Transfusion utilization at the end of life.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 303-303
Author(s):  
Lauren S. Prescott ◽  
Alaina J. Brown ◽  
Charlotte C. Sun ◽  
Charles F. Levenback ◽  
Lois M. Ramondetta ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
End Of Life ◽  
End Of Life Care ◽  
Univariate Analysis ◽  
Invasive Procedure ◽  
Red Blood Cell Transfusion ◽  
Transfusion Rate ◽  
Life Care ◽  
Anti Cancer ◽  
Chi Squared

303 Background: Both the AMA’s Consortium for Performance Improvement and the Joint Commission have identified blood transfusions as one of the top 5 treatments that are over-utilized. We sought to quantify packed red blood cell transfusion (PRBT) utilization among ovarian cancer (OCa) pts in the last 6 months of life and identify risk factors for PRBT. Methods: We performed a retrospective cohort study of deceased OCa pts treated at our institution in their last 6 months of life from 2007-2011. Pts who underwent emergent procedures for bleeding were excluded. Demographic and end of life-interventions were compared between transfusion and non-transfusion groups using chi-squared and univariate analysis. End-of-life interventions included anti-cancer treatment (chemotherapy radiation, or hormonal therapy), invasive procedure or abdominal surgery, as well as aggressive end-of-life care as defined by the NQF. Results: Of the 182 pts who met inclusion criteria, 59.9% received a PRBT in the last 6 months of life. Of those pts, 54.1% received a PRBT in the last 30 days of life. Mean hgb level at which pts were transfused was 8.4 ± 0.9 g/dL. Pts received a combined total of 436 units of PRBC. The majority of pts received 1 transfusion (n=50, range 1-16). Mean number of total units transfused was 4 (range 1-25). The most common indication for PRBT was hgb < 9 g/dL (61.1%), followed by symptomatic anemia (21.9%). There was no difference in PRBT rate between pts who received medical interventions in the last 6 months of life v. those who did not. Specifically, transfusion rate was not correlated with: anti-cancer treatments (93.2% v. 92.7%, OR 0.93; 95% CI (0.29, 2.96)), invasive procedures (82.2% v. 81.7%, OR 0.96; CI (0.45,2.08)), abdominal surgery (11.0% v. 11.0%, OR 1.01; 95% CI(0.39,2.59)), or aggressive end-of-life care (46.6% v. 56.9%, OR 1.51; 95% CI (0.83,2.74)). Conclusions: The majority of our pts received a PRBT in the last 6 months of life. We did not identify significant differences in clinical interventions between pts who received a PRBT and those who did not. Based on our analysis, transfusion practices in terminally ill OCa pts should be reevaluated. Creation of transfusion guidelines for cancer pts could potentially result in better utilization of blood bank resources.

Physician Influence on Variation in Receipt of Aggressive End-of-Life Care Among Women Dying of Ovarian Cancer

2021 ◽  
Author(s):  
Megan A. Mullins ◽  
Shitanshu Uppal ◽  
Julie J. Ruterbusch ◽  
Michele L. Cote ◽  
Philippa Clarke ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Intensive Care Unit Stay ◽  
End Of Life Care ◽  
Invasive Procedure ◽  
Life Care ◽  
Data Set ◽  
Physician Practices

PURPOSE: End-of-life care for women with ovarian cancer is persistently aggressive, but factors associated with overuse are not well understood. We evaluated physician-level variation in receipt of aggressive end-of-life care and examined physician-level factors contributing to this variation in the SEER-Medicare data set. METHODS: Medicare beneficiaries with ovarian cancer who died between 2000 and 2016 were included if they were diagnosed after age 66 years, had complete Medicare coverage between diagnosis and death, and had outpatient physician evaluation and management for their ovarian cancer. Using multilevel logistic regression, we examined physician variation in no hospice enrollment, late hospice enrollment (≤ 3 days), > 1 emergency department visit, an intensive care unit stay, terminal hospitalization, > 1 hospitalization, receiving a life-extending or invasive procedure, and chemotherapy (in the last 2 weeks). RESULTS: In this sample of 6,288 women, 51% of women received at least one form of aggressive end-of-life care. Most common were no hospice enrollment (28.9%), an intensive care unit stay (18.6%), and receipt of an invasive procedure (20.7%). For not enrolling in hospice, 9.9% of variation was accounted for by physician clustering ( P < .01). Chemotherapy had the highest physician variation (12.4%), with no meaningful portion of the variation explained by physician specialty, volume, region, or patient characteristics. CONCLUSION: In this study, a meaningful amount of variation in aggressive end-of-life care among women dying of ovarian cancer was at the physician level, suggesting that efforts to improve the quality of this care should include interventions aimed at physician practices and decision making in end-of-life care.

The Growth of Palliative Practice and End of Life Care in an Academic Teaching Intensive Care Unit

2022 ◽  
pp. 088506662110690
Author(s):  
Daniel King ◽  
Erica Schockett ◽  
Ghazi Rizvi ◽  
Daniel Fischer ◽  
Richard Amdur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Univariate Analysis ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Comfort Care ◽  
Over Time

Objective Dying in the intensive care unit (ICU) has changed over the last twenty years due to increased utilization of palliative care. We sought to examine how palliative medicine (PM) integration into critical care medicine has changed outcomes in end of life including the utilization of do not resuscitate (no cardiopulmonary resuscitation but continue treatment) and comfort care orders (No resuscitation, only comfort medication). Design: Retrospective observational review of critical care patients who died during admission between two decades, 2008 to 09 and 2018 to 19. Setting: Single urban tertiary care academic medical center in Washington, D.C. Patients: Adult patients who were treated in any ICU during the admission which they died. Interventions and Measurements We sought to measure PM involvement across the two decades and its association with end of life care including do not resuscitate (DNR) and comfort care (CC) orders. Main Results: 571 cases were analyzed. Mean age was 65 ± 15, 46% were female. In univariate analysis significantly more patients received PM in 2018 to 19 (40% vs. 27%, p = .002). DNR status increased significantly over time (74% to 84%, p = .002) and was significantly more common in patients who were receiving PM (96% vs. 72%, p < 0.001). CC also increased over time (56% to 70%, p = <0.001), and was more common in PM patients (87% vs. 53%, p < 0.001). Death in the ICU decreased significantly over time (94% to 86%, p = .002) and was significantly lower in PM patients (76% vs. 96%, p < 0.001). The adjusted odds of getting CC for those receiving versus those not receiving PM were 14.51 (5.49-38.36, p < 0.001) in 2008 to 09 versus 3.89 (2.27-6.68, p < 0.001) in 2018 to 19. Conclusion: PM involvement increased significantly across a decade in our ICU and was significantly associated with incidence of DNR and CC orders as well as the decreased incidence of dying in the ICU. The increase in DNR and CC orders independent of PM over the past decade reflect intensivists delivering PM services.

US, Russian and Indian physician perspectives regarding end of life care

2020 ◽  
Vol 24 (3) ◽  
pp. 11-20
Author(s):  
James G. Jackson ◽  
Sheetal Moolambally Raj ◽  
Yulia Matveeva ◽  
Yinghui Xu ◽  
Gerald J. Jogerst
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Physicians ◽  
Terminal Illness ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chi Squared ◽  
Dichotomous Variables

Aim. To compare US, Russian and Indian primary care physicians attitudes, comfort and experiences providing palliative care. Design. Cross sectional survey. Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India. Participants. Primary care physicians. Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores. Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p 0.001. Patient should be informed (US vs Russia vs India) of terminal illness Always (74% vs 31% vs 33%) p 0.001, If Asked (9% vs 64% vs 12%) p 0.001 or Physicians Judgement (15%, 5%, 54%) p 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care Often or Always (63% vs 36% Russian v 21% Indian) p 0.001. Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Die Entwicklung eines Instruments zur «Evaluation stationärer Hospize aus der Perspektive hinterbliebener Angehöriger» (EHPA)

Pflege ◽  
2011 ◽  
Vol 24 (3) ◽  
pp. 171-182
Author(s):  
Mandy Lohe ◽  
Manja Zimmermann ◽  
Christiane Luderer ◽  
Katharina Sadowski
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Subjektive Bewertung ◽  
Ethische Probleme

Als Einrichtungen des Gesundheitswesens sind stationäre Hospize in Deutschland zur Qualitätssicherung und internen Qualitätsentwicklung verpflichtet. Die Bedeutung der Patientenzufriedenheit als einer der indirekten Indikatoren zur Beurteilung der Pflege- und Betreuungsqualität ist mittlerweile unumstritten. Eine subjektive Bewertung des Hospizes durch den Gast selbst birgt sowohl praktische als auch ethische Probleme. Eine Befragung der Angehörigen empfiehlt sich. Der vorliegende Artikel beschreibt die Entwicklung eines Instruments zur Evaluation stationärer Hospize aus der Sicht hinterbliebener Angehöriger. Mit dessen Hilfe soll die Frage, wie Angehörige die Begleitung und Pflege beurteilen, die ihnen sowie ihrem verstorbenen Familienmitglied durch das Hospiz zuteil wurde, beantwortet werden. Die Konstruktion der Fragen erfolgte auf Basis bestehender Konzepte zum Assessment der end-of-life care und einer Analyse aller identifizierten Instrumente zur Evaluation stationärer Hospize aus der Perspektive hinterbliebener Angehöriger. Die Fragebogenentwicklung umfasste neben der umfassenden Literaturrecherche die Bildung eines Itempools, die Itemauswahl, die kritische Diskussion der Fragen im Expertenkreis sowie einen standardisierten und kognitiven Pretest. Entstanden ist ein fünfdimensionaler Fragebogen, der physische, psychologische, soziale, spirituelle und versorgungsorganisatorische Aspekte der end-of-life care integriert. Das Instrument umfasst 53 Items in Form überwiegend geschlossener Fragen.

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