End-of-life care planning in patients with recurrent gynecologic cancers.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20648-e20648
Author(s):  
Nathan L Jones ◽  
Shelley L Galvin ◽  
Timothy J Vanderkwaak ◽  
David J. Hetzel ◽  
Cameron Blair Harkness ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Median Duration ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Care Plan ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Gynecologic Cancers

e20648 Background: Gynecologic oncologists and associates must provide appropriate, acceptable, and patient-centered end-of-life care. Most women with terminal gynecologic cancers do not have do-not-resuscitate (DNR) orders upon hospital admission and many do not receive effective palliative care. Our objective was to assess quality care indicators involving end-of-life care among gynecologic oncology patients treated at our institution. Methods: An IRB-approved retrospective chart review was performed on all patients with recurrent gynecologic cancers and terminal diagnoses who died from January 2009 through October 2012. Data included intervals to death from: diagnoses, DNR status, Hospice/Palliative Care Medicine (HPCM) involvement, and other factors related to end-of-life care. Chi-squared and discriminate analyses were utilized. Results: Complete data were available for 130 of 345 (37.7%) patients. Disease sites included cervix 28 (21.5%), uterine 37 (28.5%), ovarian 51(39.2%), and vaginal/vulvar 14 (10.8%). Median age at diagnosis and death was 63 and 65 years. Relative to death, diagnoses occurred at a median of 1.65 (0.05-32) years prior. 83 (63.8%) patients were DNR at their last hospitalization, 84(64.6%) had HPCM involvement, and 18(13.8%) had an advance care plan. When HPCM was involved, 83.3% were DNR as compared to 28.3% without involvement (p=0.0001). Patients were also significantly more likely to have DNR status with diagnosis of ovarian cancer and as the duration of time between diagnosis and death increased (p=0.0001). The provider obtaining DNR was most often faculty over residents or HPCM (60.2%, 27.7%, 12%). DNR status was declared by 57 (68.7%) patients and 26 (31.3%) power of attorneys. Median duration from DNR to death was 14 days (0-308) and median duration from HPCM involvement to death was 22 days (0-391). Conclusions: DNR status is associated with ovarian cancer, HPCM involvement, and increasing time from diagnosis to death. Earlier intervention from providers or HPCM could allow for greater patient autonomy and fewer interventions at end-of-life.

The effect of a multidisciplinary palliative care initiative on end-of-life care in gynecologic oncology patients

2017 ◽  
Vol 145 ◽  
pp. 23
Author(s):  
M.M. Mullen ◽  
L.M. Divine ◽  
B. Porcelli ◽  
I. Wilkinson-Ryan ◽  
M. Dans ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Life Care ◽  
Oncology Patients

scholarly journals Does Death Anxiety Affect End-of-Life Care Discussions?

2014 ◽  
Vol 24 (8) ◽  
pp. 1521-1526 ◽  
Author(s):  
Alaina J. Brown ◽  
Megan J. Shen ◽  
Lois M. Ramondetta ◽  
Diane C. Bodurka ◽  
Robert L. Giuntoli ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death Anxiety ◽  
Linear Regression Analysis ◽  
Gynecologic Oncology ◽  
Family Members ◽  
Comfort Level ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders

ObjectivesThe aim of this study was to determine if a gynecologic cancer patient’s comfort level discussing end-of-life care issues with her caregivers is related to her death anxiety level.Materials/MethodsGynecologic oncology clinic patients were asked to rate their degree of agreeability with 4 statements regarding comfort level discussing end-of-life care issues. Participants also completed the Hoge’s Intrinsic Religiosity Scale and Templer’s Death Anxiety Scale.ResultsFour hundred one surveys were distributed. One hundred twenty-nine patients participated, with a response rate of 32.2%. The median age of the sample was 55 years. Most patients were white (72.9%), married (58.9%), and Christian (85.3%). Most patients had ovarian cancer (40.4%). Of the 74 patients who knew their cancer stage, 59% had been diagnosed with advanced (stage III-IV) disease. Thirty-three percent were currently in remission, and 17% had recurrent disease. Of all patients surveyed, 32.6% were currently receiving treatment. Chemotherapy was the most common treatment (62% of those being treated). Higher level of comfort discussing end-of-life care topics such as do-not-resuscitate orders with family members was significantly associated with decreased death anxiety (P = 0.008 and P = 0.001). There was no significant association between comfort level when patients discussed do-not-resuscitate orders with physicians and patients’ death anxiety (P = 0.14). After controlling for age, race, marital status, education level, current treatment status, and religiosity, linear regression analysis demonstrated that the relationship between a patient’s increased comfort level when discussing end-of-life care topics with family members and decreased death anxiety remained statistically significant (P = 0.005 and P = 0.001).ConclusionsConversations regarding goals of treatment are an important component of caring for cancer patients. Death anxiety may contribute to decreased communication between patients and their family members regarding the patient’s end-of-life care wishes. Obtaining a better understanding of the role death anxiety plays in end-of-life care discussions may help patients receive the end-of-life care they desire.

The effect of a multidisciplinary palliative care initiative on end of life care in gynecologic oncology patients

2017 ◽  
Vol 147 (2) ◽  
pp. 460-464 ◽  
Author(s):  
Mary M. Mullen ◽  
Laura M. Divine ◽  
Bree P. Porcelli ◽  
Ivy Wilkinson-Ryan ◽  
Maria C. Dans ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Life Care ◽  
Oncology Patients

scholarly journals End-of-life care in children and adolescents with cancer: perspectives from a French pediatric oncology care network

2021 ◽  
pp. 030089162110133
Author(s):  
Sophie Blais ◽  
Sarah Cohen-Gogo ◽  
Elodie Gouache ◽  
Lea Guerrini-Rousseau ◽  
Benoit Brethon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Children And Adolescents ◽  
End Of Life ◽  
Pediatric Oncology ◽  
End Of Life Care ◽  
Hematologic Malignancies ◽  
Developed Countries ◽  
Median Number ◽  
Life Care ◽  
Do Not Resuscitate

Background: In developed countries, cancer remains the leading cause of pediatric death from illness after the neonatal period. Objective: To describe the end-of-life care characteristics of children and adolescents with solid tumors (ST) or hematologic malignancies (HM) who died from tumor progression in the Île-de-France area. Methods: This is a regional, multicentric, retrospective review of medical files of all children and adolescents with cancer who died over a 1-year period. Extensive data from the last 3 months of life were collected. Results: A total of 99 eligible patients died at a median age of 9.8 years (range, 0.3–24 years). The most frequent terminal symptoms were pain (n = 86), fatigue (n = 84), dyspnea (n = 49), and anorexia (n = 41). Median number of medications per patient was 8 (range, 3–18). Patients required administration of opioids (n = 91), oxygen (n = 36), and/or sedation (n = 61). Decision for palliative care was present in all medical records and do-not-resuscitate orders in 90/99 cases. Symptom prevalence was comparable between children and adolescents with ST and HM. A wish regarding the place of death had been expressed for 64 patients and could be respected in 42 cases. Death occurred in hospital for 75 patients. Conclusions: This study represents a large and informative cohort illustrating current pediatric palliative care approaches in pediatric oncology. End-of-life remains an active period of care requiring coordination of multiple care teams.

Managing symptoms when “the first step or two isn’t working”: Provider and patient perceptions of the role of specialty palliative care in symptom management in gynecologic oncology.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 47-47
Author(s):  
Carolyn Lefkowits ◽  
Dio Kavalieratos ◽  
Janet Arida ◽  
Winifred Teuteberg ◽  
Heidi Donovan ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Provider ◽  
Symptom Management ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Life Care ◽  
Multiple Symptoms

47 Background: Our objective was to describe gynecologic oncology (GO) providers’ and patients’ knowledge, attitudes and preferences related to utilization of specialist palliative care (SPC) for symptom management. Methods: Semi-structured qualitative interviews with 19 GO providers (7 physicians, 7 advanced practice providers, 5 nurses) and 30 patients with advanced or recurrent gynecologic cancer from an academic medical center. Key interview domains include: patient symptoms, perceived role of oncology team regarding symptom management, familiarity with SPC, and barriers and facilitators to utilization of SPC for symptom management. Qualitative analysis is underway. Results: 19 provider interviews and 29 patient interviews were completed. Preliminary findings indicate shared beliefs between providers and patients, including an overall willingness to involve SPC in symptom management. Although providers felt comfortable initially managing common symptoms, they expressed interest in involving SPC for complex or multiple symptoms. Patients do not expect their GO providers to manage severe symptoms, noting concerns of complex symptom management as burdensome to the GO team. Barriers to involving SPC in symptom management included: patients’ perceptions of SPC as synonymous with end-of-life care, and logistical issues (e.g., scheduling and transportation). When a distinction was drawn between SPC for symptom management and end-of-life care, patients were uniformly open to seeing SPC for symptom management. Conclusions: GO patients’ and providers’ perception of the role of oncology providers in symptom management is consistent with the concept of a primary palliative care provider, delivering initial management of common symptoms. Specialty palliative care services are seen as complementary to the GO providers’ skillset and particularly useful for severe or multiple symptoms. Implications include the importance of ensuring that oncology provider training includes dedicated attention to symptom management to enable them to fulfill the role of primary palliative care provider.

Impact of mortality reviews on supportive care utilization, end-of-life care, and inpatient mortality.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 45-45
Author(s):  
Yasmin Karimi ◽  
Vasu Divi ◽  
Sandy Srinivas ◽  
Andrea Segura Smith ◽  
Jennifer Hansen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Health Workers ◽  
Hospital Setting ◽  
Care Plan ◽  
Care Utilization ◽  
Life Care ◽  
Chi Square Analysis

45 Background: 22% of US patients with cancer die in a hospital setting. As part of an effort to reduce unexpected inpatient (inpt) mortality, we reviewed records of all inpt cancer deaths at Stanford Hospital and reported findings to the treatment teams. Methods: Deaths with a cancer related ICD 9/10 code between 5/2017 and 6/2019 were reviewed by a multidisciplinary team. Findings and potential opportunities for improvement were communicated to the pt’s primary outpt oncologist, inpt oncologists and other involved providers. Observed to expected (O:E) mortality for the year prior to the intervention (5/2016–4/2017), Year 1 (5/2017–4/2018) and Year 2 (5/2018–4/2019) of the intervention were compared with two sided t test, α=0.05 (Vizient Inc, Irving TX). Changes in supportive care utilization and end of life care between cases reviewed in Year 1 and Year 2 were compared with chi square analysis. Results: There were 236 inpatient deaths reviewed. The median age was 64 years; 76% had solid tumors; 68% had metastatic disease; 33% had a previous inpt admission; 34% received chemotherapy in the last 2 weeks of life. Median length of stay was 7 days and 37% were admitted to the intensive care unit (ICU). The O:E mortality ratio significantly decreased between the year prior to intervention and Year 2 (0.95 vs. 0.69; p = .019), and Years 1 and 2 (0.90 vs. 0.69; p = .003). There was no noted difference in number of palliative care consults or resuscitation status at the time of death between Years 1 and 2. There was an increased frequency of advance care plan documentation on admission in Year 2 (p = .007). Conclusions: Cancer pts who die in the hospital have high rates of recent hospitalizations, chemotherapy/radiation use in the last 2 weeks of life and ICU admissions. Decrease in O:E is likely multifactorial. Potential factors are improved documentation of comorbidities, increased access to palliative care services, and facilitation of hospice referrals which were partially driven by results of our reviews and resulting awareness around end of life care. Work is ongoing to standardize documentation of goals of care conversations in the electronic medical record and employ lay health workers for earlier end of life discussions.

scholarly journals End of life care in a secure hospital setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S96-S96
Author(s):  
Owen Obasohan ◽  
Deepak Tokas ◽  
Mamta Kumari
Keyword(s):  
Mental Health ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Setting ◽  
Care Plan ◽  
Psychiatric Ward ◽  
Life Care ◽  
Individualised Care ◽  
Care Of The Dying

AimsTo measure the standard of care provided to patients who had a natural and expected death whilst in secure care at Roseberry Park Hospital, Middlesbrough.Mallard ward is a low secure psychiatric ward for older aged men suffering from cognitive difficulties and significant physical comorbidity in addition to a severe and enduring mental illness. The patient population is such that it will remain the most appropriate placement for some patients until their death. It is vital that staff members on Mallard ward and indeed all parts of the Trust are aware of the priorities for care of the dying person and ensure that care is provided in accordance with these priorities.The Leadership Alliance for the Care of Dying People (LACDP), a coalition of 21 national organisations, published One Chance to get it Right – Improving people's experience of care in the last few days and hours of life in June 2014. This document laid out five priorities for care of the dying person focussing on sensitive communication, involvement of the person and relevant others in decisions and compassionately delivering an individualised care plan.MethodThe data collection tool was adapted from End of Life Care Audit: Dying in Hospital, a national clinical audit commissioned by Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians. Data were collected from both electronic and paper records. There were three natural and expected deaths in the last two years.ResultFor all three patients, there was documented evidence that they were likely to die in the coming hours or days.End of life care discussion was held with the nominated persons and not with the patients due to their lack of mental capacity.The needs of the patients and their nominated persons were explored in all three cases.All patients had an individualised care plan which was followed.The palliative care team supported the staff with the care of these patients.The care provided was largely consistent with the priorities listed.ConclusionThe national audit compares performance of only acute NHS Trusts with no data to reflect the performance of mental health hospitals. It is imperative that mental health services work in collaboration with physical health and palliative care services so they are able to continue providing a high level of care to this patient group. Clinicians and staff involved in the care of dying patients also need to be adequately trained.

scholarly journals Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent

2021 ◽  
Vol 19 (1) ◽  
pp. 428
Author(s):  
Hui-Mei Lin ◽  
Chih-Kuang Liu ◽  
Yen-Chun Huang ◽  
Chieh-Wen Ho ◽  
Mingchih Chen
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
Regression Analysis ◽  
End Of Life ◽  
Logistic Regression Analysis ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation. Objective: This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding. Method: In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018. Results: Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent. Conclusions: This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.

scholarly journals Changes in 24-Hour Palliative Care Telephone Advice Service after the Introduction of Discharged End-of-Life Patients’ Care Plans

2020 ◽  
Vol 17 (16) ◽  
pp. 5876
Author(s):  
Ming-Hwai Lin ◽  
Hsiao-Ni Chen ◽  
Tzeng-Ji Chen
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Plan ◽  
Life Care ◽  
Care Plans ◽  
Telephone Advice ◽  
Significant Difference ◽  
Advice Service ◽  
At Home

Background: To provide a better quality of death for patients at the end of life who choose to die at home and their families, the hospice care team at Taipei Veterans General Hospital has promoted an personalized discharged end-of-life care plan since the initial of 2018. Methods: This study is a retrospective analysis of administrative data. All incoming calls of the 24-hour specialist palliative care emergency telephone advice service records were analyzed. Personal information of any callers or consultants was not registered in the content. Results: A total of 728 telephone consultations was registered during the study period. The content of the consultation of different callers was significantly different (p < 0.001). The decrease in the number of calls from the patients who were discharged from the hospice ward had the largest reduction in proportion, from 80 (19.0%) to 32 (10.5%), There was a significant difference in the identity of the callers between 2017 and 2018 (p = 0.025). The proportion of consultation calls for the management of near-death symptoms significantly reduced from 15.6% to 10.5% (p = 0.027). Conclusions: Though the evidence from this study is not enough to support that the personalized discharged end-of-life care plan might reduce the frequency of dialing 24-hour hotlines by the family members of discharged terminally ill patients. For patients who choose to die at home and their families, the hotlines provide a 24-hour humane support. Thus, we need to conduct relevant research to determine whether the service of this dedicated line meets the needs of patients and their families in the terminal stage.

Importance and Timing of End-of-Life Care Discussions Among Gynecologic Oncology Patients

2012 ◽  
Vol 30 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Teresa P. Díaz-Montes ◽  
Megan K. Johnson ◽  
Robert L. Giuntoli ◽  
Alaina J. Brown
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Disease Status ◽  
Optimal Timing ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Contingency Analysis ◽  
Advanced Directives

Objectives: To assess the importance and desired timing of end-of-life care (EOLC) discussions among women with gynecologic cancer. Methods: A questionnaire related to EOLC issues was distributed to patients with gynecologic cancer. Answers were analyzed via SPSS using descriptive statistics. Contingency analysis was done to evaluate for differences among disease status and age regarding preferences for timing of discussions. Results: Patients expressed that addressing EOLC is an important part of their treatment. Most patients were familiar with advanced directives (73.0%), do not resuscitate/do not intubate (88.5%), and hospice (97.5%). Designating someone to make decisions was significantly related to disease status ( P = .03) and age ( P = 0.02). Conclusions: Patients are familiar with basic EOLC with optimal timing for discussions at disease progression or when treatment is no longer available.

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