scholarly journals Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xhyljeta Luta ◽  
Baptiste Ottino ◽  
Peter Hall ◽  
Joanna Bowden ◽  
Bee Wee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cost Effectiveness ◽  
End Of Life ◽  
Resource Use ◽  
Economic Value ◽  
Healthcare Delivery ◽  
Dying Patients ◽  
Home Based ◽  
Population Type ◽  
Care Models

Abstract Background As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. Methods Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. Results A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers’ outcomes. The evidence of interventions delivered across other settings was generally inconsistent. Conclusions Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.

Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure

2017 ◽  
Vol 32 (2) ◽  
pp. 476-484 ◽  
Author(s):  
Frances Kam Yuet Wong ◽  
Ching So ◽  
Alina Yee Man Ng ◽  
Po-Tin Lam ◽  
Jeffrey Sheung Ching Ng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Cost Effectiveness ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based ◽  
End Stage Heart Failure ◽  
End Stage ◽  
Transitional Home

End-of-Life Care in Patients Exposed to Home-Based Palliative Care vs Hospice Only

2019 ◽  
Vol 67 (6) ◽  
pp. 1226-1233 ◽  
Author(s):  
Susan E. Wang ◽  
In-Lu Amy Liu ◽  
Janet S. Lee ◽  
Peter Khang ◽  
Romina Rosen ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Home Based

Sowing Across a State: Development and Delivery of a Grassroots Pediatric Palliative Care Nursing Curriculum

2019 ◽  
Vol 36 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Meaghann S. Weaver ◽  
Rebecca Jenkins ◽  
Christopher Wichman ◽  
Jacob E. Robinson ◽  
Meghan R Potthoff ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Curriculum Design ◽  
Phase 1 ◽  
Pediatric Palliative Care ◽  
Family Needs ◽  
Team Members ◽  
Curricular Content ◽  
Home Based ◽  
Perception Of Support

Background: Rural pediatricians and adult-trained hospice teams report feeling ill-prepared to care for children at end of life, resulting in geographies in which children are not able to access home-based services. Objectives: To develop a pediatric palliative care curriculum for inpatient nurses and adult-trained hospice teams caring for children in a rural region. Methods: Curriculum design and delivery was informed by local culture through an interdisciplinary, iterative development approach with confidence, intention, and support measured pre-, post-, and 4 months after delivery. A needs assessment was completed by pediatric nurses caring for children receiving palliative or end-of-life care to inform curricular content (phase 1). A curriculum was designed by an interdisciplinary pediatric palliative care team and piloted with nursing cohorts annually through educational conferences with monthly discussion series for 3 consecutive years (phase 2). Curricular content was then provided for 31 rural hospice team members (phase 3). Results: Self-reported confidence in caring for children increased by 1.1/10 points for adult-trained hospice team members. Mean score for intention to care for children increased by 5.2 points (sustained 5.1 points above baseline at 4 months). Perception of support in caring for children increased by 5 points (mean sustained 5.4 points above baseline at 4 months). Family needs, care goals, and symptom management were prioritized learning topics. Rural hospices previously unwilling to accept children enrolled pediatric patients in the 4 months following the conference. Conclusion: Grassroots curricular initiatives and ongoing educational mentorship can grow pediatric palliative and hospice services in rural regions.

A phenomenological study of nurses’ understanding of honesty in palliative care

2010 ◽  
Vol 17 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Eva Erichsen ◽  
Elisabeth Hadd Danielsson ◽  
Maria Friedrichsen
Keyword(s):  
Palliative Care ◽  
Phenomenological Study ◽  
Moral Character ◽  
Moral Conflict ◽  
Staff Members ◽  
Dying Patients ◽  
Home Based ◽  
Care At Home ◽  
Home Based Care ◽  
Seriously Ill

Honesty is essential for the care of seriously ill and dying patients. The current study aimed to describe how nurses experience honesty in their work with patients receiving palliative care at home. The interviews in this phenomenological study were conducted with 16 nurses working with children and adults in palliative home-based care. Three categories emerged from analyses of the interviews: the meaning of honesty, the reason for being honest and, finally, moral conflict when dealing with honesty. The essence of these descriptions was that honesty is seen as a virtue, a good quality that a nurse should have. The nurses’ ethical standpoint was shown in the moral character they show in their work and in their intention to do good. This study could help nurses to identify different ways of looking at honesty to promote more consciousness and openness in ethical discussions between colleagues and other staff members.

“She would be flailing around distressed”: Addressing the hidden crisis in the home of patients being treated for cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 147-147
Author(s):  
Brook Calton ◽  
Nancy Shepard ◽  
Redwing Keyssar ◽  
Nicole Thompson ◽  
Kanan Patel ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Caregiver Burden ◽  
Metastatic Cancer ◽  
Functional Decline ◽  
Severe Depression ◽  
Trial Participation ◽  
Care Needs ◽  
Risk Of Death ◽  
Home Based

147 Background: Metastatic cancer patients who have progressed on multiple lines of chemotherapy and/or have poor functional status are at risk for significant symptoms, ineffective treatments, and hospice under-utilization. Appreciating the full extent these patients’ struggles is challenging during brief oncology clinic visits. We describe Community Bridges (CB), a home-based palliative care program. Methods: The CB pilot featured a 3-person home-based palliative care MD, NP, and RN team. Patients with metastatic cancer and complex care needs ( > 3 chemotherapy lines, ECOG ≥ 3, history of missed PC clinic appointments, and/or clinical trial participation) were offered 2 months of serial home visits and phone support. Symptom severity, satisfaction, and caregiver burden were assessed. Results: 18 patients enrolled. Mean age was 66. At baseline, 79% of patients reported mild-moderate pain, 43% severe fatigue, 38% moderate-severe depression, and 65% poor-fair QOL. Half of patients died within the 2-month program or within 3 months later. 35% of patients enrolled in hospice while in CB, with a LOS of 10 days. Caregiver burden was high. 60% of patients (n = 6) and 100% of caregivers (n = 7) agreed CB provided services not otherwise available. All would recommend the program to others. Participants reported CB helped them navigate the medical system and reduce stress. Caregivers reported CB helped their loved ones regain control of care. The CB team noted key program strengths were accurately identifying the patients’ home needs, communicating findings to oncologists, and intervening quickly when patients were at the end of life and/or actively dying. Conclusions: CB met patients in their final stages, when they were experiencing heavy symptom burden, functional decline, patient/caregiver distress, and risk of death. The CB team was able to assess and respond to changing needs during key transitions points, and report the realities at home to help inform oncologists’ treatments. Although CB was not designed as a “crisis service,” it often served in that role. Home-based palliative care programs like CB may bridge the gap for patients desiring ongoing cancer treatment but in need end-of-life services.

Effectiveness of a Home-Based Palliative Care Program for End-of-Life

2003 ◽  
Vol 6 (5) ◽  
pp. 715-724 ◽  
Author(s):  
Richard D. Brumley ◽  
Susan Enguidanos ◽  
David A. Cherin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based

Patterns of Hospice and Home-Based Palliative Care in Children: An Ohio Pediatric Palliative Care and End-of Life Network Study

2020 ◽  
Vol 225 ◽  
pp. 152-156 ◽  
Author(s):  
Daniel H. Grossoehme ◽  
Lisa Humphrey ◽  
Sarah Friebert ◽  
Lili Ding ◽  
Gang Yang ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Pediatric Palliative Care ◽  
Home Based

scholarly journals Caregiving at the margins: An ethnographic exploration of family caregivers experiences providing care for structurally vulnerable populations at the end-of-life

2020 ◽  
Vol 34 (7) ◽  
pp. 946-953 ◽  
Author(s):  
Kelli I Stajduhar ◽  
Melissa Giesbrecht ◽  
Ashley Mollison ◽  
Naheed Dosani ◽  
Ryan McNeil
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Family Caregivers ◽  
Family Caregiving ◽  
Transitional Housing ◽  
Mental Health Stigma ◽  
Care Practice ◽  
Structural Vulnerability ◽  
Structured Interviews ◽  
Care Models

Background: People experiencing structural vulnerability (e.g. homelessness, poverty, racism, criminalization of illicit drug use and mental health stigma) face significant barriers to accessing care at the end-of-life. ‘Family’ caregivers have the potential to play critical roles in providing care to these populations, yet little is known regarding ‘who’ caregivers are in this context and what their experiences may be. Aim: To describe family caregiving in the context of structural vulnerability, to understand who these caregivers are, and the unique challenges, burdens and barriers they face. Design: Critical ethnography. Setting/participants: Twenty-five family caregivers participated. Observational fieldnotes and semi-structured interviews were conducted in home, shelter, transitional housing, clinic, hospital, palliative care unit, community-based service centre and outdoor settings. Results: Family caregivers were found to be living within the constraints of structural vulnerability themselves, with almost half being street family or friends. The type of care provided varied greatly and included tasks associated with meeting the needs of basic survival (e.g. finding food and shelter). Thematic analysis revealed three core themes regarding experiences: Caregiving in the context of (1) poverty and substance use; (2) housing instability and (3) challenging relationships. Conclusion: Findings offer novel insight into the experiences of family caregiving in the context of structural vulnerability. Engaging with family caregivers emerged as a missing and necessary palliative care practice, confirming the need to re-evaluate palliative care models and acknowledge issues of trust to create culturally relevant approaches for successful interventions. More research examining how ‘family’ is defined in this context is needed.

Palliative care as a predictor of healthcare resource use at end-of-life in adult Albertan lung cancer decedents between 2008-2015: A secondary data analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24009-e24009
Author(s):  
Nureen Sumar ◽  
Madalene Earp ◽  
Desiree Hao ◽  
Aynharan Sinnarajah
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Resource Use ◽  
Healthcare Resource ◽  
Strong Association ◽  
Specialist Palliative Care ◽  
Healthcare Resource Use ◽  
Aggressive Care ◽  
Aggressive Interventions

e24009 Background: Early utilization of specialist palliative care (SPC) in cancer patients may reduce healthcare resource use, aggressive interventions, and costs at end-of-life. We evaluated the impact of SPC on healthcare resource utilization and aggressive interventions at end-of-life in patients who have died from lung cancer. Methods: Descriptive and multivariable logistic regression analyses were conducted on lung cancer decedents in the Calgary Zone, Alberta Health Services from 2008 to 2015. The primary exposure was timing of SPC (Early: receipt of SPC > = 90 days before death; Late: < 90 days before death; No SPC). The primary outcome was end-of-life healthcare resource use (defined as any of: hospital death, > 1 emergency department visit, > 1 hospital admission, > 14 days of hospitalization, ≥1 intensive care unit admission, ≥1 new chemotherapy program (or any chemotherapy in the last 14 days of life) in the 30 days prior to death. Results: There were 3300 patients of which the majority (51.6%) of decedents were male. More female versus male lung cancer decedents (36.4% vs 28.7%) received early SPC. After adjusting for confounders, a strong association was found between early, late or no SPC and end-of-life healthcare resource use (ORno exposure 3.25 (95% CI 2.41-4.40) vs ORlate exposure 2.44 (95% CI 2.03-2.92) compared to those with early SPC; p < 0.001). Males had 1.53 the odds of aggressive care at end-of-life compared to females (p < 0.001). Stratified analysis by sex revealed a strong association between the absence of SPC utilization and end-of-life healthcare resource use. Young age ( < 50 at death) was a strong driver of aggressive care at end-of-life in females versus males [OR 5.44 vs 2.53]. Conclusions: Early specialist palliative care was significantly associated with less end-of-life healthcare resource use in both male and female lung cancer decedents, with less early specialist palliative care use in males. Keywords: palliative care, early palliative care, cancer, end-of-life, healthcare resource use, lung cancer.

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