The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center

51 Background: Accreditation Canada has adopted four main values for hospice, palliative, and end-of-life services: dignity and respect; information sharing; partnership and participation; and collaboration . These domains, as well as communication and joint decision-making, are important for satisfaction of caregivers for patients with cancer, and can be measured using the FAMCARE questionnaire. We aimed to assess satisfaction of caregivers for patient admitted to an acute palliative care unit at a comprehensive cancer center in Toronto, Canada. Methods: The FAMCARE questionnaire was administered by a trained volunteer to self-identified caregivers of patients who were admitted for more than five days on the acute palliative care unit. A short, anonymous demographic survey accompanied the FAMCARE questionnaire to gather information on relationship to patient, ethnicity, patient length of stay, and location of residence. The survey package either was completed in the presence of the volunteer, or was left to be completed by the caregiver alone and collected later by the volunteer. Results were reviewed regularly at the quality committee of the palliative care service. Results: From September 2014 to March 2017, 90 caregivers completed the questionnaire. Most caregivers were female (69%), identified as Canadian or Caucasian (57%), and lived in Toronto (63%). In all, 57% were spouses while 31% were children of the patient. Most patients had been admitted between a week and a month (67%). Care was rated as “Satisfied” or “Very satisfied” most of the time on all items (range 81-100%). The availability of nurses and doctors (100% satisfied/very satisfied) and the way tests and treatments were followed-up (99%) were rated highest. Information given about side effects (81%) and referral to specialists (83%) were rated lowest. Conclusions: Despite the nature of the acute palliative care unit, where patients admitted tend to be very ill with complex symptoms and psychosocial issues, caregiver satisfaction was high. Future research will examine whether caregivers of different ethnicities value different aspects of cancer care.

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Predictors of outpatients’ request for palliative care service at a medical oncology clinic of a German comprehensive cancer center

Supportive Care in Cancer ◽

10.1007/s00520-018-4245-7 ◽

2018 ◽

Vol 26 (10) ◽

pp. 3641-3647 ◽

Cited By ~ 2

Author(s):

Mitra Tewes ◽

Teresa Rettler ◽

Nathalie Wolf ◽

Jörg Hense ◽

Martin Schuler ◽

...

Keyword(s):

Palliative Care ◽

Medical Oncology ◽

Care Service ◽

Palliative Care Service ◽

Comprehensive Cancer Center ◽

Cancer Center

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Assessing caregiver satisfaction with care on an acute palliative care unit.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.180 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 180-180 ◽

Cited By ~ 1

Author(s):

Ernie Mak ◽

Patricia Murphy-Kane ◽

Camilla Zimmermann

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Palliative Care Unit ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Future Research ◽

Joint Decision ◽

Caregiver Satisfaction ◽

Patients With Cancer

180 Background: Accreditation Canada has adopted four main values for hospice, palliative, and end-of-life services: dignity and respect; information sharing; partnership and participation; and collaboration . These domains, as well as communication and joint decision-making, are important for satisfaction of caregivers for patients with cancer, and can be measured using the FAMCARE questionnaire. We aimed to assess satisfaction of caregivers for patient admitted to an acute palliative care unit at a comprehensive cancer center in Toronto, Canada. Methods: The FAMCARE questionnaire was administered by a trained volunteer to self-identified caregivers of patients who were admitted for more than five days on the acute palliative care unit. A short, anonymous demographic survey accompanied the FAMCARE questionnaire to gather information on relationship to patient, ethnicity, patient length of stay, and location of residence. The survey package either was completed in the presence of the volunteer, or was left to be completed by the caregiver alone and collected later by the volunteer. Results were reviewed regularly at the quality committee of the palliative care service. Results: From September 2014 to May 2018, 116 caregivers completed the questionnaire. Most caregivers were female (66%), identified as Canadian or Caucasian (56%), and lived in Toronto (66%). In all, 52% were spouses while 27% were children of the patient. Most patients had been admitted between a week and a month (68%). Care was rated as “Satisfied” or “Very satisfied” most of the time on all items (range 77-99%). The availability of nurses and doctors (99% satisfied/very satisfied) were rated highest. Information given about side effects (77%) and referral to specialists (84%) were rated lowest. Conclusions: Despite the nature of the acute palliative care unit, where patients admitted tend to be very ill with complex symptoms and psychosocial issues, caregiver satisfaction was high. Developing adequate support for the spouses of patients is important. Future research will examine whether caregivers of different ethnicities value different aspects of cancer care.

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What are the Challenges for Evaluating a Palliative Care Service?

Australian Journal of Primary Health ◽

10.1071/py05038 ◽

2005 ◽

Vol 11 (3) ◽

pp. 19

Author(s):

Kate Senior ◽

David Perkins

Keyword(s):

Palliative Care ◽

Care Service ◽

Medical Model ◽

Palliative Care Service ◽

Respondent Burden ◽

Evaluation Approaches ◽

The Impact

This paper identifies the challenges in researching the impact of a rural palliative care service on its patients, carers and providers in the context of the National Palliative Care Strategy. It describes the use of an anthropological method to overcome problems of acceptability and respondent burden and to enable the elaboration of meaning and valuation by participants. It uses the Griffith Area Palliative Care Service as a case study to illustrate the problems of such research and the value of the anthropological method over more conventional research and evaluation approaches. It makes recommendations about how to assess the outcomes of services such as palliative care where the focus of care is complex, individual and family, and the outcomes go far beyond what can be measured with the medical model.

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P-261 Assessing the impact of interventions to promote clinical effectiveness in a palliative care service

10.1136/bmjspcare-2018-hospiceabs.286 ◽

2018 ◽

Author(s):

Nicola Loveday ◽

Matthew Curtis

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Clinical Effectiveness ◽

The Impact

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Quality matters: Patterns of palliative interventions in metastatic colorectal cancer (mCRC) patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.83 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 83-83

Author(s):

Rebecca M. Prince ◽

Shuyin Liang ◽

Mantaj Brar ◽

Stephanie Ramkumar ◽

Adena Scheer ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Service ◽

Quality Care ◽

Symptom Relief ◽

Palliative Care Service ◽

Palliative Surgery ◽

Cancer Center ◽

The Mean ◽

Mean Time

83 Background: Increasing recognition that high-quality end of life care is essential has resulted in internationally endorsed metrics allowing assessment of interventions at the end of life. Median survival for mCRC patients has improved to more than 24 months resulting in increased opportunity to undergo interventions for symptom relief at the end of life. We explored patterns of palliative interventions (chemotherapy, radiotherapy, surgery, endoscopy, drainage procedures) and outcomes in mCRC patients. Methods: A retrospective review was undertaken of all mCRC patients referred to the palliative care service from 2000 to 2010 at a tertiary cancer center in Toronto, Canada. Descriptive statistics, survival analysis and regression were employed. Results: A total of 542 patients were included of whom 52.8% were male, mean age was 62.8 years and 44.6% had stage 4 disease at diagnosis. Over the course of their disease 93.9% had an intervention at any time after their diagnosis including 27.5% of patients undergoing palliative surgery, 77% of patients had an intervention in the last year of life and 19.1% had an intervention in the last 30 days of life. The percentage of patients receiving interventions within the last 14 days of life were 1.23% for chemotherapy, 4.6% for radiotherapy, 0.5% for surgery, 10.4% for endoscopy and 23% drainage procedures. The mean time between referral to palliative care and death was 7 months (SD 10.4). For patients who received chemotherapy, the mean time between last chemotherapy and death was 9.5 months (SD 14.9). Overall survival for patients who did not receive chemotherapy was 28 months (SD 33) compared with 40 months (SD 32) for those who received chemotherapy. Regression analysis for risks of dying within 30 days of chemotherapy was limited by a low event rate. Increasing age was significantly associated with a lower risk of dying within 30 days of chemotherapy. Conclusions: In their final months of life, palliative mCRC patients undergo a significant number of interventions aiming to improve quality of life. These require considerable multi-disciplinary input with ramifications for quality care, planning for service provision and funding.

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The outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.131 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 131-131

Author(s):

Si Won Lee ◽

Hye Jin Choi

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Group Performance ◽

Care Service ◽

Symptom Control ◽

Palliative Care Service ◽

Cancer Center ◽

Anticancer Treatment ◽

Tertiary Cancer Center

131 Background: The importance of palliative care in cancer patients continues to be emphasized and studies are proving its importance. Several studies proved the improvement of quality of life in advanced cancer patients. The efficacy of symptom control based on outpatient palliative care service has not yet been reported in Korea. The objective of this study is to review the outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea. Methods: We retrospectively reviewed 155 cancer patients who used outpatient clinic at Yonsei Cancer Center in Korea between April 2014 and December 2014. Symptom severity was measured by modified Korean version of Edmonton Symptom Assessment System. Twelve symptoms were assessed: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, anorexia, constipation, wellbeing, financial distress. Higher score means worse symptom. ESAS scores at baseline and follow-up assessments were analyzed. Results: The 155 patients had following characteristics: female 52.3%, median age 65 years (range 58-75), Hepatobiliary-pancreatic cancer and lung cancer patients accounted for the largest portion (n = 37, 23.9%; n = 36, 23.2% respectively). Most patients were Eastern Cooperative Oncology Group performance status 1 (n = 28, 18.1%) or 2 (n = 24, 15.5%). Ninety-two (59.4%) patients were referred to the palliative care team after anti-cancer treatments were all finished. Overall the symptoms did not change significantly from baseline to 2 consecutive follow up assessment except anorexia ( p value = 0.0195). Patients who were on active anticancer treatment had tendency of higher ESAS score than those finished with the anticancer treatment. However, all symptoms except nausea were not statistically significant. Conclusions: Most patients in this study did not have severe symptom scores that would show the differences of the symptom changes. Nevertheless, although not statistically significant, we found that patients on active anticancer treatment had higher symptom burden than those who were finished with the anticancer treatment. More meticulous symptom management is necessary to improve the symptom control.

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Impact of parenteral opioid shortage on opioid prescriptions among patients seen by the palliative care team of a comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.34_suppl.201 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 201-201

Author(s):

Ali Haider ◽

Yu Qian ◽

Zhanni Lu ◽

Syed Mussadiq Ali Akbar Naqvi ◽

Amy Zhuang ◽

...

Keyword(s):

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Cancer Type ◽

Cancer Pain Management ◽

Before And After ◽

The Impact

201 Background: Recent parenteral opioid shortage (POS) has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient palliative care (PC) team before and after the institution first reported the POS. Methods: We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in one month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Results: POS was associated with less use of parenteral opioids (patient controlled analgesia, and intravenous breakthrough) and more use of non-parenteral opioids (extended release, transdermal, and oral breakthrough) by the referring oncology teams, and PC team (P≤.001) (Table 1). At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) versus 144/193 (75%) (P=.006)] However, at second PC follow-up, the proportion of pain improvement was similar in both cohorts. Conclusions: There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia. More research is needed to better understand the impact of POS on cancer pain management.[Table: see text]

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