends of futile treatment for cancer patients near the end of their life. Methods: The definition of potential medical futility for cancer patients near the end of their life was developed based on the RAND/UCLA Appropriateness Method. Nine experts or academics from medical, political, social, or legal fields built a consensus that treatment after 7 days in the intensive care unit following a cardiopulmonary resuscitation for cancer patients who died within 3 months is probably futile. Based on this definition, we used death registry and Taiwan’s National Health Insurance claim data from 2000-2001 and 2009-2010 respectively to estimate the cost of potential futile treatment for cancer patients near the end of their life in 2001 and 2010. Results: The percentage of cancer patients receiving potentially futile treatment near the end of their life reduced from 2.68% in 2001 (883/32,993) to 1.58% in 2010 (649/41,046). The cost of potentially futile cancer care also decreased from $283 million NTD (New Taiwan Dollar) in 2001 to $255 million NTD in 2010 (1USD=30NTD). Nevertheless, the per capita cost of potentially futile cancer care slightly increased from $320 thousand NTD to $393 thousand NTD. Conclusions: Although the cost of potentially futile cancer care for patients near the end of life is not huge in Taiwan, its trend of decrease may indicate that supportive but not aggressive cancer care is more and more prevailing and acceptable by patients, their family, as well as health care providers.

Identifying Potential Indicators of the Quality of End-of-Life Cancer Care From Administrative Data

2003 ◽  
Vol 21 (6) ◽  
pp. 1133-1138 ◽  
Author(s):  
Craig C. Earle ◽  
Elyse R. Park ◽  
Bonnie Lai ◽  
Jane C. Weeks ◽  
John Z. Ayanian ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Quality Indicators ◽  
Administrative Data ◽  
Cancer Care ◽  
Symptom Control ◽  
Family Members ◽  
Data Systems ◽  
Delphi Approach

Purpose: To explore potential indicators of the quality of end-of-life services for cancer patients that could be monitored using existing administrative data. Methods: Quality indicators were identified and assessed by literature review for proposed indicators, focus groups with cancer patients and family members to assess candidate indicators and generate new ideas, and an expert panel ranking the meaningfulness and importance of each potential indicator using a modified Delphi approach. Results: There were three major concepts of poor quality of end-of-life cancer care that could be examined using currently-available administrative data (such as Medicare claims): institution of new anticancer therapies or continuation of ongoing treatments very near death; a high number of emergency room visits, inpatient hospital admissions, or intensive care unit days near the end of life; and a high proportion of patients never enrolled in hospice, only admitted in the last few days of life, or dying in an acute-care setting. Concepts such as access to psychosocial and other multidisciplinary services and pain and symptom control are important and may eventually be feasible, but they cannot currently be applied in most data systems. Indicators based on limiting the use of treatments with low probability of benefit or indicators based on economic efficiency were not acceptable to patients, family members, or physicians. Conclusion: Several promising claims-based quality indicators were identified that, if found to be valid and reliable within data systems, could be useful in identifying health-care systems in need of improving end-of-life services.

Racial differences in the impact of financial hardship on the intensity of end-of-life cancer care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6012-6012
Author(s):  
Reginald D Tucker-Seeley ◽  
Gregory Alan Abel ◽  
Holly Gwen Prigerson
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Racial Differences ◽  
Cancer Care ◽  
Financial Hardship ◽  
Advanced Cancer Patients ◽  
White Families ◽  
Eol Care ◽  
The Impact ◽  
White Patients

6012 Background: Research suggests that Black cancer patients have higher end-of-life (EOL) medical costs than White patients; and that Black, compared with White, families are more likely to use all or most of their savings to pay for EOL care. Although Black cancer patients receive more intense EOL care than Whites, research has yet to determine the effect of financial hardship on receipt of intensive EOL care, and whether the effect varies by the patient’s race. Methods: Coping with Cancer (CwC) is a longitudinal, multi-site cohort study of advanced cancer patients and their informal caregivers recruited from September 2002-February 2008. CwC was designed to investigate Black/White differences in EOL care. The purpose of this analysis was to determine the association between baseline financial hardship and receipt of intensive EOL care in the last week of life (CwC deceased cohort N=342), and to identify racial differences in this association. Financial hardship was defined as whether the household had to use all or most of their savings due to the family member’s illness (response =yes/no). Intensive EOL care was defined as the receipt of ventilation or resuscitation in the last week of life assessed by medical record review and patient’s caregiver. Results: Patients reporting financial hardship had higher odds of receiving intensive EOL care (OR = 2.83, CI: 1.33, 6.05). After adjusting for socio-demographic characteristics the significant association remained (OR = 2.55, CI: 1.13, 5.81). Race-stratified fully adjusted models revealed no statistically significant association between financial hardship and intensive EOL care for Whites; however, for Blacks, those reporting financial hardship had over five times higher odds of receiving intensive EOL care (OR = 5.21, CI: 1.51, 17.99) compared to those not reporting financial hardship. Conclusions: Financial hardship was associated with greater likelihood of receiving intensive EOL care. The intensity of EOL care received by White patients was insensitive to financial hardship; in contrast Black patients reporting depletion of life savings for cancer care were much more likely to die receiving intensive EOL care than their non-financially strained counterparts.

Spiritual care provided by oncology physicians and nurses to advanced cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9116-9116
Author(s):  
Zachary Epstein-Peterson ◽  
Adam Sullivan ◽  
Andrea C. Phelps ◽  
Michael J. Balboni ◽  
Tyler J. Vanderweele ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Spiritual Care ◽  
Cancer Care ◽  
End Of Life Care ◽  
Life Care ◽  
Advanced Cancer Patients ◽  
Care Guidelines

9116 Background: For many patients facing a diagnosis of advanced cancer, religion and/or spirituality (R/S) play an important role in coping with illness. Data suggest that cancer patients receiving spiritual care (SC) have better quality of life and receive less futile, aggressive interventions at the end of life. National palliative care guidelines include SC as a key component of end-of-life care. However, current SC practices and the role clinicians should play in SC provision remain unclear. Methods: The Religion and Spirituality in Cancer Care (RSCC) study is a survey-based, cross-sectional study of oncology physicians and nurses and advanced cancer patients from five Boston-area institutions. The survey elicited respondents’ R/S beliefs/practices, their views on the appropriateness of SC in the advanced cancer care setting, and their experiences in giving or receiving SC (e.g., spiritual history, referrals to chaplains). In total, 68 patients, 204 physicians, and 114 nurses responded (response rates: patients = 73%; clinicians = 63%). Multivariable analyses (MVAs) were performed to determine predictors (e.g., clinician demographics, R/S, spiritual care training) of SC provision by clinicians. Results: All respondents reported a low frequency of SC provision, with only 9% of patients receiving SC from physicians, 20% from nurses, and physicians reporting performing SC during only 8% of interactions, nurses during 12% of interactions. In MVAs, prior training in spiritual care was significantly associated with SC provision (OR physicians 5.89, CI 2.14-16.22; OR nurses 10.42, CI 1.30-89.19), as was the provider identifying as being spiritual (OR 3.85 physicians CI, 2.12-6.98; OR 2.92 nurses CI, 1.15-7.42). Conclusions: These data highlight the current inadequacies of SC provision by clinicians, despite national palliative care guidelines, and underscore the central role of SC training for doctors and nurses, as this was the strongest predictor of SC provision. Given the important role that SC has in end-of-life care and the paucity of data guiding its provision, we hope this research will advance the understanding of how to integrate SC into end-of-life care, and ultimately improve patient outcomes at the end-of-life.

Breaking bad news to cancer patients in palliative care: A comparison of national cross-sectional surveys from 2006 and 2012

2015 ◽  
Vol 13 (6) ◽  
pp. 1623-1630 ◽  
Author(s):  
Kanako Ichikura ◽  
Ayako Matsuda ◽  
Mika Kobayashi ◽  
Wataru Noguchi ◽  
Toshiko Matsushita ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Treatment Options ◽  
Family Members ◽  
Bad News ◽  
Cross Sectional ◽  
Breaking Bad ◽  
Cross Sectional Design ◽  
Patients Experience

AbstractObjective:Most cancer patients experience the time when a doctor must “break the bad news” to them, a time when it is necessary for patients to call upon their self-determination to aid in the battle with cancer. The purpose of our study was to clarify the percentage of times doctors deliver bad news to patients at the end of life in each of four different situations, and to define the most common recipients of this bad news. We compare these results for two timepoints: 2006 and 2012.Methods:The study had a national cross-sectional design consisting of self-completed questionnaires sent to all hospitals that provide cancer care. We mailed them to hospital directors in January and February of 2012, requesting a reply. The results of the same survey in 2006 were employed as a point for comparison.Results:A total of 1224 questionnaires were returned during 2012. 1499 responses collected in 2006 were employed as reference data. Some hospital characteristics had changed over that interval; however, the new data obtained were representative for patients being treated in Japanese cancer care hospitals. In hospitals with 300–499, there were significant differences between 2006 and 2012 in the providing information about (“disclosure of cancer diagnosis,” “therapeutic options for treatment,” and “a life-prolonging treatment”). In addition, the likelihood of doctors delivering bad news to patients and family members (as opposed to family members only) at the end of life increased from 2006 to 2012.Significance of Results:Our results suggest that the overall incidence of bad news being disclosed has increased, especially in hub medical institutions for cancer care. Advanced treatment options or domestic legislation may have influenced the frequency or type of bad news.

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