Feasibility of screening hospitalized cancer patients for palliative care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9094-9094
Author(s):  
Paul A. Glare ◽  
Mary K. Plakovic ◽  
Anna Schloms ◽  
Barbara Egan ◽  
Leonard Saltz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Judgment ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Nursing Satisfaction ◽  
Referral Criteria ◽  
Operational Metrics ◽  
Cancer Network ◽  
Seriously Ill ◽  
Extent Of Disease

9094 Background: The National Comprehensive Cancer Network Palliative Care (PC) Guideline recommends screening all oncology patients for PC needs, and to call a PC consult when referral criteria are met. There are no data on the feasibility or impact of this approach. The aim of this pilot study was to assess the feasibility of PC screening in patients admitted to a comprehensive cancer center (CCC). Methods: Design: Observational study. From 11/1/10 to 1/31/11, floor nurses screened all patients the day after admission under the two teams (“Team A” and “Team B”) of the Gastrointestinal Oncology Service at Memorial Sloan-Kettering Cancer Center. Team A patients were also evaluated by the referral criteria. Endpoints: Patients screened ‘positive’ if they had advanced disease and any of the clinical situations nominated in the Guideline. The referral criteria triggered PC consults in Team A patients; clinical judgment triggered Team B consults. Outcomes: Screening rates, nursing satisfaction survey, clinical and operational metrics. Results: Ninety percent (229 of 254) of admissions were screened. Both Teams’ patients were seriously ill (see Table), and it was no surprise that 63% (145 of 229) screened positive. Survey respondents (response rate 50%) rated screening as simple, quick and helpful, although nurses scored the extent of disease wrong in 16%. Sixty eight percent (55 of 780) of Team A patients who screened positive met the referral criteria. This generated more consults on Team A, but the effect on key outcomes was not significant (n.s.). Conclusions: Screening for PC was feasible in this setting, but is a challenging concept in terms of reliability, validity and timing. The value to a CCC of increasing PC access via referral criteria needs evaluation in well-designed trials. [Table: see text]

Feasibility of screening hospitalized patients for palliative care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 176-176
Author(s):  
Paul A. Glare ◽  
Kathy Plakovic ◽  
Anna Schloms ◽  
Barbara Egan ◽  
Leonard Saltz
Keyword(s):  
Palliative Care ◽  
Clinical Judgment ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Nursing Satisfaction ◽  
Referral Criteria ◽  
Specialist Services ◽  
Operational Metrics ◽  
Cancer Network ◽  
Seriously Ill

176 Background: The National Comprehensive Cancer Network (NCCN) Palliative Care (PC) Guideline recommends screening all oncology patients for PC, and to call a consult when the referral criteria are met. There are no data on the feasibility or impact of following this recommendation. Methods: Design: Prospective observational study. From 11/1/10 to 1/31/11, floor nurses screened all admissions under the two teams (“Team A” and “Team B”) of the Gastrointestinal Oncology (GIO) service at Memorial Sloan-Kettering Cancer Center. Team A patients were also evaluated by the referral criteria. Endpoints: Patients screened ‘positive’ if they had any of the clinical situations nominated in the Guideline. A PC consult was triggered on Team A patients who met the referral criteria. Team B patients got PC consults based on clinical judgment. Outcomes: screening rates, nursing satisfaction survey, clinical and operational metrics. Results: 90% (228 of 254) admissions were screened, typically taking < 5 minutes. Both teams’ patients were seriously ill (Table 1a), and it is no surprise 75% (170 of 228) screened positive and that 68% (60 of 87) of screen-positive Team A patients met the referral criteria. Screening generated more consults on Team A than Team B (47 vs. 15 p<0.0001), and they were referred earlier (Table 1b). Nurses (response rate 50%) rated screening as quick and simple but not very helpful. Conclusions: Screening for PC was feasible and sustainable, increasing access to specialist services. The value to a comprehensive cancer center of markedly increasing PC consults through implementation of guidelines needs to be evaluated in well-designed trials. [Table: see text]

scholarly journals Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center

Cancer ◽  
2010 ◽  
Vol 116 (8) ◽  
pp. 2036-2043 ◽  
Author(s):  
David Hui ◽  
Ahmed Elsayem ◽  
Zhijun Li ◽  
Maxine De La Cruz ◽  
J. Lynn Palmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Antineoplastic Therapy ◽  
Advanced Cancer ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center

Interval between first palliative care consultation and death among patients in a comprehensive cancer center in Saudi Arabia

2015 ◽  
Vol 3 (2) ◽  
pp. 61 ◽  
Author(s):  
SamiAyed Alshammary ◽  
Abdullah Alsuhail ◽  
BalajiP Duraisamy ◽  
Savithiri Ratnapalan ◽  
SaadHamad Alabdullateef
Keyword(s):  
Palliative Care ◽  
Saudi Arabia ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Palliative Care Consultation ◽  
Care Consultation

scholarly journals Work Experiences of Patients Receiving Palliative Care at a Comprehensive Cancer Center: Exploratory Analysis

2017 ◽  
Vol 20 (7) ◽  
pp. 770-773 ◽  
Author(s):  
Paul A. Glare ◽  
Tanya Nikolova ◽  
Alberta Alickaj ◽  
Sujata Patil ◽  
Victoria Blinder
Keyword(s):  
Palliative Care ◽  
Exploratory Analysis ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Work Experiences

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

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 8034-8034
Author(s):  
A. F. Elsayem ◽  
R. Jenkins ◽  
L. Parmley ◽  
M. L. Smith ◽  
J. L. Palmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospital Mortality ◽  
Care Service ◽  
Palliative Care Service ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
The Impact

The use of palliative sedation for intractable symptoms in a palliative care unit (PCU) in a comprehensive cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8577-8577 ◽  
Author(s):  
A. Elsayem ◽  
E. Curry ◽  
J. Boohene ◽  
H. Ibrahim ◽  
E. Pace ◽  
...  
Keyword(s):  
Palliative Care ◽  
Head And Neck ◽  
Poor Prognosis ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Pharmacy Records ◽  
Progressive Dyspnea ◽  
Midazolam Infusion

8577 Background: There is wide variation in the frequency of reported use of palliative sedation (PS) to control intractable and refractory symptoms. Institutions have established policies for midazolam infusion in cases of PS. The indications and outcomes of this procedure have not been well characterized Methods: Our midazolam policy for PS requires 1:1 nursing for the first 24 hours and documentation of discussions regarding sedation. We reviewed our PCU database for all admissions for the first 11 months of 2005. We used pharmacy records for all patients who received medications used for sedation (chlorpromazine, lorazepam, midazolam). We reviewed all charts of pts who received any of these drugs to establish if the indication had been PS. Results: 148/484 admissions died in the PCU [31%]. 65/484 admissions (13%), and 47/ 148 patients who died (32%) received PS. Median age of patients (pts) was 58, 42 pts were male [65%], and the most frequent primaries observed were lung 24 [37%], hematologic 12 [18%], head and neck 7 [11%], and gastrointestinal 7 [11%]. Results are indicated in the table. * 2 patients had more than one indication for sedation The main causes for PS in our patients were delirium 57 [88%], dyspnea 6 [9%], and bleeding 4 [6%]. 18/65 patients who received PS [35%] were discharged alive, versus 318/419 [76%] who did not receive PS [p< 0.001]. Midazolam was used in 11/65 episodes [17%]. 4/6 pts with PS for dyspnea received midazolam [66%], versus 8/57 with PS for delirium or bleeding [14%], p=0.01]. 18/54 pts who received PS using other drug were discharged alive [33%], versus 0/11 pts who received midazolam [p=0.02]. Conclusions: Palliative sedation was required in 32% of pts who died in the hospital. Reporting midazolam utilization rates for monitoring overall PS outcomes, results in significant under reporting. Midazolam was used more frequently in cases of progressive dyspnea and poor prognosis. Less restrictive policies in the use of midazolam may result in more use for PS. Data accrual continues. [Table: see text] No significant financial relationships to disclose.

Utilization of antineoplastic therapy (ANT) in advanced cancer patients admitted to an acute palliative care unit (APCU) at a comprehensive cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9590-9590
Author(s):  
D. Hui ◽  
E. Bruera ◽  
Z. Li ◽  
J. L. Palmer ◽  
M. de la Cruz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Univariate Analysis ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Targeted Agents ◽  
Cox Regression Analysis ◽  
Younger Age

9590 Background: Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of ANT (chemotherapy and targeted agents) in these patients is unclear. We examined the frequency, trends, factors and survival associated with ANT use in hospitalized patients who required an APCU stay. Methods: All patients admitted to APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis and ANTs utilization from day of hospitalization to discharge, and survival information were retrieved retrospectively. Results: 2604 cancer patients had the following characteristics: median age 59 (range 18–101), male 51%, hematologic malignancy 11%, median hospital stay 11 (Q1-Q3 8–17) days, median APCU stay 7 (Q1-Q3 4–10) days and median survival 22 days. During hospitalization, 393 patients (15%) received ANTs, including chemotherapy (N=297, 11%) and targeted therapy (N=155, 6%). No significant change in frequency of ANTs was detected over the 5 year period. Multivariate logistic regression analysis ( Table ) revealed that younger age, cancer primaries and longer admissions were associated with ANT use. Patients with hematologic malignancies received more chemotherapy (38% vs. 8%, p<0.001) and targeted agents (18% vs. 4%, p<0.001) compared to patients with solid tumors. ANT use was associated with longer overall survival in univariate analysis (median 25 days vs. 21 days, p=0.001); however, this was no longer significant in multivariate Cox regression analysis. Conclusions: The use of ANT during hospitalization that included an APCU stay was limited to a highly selected group of patients, and did not increase overtime. ANT use was associated with younger age, specific cancer primaries, longer admissions, and no significant improvement in survival. The APCU at our cancer center facilitates simultaneous care where patients access palliative care while on ANT. [Table: see text] No significant financial relationships to disclose.

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