Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?

The purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.

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Resource utilization, costs, and quality of end-of-life cancer care: A systematic review of retrospective cohort studies based on routinely collected data (1990-2011).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.111 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 111-111

Author(s):

Julia M. Langton ◽

Bianca Blanch ◽

Annabelle Drew ◽

Marion Haas ◽

Jane M. Ingham ◽

...

Keyword(s):

Systematic Review ◽

Quality Of Care ◽

End Of Life ◽

Resource Utilization ◽

Administrative Data ◽

Cancer Care ◽

Observational Studies ◽

Cost Driver ◽

Health Administrative Data

111 Background: The last year of life is one of the most resource intensive periods in cancer care. The aim of this systematic review is to synthesize retrospective observational studies examining resource utilization and costs at the end-of-life period in adult cancer patients. The purpose is to examine study methodology and outcomes, with a particular focus on studies using quality indicators. Methods: We searched Medline, Embase, CINAHL, and York Centre for Research and Dissemination (1990-2011). Two reviewers screened titles and abstracts of 14,424 articles and 835 full-text, potentially relevant articles. Inclusion criteria were: English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life or palliative focus. Results: We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 55 were from the North America; and 33 published since 2008. We observed exponential increases in service use and costs as death approached. Hospital services were the main cost driver. Palliative services were relatively underutilized, and associated with lower expenditures than hospital-based care. The 15 studies using quality of care indicators demonstrated significant proportions of up to 33% of patients receive chemotherapy or life sustaining treatments in the last month of life; up to 66% do not receive hospice/palliative services. Conclusions: Observational studies using routinely collected health administrative data have the potential to drive evidence-based palliative care practice and policy. Further refinement of quality of care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations.

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Multidisciplinary Cancer Care With a Patient and Physician Satisfaction Focus

Journal of Oncology Practice ◽

10.1200/jop.2010.000028 ◽

2010 ◽

Vol 6 (6) ◽

pp. e35-e37 ◽

Cited By ~ 24

Author(s):

Gregory Litton ◽

Dianne Kane ◽

Gina Clay ◽

Patricia Kruger ◽

Thomas Belnap ◽

...

Keyword(s):

Quality Of Care ◽

Cancer Care ◽

Physician Satisfaction ◽

Care Process ◽

Multidisciplinary Clinic ◽

Intermountain Healthcare ◽

Multidisciplinary Clinics

If implemented appropriately, multidisciplinary clinics can enhance quality of care and increase downstream revenue. The multidisciplinary clinic at Intermountain Healthcare has greatly improved the cancer care process for patients, physicians, and the community.

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Hospital end-of-life care: families’ free-text notes

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-00239 ◽

2020 ◽

pp. bmjspcare-2020-00239

Author(s):

Sandra Kurkowski ◽

Johannes Radon ◽

Annika R Vogt ◽

Martin Weber ◽

Stephanie Stiel ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

End Of Life ◽

End Of Life Care ◽

Qualitative Content Analysis ◽

Free Text ◽

Life Care ◽

Quality Aspects ◽

Care Of The Dying

BackgroundPalliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients’ loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones’ perspectives on need for improvements.AimTo identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire.DesignWithin the validation study of the questionnaire ‘Care of the Dying Evaluation’ (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring.Setting/participantsLoved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017.Results993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient’s and/or loved one’s will, involvement in decision-making at the end of life (patient’s volition) and having the possibility to say goodbye.ConclusionsIt is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients’ will and to be emotionally supported.Trial registration numberThis study was registered at the German Clinical Trials Register (DRKS00013916).

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Incarceration and Cancer-Related Outcomes (ICRO) study protocol: using a mixed-methods approach to investigate the role of incarceration on cancer incidence, mortality and quality of care

BMJ Open ◽

10.1136/bmjopen-2021-048863 ◽

2021 ◽

Vol 11 (5) ◽

pp. e048863

Author(s):

Lisa Puglisi ◽

Alexandra A Halberstam ◽

Jenerius Aminawung ◽

Colleen Gallagher ◽

Lou Gonsalves ◽

...

Keyword(s):

Socioeconomic Status ◽

Quality Of Care ◽

Mixed Methods ◽

Cancer Incidence ◽

Cancer Care ◽

Survival Models ◽

Structural Racism ◽

Interaction Terms ◽

The Relationship

IntroductionIncarceration is associated with decreased cancer screening rates and a higher risk for hospitalisation and death from cancer after release from prison. However, there is a paucity of data on the relationship between incarceration and cancer outcomes and quality of care. In the Incarceration and Cancer-Related Outcomes Study, we aim to develop a nuanced understanding of how incarceration affects cancer incidence, mortality and treatment, and moderates the relationship between socioeconomic status, structural racism and cancer disparities.Methods and analysisWe will use a sequential explanatory mixed-methods study design. We will create the first comprehensive linkage of data from the Connecticut Department of Correction and the statewide Connecticut Tumour Registry. Using the linked dataset, we will examine differences in cancer incidence and stage at diagnosis between individuals currently incarcerated, formerly incarcerated and never incarcerated in Connecticut from 2005 to 2016. Among individuals with invasive cancer, we will assess relationships among incarceration, quality of cancer care and mortality, and will assess the degree to which incarceration status moderates relationships among race, socioeconomic status, quality of cancer care and cancer mortality. We will use multivariable logistic regression and Cox survival models with interaction terms as appropriate. These results will inform our conduct of in-depth interviews with individuals diagnosed with cancer during or shortly after incarceration regarding their experiences with cancer care in the correctional system and the immediate postrelease period. The results of this qualitative work will help contextualise the results of the data linkage.Ethics and disseminationThe Yale University Institutional Review Board (#2000022899) and the Connecticut Department of Public Health Human Investigations Committee approved this study. We will disseminate study findings through peer-reviewed publications and academic and community presentations. Access to the deidentified quantitative and qualitative datasets will be made available on review of the request.

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Clinical Governance Benchmarking Issues in Oncology: Aggressiveness of Cancer Care and Consumption of Strong Opioids. A Single-Center Experience on Measurement of Quality of Care

Tumori Journal ◽

10.1177/030089161009600311 ◽

2010 ◽

Vol 96 (3) ◽

pp. 443-447 ◽

Cited By ~ 5

Author(s):

Petros Giovanis ◽

Giovanni De Leonardis ◽

Antonella Garna ◽

Viviana Lovat ◽

Francesca Caldart ◽

...

Keyword(s):

Quality Of Care ◽

Cancer Care ◽

Clinical Governance ◽

Single Center ◽

Single Center Experience ◽

Strong Opioids

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Improving the organisation of breast cancer care increases quality of care while reducing costs

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(04)90810-5 ◽

2004 ◽

Vol 2 (3) ◽

pp. 113

Author(s):

G.L Beets ◽

C.N.A Frotscher ◽

C.D Dirksen ◽

M.H Hebly ◽

M.F von Meyenfeldt

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

Cancer Care ◽

Breast Cancer Care ◽

Reducing Costs

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Exploring caregivers' perspectives on improving care for older people at the end of life in Thailand

International Journal of Palliative Nursing ◽

10.12968/ijpn.2019.25.7.326 ◽

2019 ◽

Vol 25 (7) ◽

pp. 326-332

Author(s):

Kanyanat Supaporn ◽

Sang-arun Isaramalai ◽

Wandee Suttharangsee

Keyword(s):

Quality Of Care ◽

Older People ◽

End Of Life ◽

Care Quality ◽

Ageing Population ◽

Home Setting ◽

Experience Of Care ◽

Care Recipients ◽

Care For Older People

Background: Older people in Thailand receive general medical and social care at the end of life, and many rarely access palliative services. In light of this, improving the quality of care for the ageing population relies on addressing the needs of family caregivers, who provide the majority of care in a home setting. Understanding caregivers' perspectives when caring for a friend or relative will help to improve the quality of care that they provide. Aim: To explore caregivers' perspectives on improving care for older people in Thailand in the palliative stage. Methods: A qualitative study using in-depth interviews and observation of 10 older people in the palliative stage and their caregivers was undertaken. Data were analysed using content analysis. Findings: Data analysis revealed three themes: caregivers cared to repay the older person's previous kindness, caregivers cared and changed their caregiving behaviour to minimise the older person's perception of being abandoned or being a burden, and to follow Thai ancestral traditions, so that the older person could die peacefully. Conclusion: This study provides specific instructions for those who provide care for older Thai people in the palliative stage. Finding ways to address caregivers' perspectives on improving care quality could enhance the experience of care recipients.

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