Retrospective assessment of quality of cancer care in last 6 months of life.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 234-234
Author(s):  
Brian Cassel ◽  
Nevena Skoro ◽  
Kathleen Kerr ◽  
Lisa Shickle ◽  
Patrick J. Coyne ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Specialist Palliative Care ◽  
Retrospective Assessment ◽  
Palliative Care Teams ◽  
Social Security Death Index ◽  
National Quality ◽  
National Organizations

234 Background: National organizations such as the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum (NQF) have developed metrics that assess the quality of cancer care. These metrics include consensus standards by the NQF for management of symptoms and end-of-life-care. Cancer centers need feasible methods for self-evaluating their performance on such metrics. Methods: Claims for our cancer patients were matched to Social Security Death Index data to determine date of death.3,128 adult cancer patients died between January 2009 and July 2011 and had at least 1 contact with our center in their last six month of life. All inpatient and outpatient claims data generated in the last six months of life at our hospital were analyzed. Results: 32% of patients had an admission in their last 30 days of life, with 15% dying in the hospital. 19% had at least one 30-day readmission in their last six months of life. 6.7% had chemotherapy in the 2 weeks prior to death, and 11.4% in the last month. 27.5% had some contact with the specialist palliative care (SPC) team. Solid tumor patients with SPC earlier than 1 month until death had fewer in-hospital deaths (15.6%) versus those with later or no SPC (19.5%), p=.041. There was no SPC difference for 30-day mortality, or 14- or 30-day chemotherapy metrics. Conclusions: Hospitals can self-evaluate their own performance on NQF endorsed measures, and CMS outcome measures. These data provide additional impetus for earlier integration of specialist palliative care teams. SPC in the last 1-3 weeks of life did not improve most utilization metrics.[Table: see text]

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 A randomized trial of a specialist palliative care intervention for patients undergoing surgery for cancer: rationale and design of the Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Myrick C. Shinall ◽  
Aimee Hoskins ◽  
Alexander T. Hawkins ◽  
Christina Bailey ◽  
Alaina Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Randomized Controlled Trial ◽  
Cancer Patients ◽  
Controlled Trial ◽  
Specialist Palliative Care ◽  
Randomized Controlled ◽  
Care Intervention ◽  
Scope Trial

Abstract Background In medical oncology settings, early specialist palliative care interventions have demonstrated improvements in patient quality of life and survival compared with usual oncologic care. However, the effect of early specialist palliative care interventions in surgical oncology settings is not well studied. Methods The Surgery for Cancer with Option for Palliative Care Expert (SCOPE) Trial is a single-center, prospective, single-blind, randomized controlled trial of a specialist palliative care intervention for cancer patients undergoing non-palliative surgery. It will enroll 236 patients scheduled for major abdominal operations for malignancy, who will be randomized 1:1 at enrollment to receive usual care (control arm) or specialist palliative care consultation (intervention arm). Intervention arm patients will receive consultations from a palliative care specialist (physician or nurse practitioner) preoperatively and postoperatively. The primary outcome is physical and functional wellbeing at 90 days postoperatively. Secondary outcomes are quality of life at 90 days postoperatively, posttraumatic stress disorder symptoms at 180 days postoperatively, days alive at home without an emergency room visit in the first 90 postoperative days, and overall survival at 1 year postoperatively. Participants will be followed for 3 years after surgery for exploratory analyses of their ongoing quality of life, healthcare utilization, and mortality. Discussion SCOPE is an ongoing randomized controlled trial evaluating specialist palliative care interventions for cancer patients undergoing non-palliative oncologic surgery. Findings from the study will inform ways to identify and improve care of surgical patients who will likely benefit from specialist palliative care services. Trial registration ClinicalTrials.gov Identifier: NCT03436290 First Registered: 16 February 2018 Enrollment Began: 1 March 2018 Last Update: 20 December 2018

The oncologist’s role in delivering palliative care

2021 ◽  
pp. 787-799
Author(s):  
Nathan I. Cherny ◽  
Stein Kaasa
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Patient Care ◽  
Cancer Patients ◽  
Continuity Of Care ◽  
Cancer Care ◽  
Palliative Medicine ◽  
Collaborative Practice ◽  
Interdisciplinary Care

The division of cancer care into initial primary antitumour therapies followed by hospice or palliative care for patients who have progressive disease is anachronistic. Since the goals of medical oncology extend beyond the reduction of tumour burden and the deferral of death and incorporate a quality-of-life dimension, there is need for a continuum in patient care independent of whether the treatment intention is curative, life-prolonging, or symptomatic. Palliative care interventions should be integrated according to the clinical circumstances of the patient. This chapter outlines the oncologist’s role in the delivery of palliative care to cancer patients, emphasizing issues related to communication, interdisciplinary care, and collaborative practice with palliative medicine experts, and emphasizing principles of non-abandonment and continuity of care.

End-of-life discussions with advanced cancer patients and their effects on bereaved families’ mental health.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 3-3
Author(s):  
Takashi Yamaguchi ◽  
Isseki Maeda ◽  
Yutaka Hatano ◽  
Masanori Mori ◽  
Yasuo Shima ◽  
...  
Keyword(s):  
Mental Health ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Complicated Grief ◽  
Advanced Cancer Patients ◽  
Palliative Care Teams ◽  
Prevalence Of Depression

3 Background: End-of-life (EOL) discussions are important for providing appropriate care to patients with advanced cancer at the end of their life. To explore the relationship between EOL discussions and bereaved families’ mental health, as well as the quality of the patient’s death and quality of care at the end of life. Methods: This was a nationwide questionnaire survey of bereaved families of deceased cancer patients who died at 75 sites (20 inpatient palliative care teams in acute hospitals, 33 palliative care units/inpatient hospices, and 22 outpatient clinics that provide home palliative care service) in Japan. 13,711 bereaved family members of cancer patients who died before January 2014 in each of the participating institutions were potential participants. We evaluated the prevalence and details of EOL discussions which were defined as “a discussion with physicians about the preferred place of death or resuscitation”. We also evaluated the prevalence of depression (defined as the Patient Health Questionnaire-9 ≥ 10) and complicated grief (defined as the Brief Grief Questionnaire ≥ 8) in bereaved families. Results: 9123 questionnaires returned (response rate 67%). Of those, 80.6% had EOL discussions. After propensity score weighted adjustment, bereaved families with EOL discussion less frequently developed depression (17.3% and 21.6% ; P < 0.001) and complicated grief (13.7% and 15.9% ; P = 0.03) than without. There were significant differences in the trend test among families without and in those with EOL discussions < 1, 1–3, and > 3 months before the patient’s death, for the prevalence of depression (21.6%, 20.6%, 16.8%, and 15.5%, respectively; P trend < 0.001) and complicated grief (15.9%, 16.4%, 12.8%, and 12.9%, respectively; P trend < 0.001). Conclusions: EOL discussions may contribute to decrease depression and complicated grief in bereaved families. EOL discussions should be initiated with advanced cancer patients when physicians expect a patient’s prognosis is limited to several months.

Palliative care from the perspective of cancer physicians: a qualitative semistructured interviews study

2020 ◽  
pp. bmjspcare-2020-002455
Author(s):  
Guillaume Economos ◽  
Alice Bonneville-Levard ◽  
Ines Djebari ◽  
Kevin Van Thuynes ◽  
Colombe Tricou ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Terminal Care ◽  
Qualitative Methodology ◽  
Psychosocial Support ◽  
Specialist Palliative Care ◽  
Palliative Care Teams ◽  
Semistructured Interviews ◽  
Data Saturation

ObjectiveIntegrated palliative care for populations with cancer is now highly recommended. However, numerous physicians working in cancer care are still reluctant to refer patients to specialist palliative care teams. This study explores their perceptions of palliative care and factors influencing reasons to refer to specialist palliative care.MethodsWe used a qualitative methodology based on semistructured interviews with physicians working in cancer care, in two tertiary hospitals and one comprehensive cancer centre with access to a specialist palliative care team. Forty-six physicians were invited and 18 interviews were performed until data saturation. Participants were mainly men, licensed in cancer care, 37.9 years old on average and had 13 years of professional experience. The length of interviews was on average 34 min (SD=3). Analysis was performed accordingly with the thematic analysis.ResultsThe data analysis found four themes: symptom management as a trigger, psychosocial support, mediation provided by interventions, and the association with terminal care or death. Palliative care integrated interventions were mainly perceived as holistic approaches that offered symptom management expertise and time. They were valued for helping in consolidating decision-making from a different or external perspective, or an ‘outside look’. Several barriers were identified, often due to the confusion between terminal care and palliative care. This was further highlighted by the avoidance of the words ‘palliative care’, which were associated with death.ConclusionsNational policies for promoting palliative care seemed to have failed in switching oncologists' perception of palliative care, which they still consider as terminal care.

Use of palliative care measures to support improved patient outcomes and quality of life.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 281-281
Author(s):  
Ken Williams ◽  
Tilithia McBride
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Quality Improvement ◽  
Cancer Patients ◽  
Patient Outcomes ◽  
Quality Measurement ◽  
Quality Measure ◽  
National Quality ◽  
Patient Reported

281 Background: Key public-private quality improvement entities, such as the National Quality Forum (NQF) and the National Priorities Partnership, have identified palliative care measures as being critical for the care of cancer patients. In this study, Avalere sought to understand whether current palliative care measures are adequate to support desired patient outcomes, including quality of life. Methods: Avalere conducted searches of large, national quality measure databases—including the Agency for Healthcare Research and Quality’s National Quality Measure Clearinghouse and NQF—as well as public quality measurement programs to better understand the range of existing palliative care measures and the use thereof. In addition, Avalere augmented this research through a review of the white and grey literature to determine how such measures may be better used to support desired outcomes. Results: Several organizations—most notably the American Society of Clinical Oncology (ASCO); the American Medical Association–convened Physician Consortium for Performance Improvement, with the National Comprehensive Cancer Network and ASCO; and the RAND Corporation—have developed measures addressing palliative care for cancer patients. Several of these measures have been subsequently endorsed by NQF. Despite this, few palliative care measures have been incorporated into national quality measurement programs, outside of ASCO’s proprietary Quality Oncology Practice Initiative (QOPI). Conclusions: While it is widely acknowledged that palliative care measures are critical for the care of cancer patients, particularly as it relates to supporting quality of life, little has been done to ensure such measures are incorporated into national public quality improvement initiatives, such as the Centers for Medicare & Medicaid Services’ Physician Quality Reporting System. As calls for increased use of patient-reported outcomes and other palliative care measures continue to rise, policymakers may need to consider incorporating existing, NQF–endorsed measures, such as those used in QOPI, into public programs.

Access to Outreach Specialist Palliative Care Teams among Cancer Patients in Denmark

2013 ◽  
Vol 16 (8) ◽  
pp. 951-957 ◽  
Author(s):  
Mette Asbjoern Neergaard ◽  
Anders Bonde Jensen ◽  
Frede Olesen ◽  
Peter Vedsted
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Specialist Palliative Care ◽  
Palliative Care Teams
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