Standardized criteria for required palliative care consultation on the solid tumor oncology service.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 37-37 ◽  
Author(s):  
Kerin Adelson ◽  
Julia Paris ◽  
Cardinale B. Smith ◽  
Jay Horton ◽  
R. Sean Morrison
Keyword(s):  
Palliative Care ◽  
Solid Tumor ◽  
Readmission Rate ◽  
Symptom Control ◽  
Disease Stage ◽  
Hospital Death ◽  
Oncology Service ◽  
Palliative Care Consultation ◽  
Mortality Index ◽  
Care Consultation

37 Background: Studies have shown that routine integration of Palliative Care (PC) for patients with advanced cancer is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. The 2012 ASCO guidelines call for incorporation of PC for any patient with metastatic cancer and/or high symptom burden. Despite a top-rated PC division at Mount Sinai, our Solid Tumor (ST) Division utilized PC and hospice less than other medical centers. Our inpatient ST service consistently demonstrated poor quality metrics. Our 2011-2012 UHC statistics were: mortality index, 1.35 (target <1), 30-day readmission rate, 21.7%, (target < 10.3%) and length of stay (LOS) index, 1.23 (target <1). We hypothesized that implementing standardized criteria for PC consultation would improve these metrics. Methods: During this 3-month pilot, criteria for PC consultation included patients with one or more of the following: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within prior 30 days, >7 day hospitalization, uncontrolled symptoms (pain, nausea, dyspnea, delirium, distress). We looked at two baseline groups for comparison: 1) patients who met eligibility in a six week period prior to the intervention 2) For UHC index data, we used the hospital dashboard average over a 1-year period prior to the intervention. This included all ST patients who were eligible for the intervention (60%) and those who were not (40%). Primary outcomes were: hospice utilization, ST mortality index, 30-day readmission rate and LOS. Results: Comparing Group 1 to the Pilot Group, palliative care consultation doubled from 41% to 82%, 30-day readmission decreased from 36% to 17% (p= .022), and hospice utilization increased from 14% to 25% (p=.146). UHC data (Group 2 vs. Pilot) showed: mortality index improved (1.35 to .59) and 30-day readmission rates decreased (21.7% to 13.5%, p=.026). LOS was unchanged (1.23 to 1.25). Conclusions: Mandating palliative care consults for patients at the highest risk for in hospital death and readmission improved hospice utilization, 30-day readmission, oncology service mortality and adherence with ASCO guidelines.

scholarly journals Standardized Criteria for Integrated Palliative Care Consultation on the Solid Tumor Oncology Service (S752)

2014 ◽  
Vol 47 (2) ◽  
pp. 497-498 ◽  
Author(s):  
Julia Paris ◽  
Cardinale Smith ◽  
Jay Horton ◽  
Kerin Adelson ◽  
R Sean Morrison
Keyword(s):  
Palliative Care ◽  
Solid Tumor ◽  
Oncology Service ◽  
Palliative Care Consultation ◽  
Care Consultation

Standardized criteria for required palliative care consultation on the solid tumor oncology service.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. 6623-6623 ◽  
Author(s):  
Kerin B. Adelson ◽  
Julia Paris ◽  
Cardinale B. Smith ◽  
Jay Horton ◽  
R. Sean Morrison
Keyword(s):  
Palliative Care ◽  
Solid Tumor ◽  
Oncology Service ◽  
Palliative Care Consultation ◽  
Care Consultation

scholarly journals Outcomes of Patients with Hematologic Malignancies Who Received Inpatient Palliative Care Consultation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 46-46
Author(s):  
Anthony Vito Pasquarella ◽  
Angela Ramdhanny ◽  
Mina Gendy ◽  
Priya Pinto ◽  
Shahidul Islam ◽  
...  
Keyword(s):  
Palliative Care ◽  
Board Of Directors ◽  
Readmission Rate ◽  
Hematologic Malignancies ◽  
Control Group ◽  
Advisory Committees ◽  
Oncology Service ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Introduction: Supportive oncology provided by palliative care consultation has proven to prolong survival in randomized studies of patients with advanced cancers, particularly in those with solid tumors. However, the impact of palliative care consultation is less well characterized in patients with hematologic malignancies. We hypothesize that patients with hematologic malignancies are less likely to receive inpatient palliative care consultation. In this study, outcomes of patients with hematologic malignancies who received inpatient palliative care consultation were compared to a control group of disease-matched controls who were not seen by palliative care. Methods: A retrospective chart review of patients with hematologic malignancies admitted to our inpatient oncology service between 2013-2019 was performed. Data were summarized in SAS v9.4 (SAS, Cary, NC) using descriptive statistics for patients who received palliative care consultation and controls who did not, and these groups were also compared using Wilcoxon rank-sum, chi-square, and Fisher's exact tests as appropriate based on the type and distribution of the data. Multiple logistic regression models with stepwise variable selection methods were used to find predictors of outcomes. Results: Over the 7-year study period, there were 3,654 admissions to the oncology service, among which 370 hematologic malignancy patients who were actively on treatment were included. Of these, 102 (27%) received palliative care consultation, and the 268 who were not seen by palliative care served as a comparator group. Demographics, disease subgroups, and outcomes are summarized in the table. Groups were similar in terms of comorbidities, as shown in the table. Palliative care consults were greater for patients with acute leukemia and myelodysplasia (38% in each group), and least for those with chronic leukemias (15%) and myeloproliferative diseases (18%). Median length of stay was longer for patients seen by palliative care (11.5 vs. 6 days, P=.001), and these patients were more likely to be admitted to the intensive care (27.5 vs. 8.6%, P&lt;.0001). Readmissions within 30 days of discharge were significantly lower among patients receiving palliative care consultation (15.7 vs 26.9%, P=.024), and 6-month morality was higher (66.7 vs 14.6%, P&lt;.0001). Among all the patients who died within 6-months of admission, 36% did not receive palliative care consultation. Discussion: Patients with hematologic malignancies who received palliative care consultation had a lower 30-day readmission rate and higher 6-month mortality, despite lack of differences in the time from their cancer diagnosis compared to the control group not seen by palliative care. More than two thirds of all patients did not receive a palliative care consultation, nor did over a third of patients who expired within 6 months of admission. Further research is required to investigate other factors that might warranted palliative care consultation, such as the severity of illness at the time of hospitalization. Results of this study suggest that inpatient palliative care consultation is associated with decreased readmission rate, yet these services are underutilized in patients with hematologic malignancies who are projected to have shorter overall survival. Disclosures Braunstein: Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Epizyme: Membership on an entity's Board of Directors or advisory committees; Morphosys: Membership on an entity's Board of Directors or advisory committees; Verastem: Membership on an entity's Board of Directors or advisory committees; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 992
Author(s):  
Tassaya Buranupakorn ◽  
Phaviga Thangsuk ◽  
Jayanton Patumanond ◽  
Phichayut Phinyo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Palliative Care ◽  
Survival Time ◽  
Causal Effect ◽  
Symptom Control ◽  
P Value ◽  
Target Trial ◽  
Immortal Time Bias ◽  
Palliative Care Consultation ◽  
Care Consultation

Palliative care has the potential to improve the quality of life of patients with incurable diseases or cancer, such as hepatocellular carcinoma (HCC). A common misconception of palliative care with respect to the patient’s survival remains a significant barrier to the discipline. This study aimed to provide causal evidence for the effect of palliative care consultation on the survival time after diagnosis among HCC patients. An emulation of a target trial was conducted on a retrospective cohort of HCC patients from January 2017 to August 2019. The primary endpoint was the restricted mean survival time (RMST) at 12 months after HCC diagnosis. We used the clone–censor–weight approach to account for potential immortal time bias. In this study, 86 patients with palliative care consultation and 71 patients without palliative care consultation were included. The adjusted RMST difference was −29.7 (95% confidence interval (CI): −81.7, 22.3; p-value = 0.263) days in favor of no palliative care consultation. However, palliative care consultation was associated with an increase in the prescription of symptom control medications, as well as a reduction in life-sustaining interventions and healthcare costs. Our findings suggest that palliative care consultation was associated with neither additional survival benefit nor harm in HCC patients. The misconception that it significantly accelerates the dying process should be disregarded.

Predictors of palliative care consultation on an inpatient gynecologic oncology service: Are we following ASCO recommendations?

2014 ◽  
Vol 133 ◽  
pp. 45-46
Author(s):  
C. Lefkowits ◽  
A. Binstock ◽  
M. Courtney-Brooks ◽  
W. Teuteberg ◽  
J. Leahy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Gynecologic Oncology ◽  
Oncology Service ◽  
Palliative Care Consultation ◽  
Care Consultation

Outcomes of patients receiving chemotherapy at the end of life.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 70-70
Author(s):  
Laura Jennifer Van Metre ◽  
Bethann Scarborough ◽  
Cardinale B. Smith
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cause Of Death ◽  
Solid Tumor ◽  
Hematologic Malignancy ◽  
Performance Status ◽  
Tumor Patients ◽  
Palliative Care Consultation ◽  
Progression Of Disease ◽  
Care Consultation

70 Background: Chemotherapy within 14 days of death indicates poor quality end-of-life (EOL) care. Despite this, approximately 25% of patients receive EOL chemotherapy. This study identifies determinants of EOL chemotherapy. Methods: We identified patients who died in the hospital within 2 weeks of receipt of chemotherapy in 2012 and conducted a detailed chart review to identify demographic and clinical factors, clinical intent, and cause of death. Provider reasoning and assessments were collected. We identified and grouped cause of death into: treatment related, progression of disease, and sudden/unexpected. We used descriptive statistics to document factors associated with receipt of EOL chemotherapy. Results: Of 41 patients, 73% were male; mean age was 63 years; 71% had a hematological malignancy. Whereas solid tumor patients overwhelmingly died of progression of disease (83%), the majority of hematologic patients died of treatment related causes (62%) such as neutropenic sepsis and graft versus host disease. Furthermore, 41% of hematologic malignancy decedents were undergoing induction therapy. Similarly, though all solid tumor chemotherapy was palliative, 33% was for a new diagnosis. All solid tumor patients had a palliative care consultation, whereas 28% of hematologic malignancy patients did. Only 17% of induction chemotherapy patients received a palliative care consult. 76% of hematologic patients were DNR at time of death, while all solid tumor patients were DNR. Site of death varied with 52% of hematologic patients dying in ICU and 10% on the inpatient hospice unit. No solid tumor patients died in the ICU; 67% died on inpatient hospice. Only 10% of all patients had performance status documented. Clinical reasoning for chemotherapy included: disease modification, bridge to clinical trial or transplant, and palliation of symptoms. Conclusions: Patients with hematologic malignancies who received EOL chemotherapy had high ICU utilization and were less likely to have a palliative care consultation. Clinical intent, including early line therapy, may foster unrealistic clinician expectations. An improved understanding of avoidable causes of receipt of chemotherapy at EOL is important in addressing this gap in quality of care.

Integration of palliative care into the inpatient oncology service.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 46-46
Author(s):  
Sasha Waldstein ◽  
Benjamin Smith ◽  
J. Chris Nunnink
Keyword(s):  
Palliative Care ◽  
Medical Center ◽  
Symptom Control ◽  
Inpatient Setting ◽  
Readmission Rates ◽  
Advanced Malignancy ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Significant Difference ◽  
Care Consultation

46 Background: Research has demonstrated that early palliative care involvement for patients with advanced cancer has multiple benefits, including improved symptom control/quality of life and reduced readmission rates. Based on this data, the American Society of Clinical Oncology (ASCO) has developed guidelines for early palliative care consultation. At the University of Vermont Medical Center, historically 40% of such patients were evaluated by palliative care during hospital admission. The purpose of this study was to better integrate palliative care into the oncology inpatient setting through the use of a standardized admission template. Methods: A specific oncology H&P template, with inclusion of a drop down menu of ASCO based criteria for palliative care consultation, was created. Providers were educated on template use, and data then were collected for oncology admissions from 2/1-8/31/2018 regarding template usage, if criteria was met for palliative care consultation, and whether consultation occurred. Additionally, 30 day post discharge ED visits and readmissions were recorded, extending data collection for this purpose to 9/30/2018. Results: There were 372 medical oncology admissions during the studied time period, with 284 individual patients. The template was used for 95 (26%) admissions. 267 of those patients admitted qualified for palliative care consultation and, of those in which the template was used, 72% had palliative care consulted versus 50% without the template (p= 0.0013). There was no statistically significant difference in readmission rates between those with palliative care consultation and without. Conclusions: Early palliative care consultation for patients with advanced malignancy has been shown to have multiple benefits on an individual and system-wide basis. It was shown in this study that, though the created template was used for a minority of admissions, with template use a significantly greater proportion of appropriate patients had palliative care consulted. This suggests that, with more widespread practice, this strategy could further promote inpatient palliative care involvement for appropriate oncology patients.

Predictors of palliative care consultation on an inpatient gynecologic oncology service: Are we following ASCO recommendations?

2014 ◽  
Vol 133 (2) ◽  
pp. 319-325 ◽  
Author(s):  
Carolyn Lefkowits ◽  
Anna B. Binstock ◽  
Madeleine Courtney-Brooks ◽  
Winifred G. Teuteberg ◽  
Janet Leahy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Gynecologic Oncology ◽  
Oncology Service ◽  
Palliative Care Consultation ◽  
Care Consultation
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