Extended impact of an embedded palliative care program in a community cancer center.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 24-24
Author(s):  
Angela Kalisiak ◽  
Lyn A. Glenn ◽  
Mark Weinmeister
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Program ◽  
Quality Metrics ◽  
Care Quality ◽  
Cancer Center ◽  
Life Care ◽  
Palliative Care Program ◽  
Pancreas Carcinoma

24 Background: High-level evidence has demonstrated that earlier palliative care (PC) improves outcomes for patients with advanced cancers, but a limited PC workforce and lack of outpatient resources remain barriers to access. In 2010, a productive intersection of oncologist-driven response to new evidence and Providence Cancer Center assessment of end of life care quality metrics resulted in funding of an outpatient Oncology Palliative Care Program (OPCP). An initial NP/LCSW team began concurrent PC for advanced lung and pancreas carcinoma patients in a specialty clinic setting in 2011. Scope of service was expanded to include other diagnoses in 2012. Early positive outcomes and oncology team feedback led to Cancer Center funding of a second PC team at a separate service site in August 2013; the OPCP simultaneously transitioned to an embedded care model. Methods: Retrospective chart review of patient deaths for all Providence Medical Group (PMG) Cancer Center patients not served by OPCP; review of OPCP referral data since adoption of embedded model (n= 177). Quarterly quality metrics included: % patients on hospice at time of death; % patients with evidence of an Advance Care Planning (ACP) discussion documented in the electronic medical record (EMR); and % patients receiving chemotherapy at end of life. Results: A significant improvement in the % PMG oncology patients with evidence of an ACP discussion occurred from 2010 baseline of 59.5% to 74.5% in 2013 (z=4.03, p<.001). In addition, % patients receiving chemotherapy in the last 14 days of life decreased from 5.9% in 2010 to 2.7% in 2013 (z=1.9; p<.05). For patients referred to the OPCP, referral diagnoses evolved from 100% lung and pancreas carcinoma to 34 % lung and pancreas carcinoma and 66 % other diagnoses. Conclusions: Incremental growth of the Providence OPCP has demonstrated successful expansion to diagnoses beyond end stage lung carcinoma. Improvement in end of life care quality metrics for oncology patients not served by the program (perhaps by elevating "generalist" PC skills) may be an additional benefit and value of a highly visible embedded PC team in a community cancer center, particularly with respect to modeling best practice of early goals of care discussions and ACP.

End-of-Life Care for Children Enrolled in a Community-Based Pediatric Palliative Care Program

2014 ◽  
Vol 17 (5) ◽  
pp. 589-591 ◽  
Author(s):  
Lisa M. Niswander ◽  
Philene Cromwell ◽  
Jeanne Chirico ◽  
Alyssa Gupton ◽  
David N. Korones
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Program ◽  
Pediatric Palliative Care ◽  
Life Care ◽  
Palliative Care Program ◽  
Community Based

scholarly journals Impact of a palliative care program on end-of-life care in a neonatal intensive care unit

2014 ◽  
Vol 35 (3) ◽  
pp. 218-222 ◽  
Author(s):  
N Younge ◽  
P B Smith ◽  
R N Goldberg ◽  
D H Brandon ◽  
C Simmons ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
End Of Life ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Care Program ◽  
Life Care ◽  
Palliative Care Program

Outpatient palliative care at a tertiary cancer center: Perceptions, pathways, and pitfalls.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 28-28
Author(s):  
Kavitha Ramchandran ◽  
Sandy Trieu ◽  
Stephanie Harman ◽  
Judy Passaglia ◽  
Janet Rodriguez ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Cancer Center ◽  
Care Planning ◽  
Life Care ◽  
Code Status ◽  
Wide Range ◽  
Advance Care

28 Background: To describe an outpatient palliative care program at a quaternary cancer center- Stanford Cancer Institute. Outpatient palliative care (PC) programs are still in their nascency. Best practices are still being developed and key performance metrics are being delineated. This is a description of Stanford Cancer Institute outpatient PC program. Methods: Observational study of the first six months of encounters to the outpatient PC program. Description of potential barriers to launch and growth, as well as description of resources required for continued success. Data evaluated included program volume, referral patterns, advance care planning, symptom assessment and team structure as collected by the clinical team. Results: Initial barriers to program initiation included lack of funding and infrastructure. Additional barriers included coordination between teams, flow of care (patients late for next appointments), and cultural perceptions of palliative care as equal to end of life care. There are 32 referring practitioners to the program. Over the first six months the outpatient PC program has seen growth with volume increasing from 10 consults per month to 26 consults per month for a total of 60 patients. At the time of initial consult, 11 of the 60 patients seen had an advance directive. Only 1 patient had a physician order for life sustaining treatment (POLST). Code status was documented in 21 of the 60 patients. Conclusions: Our program had multiple barriers to launch: perceptions that palliative care equaled end of life care, lack of infrastructure and funding, and difficulty with coordination between teams. With administrative support the program secured funding, developed infrastructure with the assistance of IT, Cancer Center administration, and Care Coordination. Consults now come from a wide range of providers. Based on preliminary data indicating a very low percentage of completion of these tasks by patients on initial consult there is need for outpatient palliative care for advance care planning. Future growth will include continued penetration of the cancer center, increasing volume of consults, and additional assessments of patient satisfaction, symptom improvement, and hospital utilization.

The impact of a one month palliative care rotation on medical residents working in a tertiary cancer center in Jordan.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 168-168
Author(s):  
Omar M. Shamieh ◽  
Alia Alawneh ◽  
Wafa Ahamd ◽  
Sewar S Salmany ◽  
Barakat Altamimi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Medical Residents ◽  
Cancer Center ◽  
Clinical Rotation ◽  
Life Care ◽  
The Impact ◽  
Tertiary Cancer Center

168 Background: Palliative care education and training remains inadequate for medical professionals especially in developing countries. We evaluated the impact of a one month palliative care clinical rotation on medical residents’ attitude, competency, and knowledge related to palliative care in a tertiary cancer center in Jordan. Methods: All transitional Internal Medicine residents rotated in a monthly palliative care rotation at King Hussein Cancer Center (KHCC), in Amman, Jordan, were requested to participate in this educational intervention study. A concise curriculum in palliative and end of life care, adapted from the Education for Physicians on End-Of-Life Care (EPEC) Curriculum and delivered by our faculty was piloted as a part of the clinical rotation. Residents spent one month in the inpatient palliative care unit, in addition to 10 hours of classroom interactive sessions. The curriculum comprised of five modules: 1- Principles of palliative care, 2- Pain management, 3- Management of distressing symptoms, 4- Communication skills, 5- End-of- life care. To assess our educational outcomes, we adapted a previously developed instruments by David Weisman and used by the National Residency Education in the United States. All Instruments were completed by each resident before and after the rotation, and included self-assessment of attitude, competency and a knowledge test comprising of 32-items of multiple choice questions. Results: Twenty of 27 (74%) residents who started the palliative care rotation completed the required education and had paired evaluations. There was improvement in all three instruments: 37% improvement in competence (p < 0.0001), 17% Improvement in knowledge (p = 0.015), and 5% improvement in attitude (p = 0.02). Conclusions: The one-month mandatory rotation improved knowledge, attitude and competence related to palliative care for medical residents.

Predictors of home death and the quality of end-of-life care at a cancer center in Brazil.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24004-e24004
Author(s):  
Sarah Gomes ◽  
Danielle Silva ◽  
Júlia Sá ◽  
Thais Passarini ◽  
Matheus Viana ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Palliative Care Team ◽  
Cancer Center ◽  
Life Care ◽  
Home Death

e24004 Background: Early palliative care has shown an improvement in the quality of life of cancer patients by reducing overtreatment at the end of life and improving symptomatic control. Little is known about the quality of death in developing countries. End-of-life cancer care varies widely, and very few centers evaluate it systematically. The aim of the present study is to analyze the impact of follow-up of cancer patients by an outpatient palliative care team (OPCT) on the end-of-life outcomes at a Cancer Center in Brazil. Methods: We retrospectively retrieved data from electronic medical records of cancer patients who were treated at a Cancer Center in Brazil and who died from cancer or associated complications during the year of 2020. They were divided into two groups: OPCT and No-OPCT. OPCT group was followed-up by a multidisciplinary team composed of physician, nurse, physiotherapist, psychologist, nutritionist, social worker, speech-language therapist, and pharmacist, who regularly evaluated cancer patients during their treatments at outpatient setting. During COVID-19 pandemic, some patients were evaluated by telemedicine appointments. No-OPCT group was followed-up by cancer physicians exclusively. We performed univariate comparisons and multivariate analysis by Cox proportional hazards model. p < 0.05 was deemed as statistically significant. Results: A total of 315 patients were included in the study: OPCT (N=122) and No-OPCT (N=193). The groups were well balanced in relation to median age (61yo vs 63yo), gender (women: 51% vs 54%), and TNM stage (stage IV: 69% vs 65%). Gastrointestinal and breast cancers were the most prevalent. The rate of home death was 44% in the OPCT group, compared to 16% in the No-OPCT group (p<0.001). The rate of admission in intensive care unit in the last 30 days of life (ICU30) was 13% vs 10%, respectively (p=0.413). Likewise, the rate of patients treated with chemotherapy in the last 30 days of life (CT30) was 42% vs 51% (p=0.146). In multivariate analysis, follow-up by the OPCT was the strongest independent predictor of home death (Table). In contrast, ICU30 and CT30 were inversely correlated with this outcome. Age, gender, and TNM stage did not have influence on the place of death. Conclusions: Follow-up by an OPCT had a strong positive impact on end-of-life care of cancer patients in a country which does not have Hospice culture. The OPCT was able to offer home death to a greater number of patients, with proximity to caregivers, and respect to their beliefs and values. Our data highlight the importance of early conversations about goals of care, prognostic awareness, and end-of-life preferences, while also reinforcing the need of early referral to a palliative care team.[Table: see text]

Process measures of palliative and end-of-life care among young adults who died from cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 54-54
Author(s):  
Hanneke Poort ◽  
Sophia Zupanc ◽  
Alexi A. Wright ◽  
Charlotta Lindvall
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Cancer Center ◽  
Life Care ◽  
Process Measures ◽  
Goals Of Care ◽  
Code Status ◽  
Essential Components ◽  
Eol Care

54 Background: Timely delivery of palliative and end-of-life care (EOL) are essential components of high-quality cancer care. To date, however, few studies have examined process measures for EOL care in young adult (YA; ages 18-35 years) cancer decedents. Methods: We conducted a retrospective study using medical records of YA decedents who received cancer treatment at an academic cancer center between Jan. 1, 2012 and June 13, 2018. We used natural language processing (NLP) with validated key words to identify documentation of four process measures – palliative care involvement, and discussions of goals of care, code status, and hospice – from documented clinical encounters in the medical record within 6 months of death. Results: During this period 146/2,878 (5.1%) YA patients had a recorded death date and a first note at least 31 days prior to death. In this decedent cohort, the mean age was 28.2 years (SD=4.4) and 58.9% were men. The most common diagnoses were brain cancer (33.6%), sarcoma (19.9%), and breast cancer (12.3%). The 146 patients accrued 26,441 clinical notes during the last 6 months of life (median=116.5 notes, IQR 37.0-222.0). Using NLP, we identified that 68.5% of the 146 YAs had at least one process measure documented in the last 6 months of life, including: 54.1% palliative care involvement; 56.8% discussions of goals of care; 47.3% discussions of code status; and 51.4% discussions of hospice. On average, palliative care was documented 7.5 times (range 0-75); goals of care 6.1 times (range 0-43), code status 1.9 times (range 0-12), and hospice 8.1 times (range 0-67). Late documentation of process measures (defined as first recorded within 30 days of death) included: hospice (45.3%), code status (30.3%), palliative care (20.8%), and goals of care (9.6%). Notably, in 31.5% of YAs, we did not detect documentation of any process measures prior to death. Conclusions: In this cohort of YA cancer decedents, nearly one-third of YAs did not have documentation of any process measures, highlighting the importance of efforts to improve EOL care communication with this young population.

scholarly journals End-of-Life Care at a Community Cancer Center

2012 ◽  
Vol 8 (4) ◽  
pp. e40-e44 ◽  
Author(s):  
David E. Cowall ◽  
Bennett W. Yu ◽  
Sandra L. Heineken ◽  
Elizabeth N. Lewis ◽  
Vishal Chaudhry ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Cancer Center ◽  
Improve Quality ◽  
Life Care

Early concurrent palliative care and earlier hospice admission may improve quality of life because of better symptom management and avoidance of aggressive and/or toxic therapies at end of life.

scholarly journals NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Emilio Mota-Romero ◽  
Ana Alejandra Esteban-Burgos ◽  
Daniel Puente-Fernández ◽  
María Paz García-Caro ◽  
Cesar Hueso-Montoro ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Focus Group ◽  
End Of Life ◽  
Complex Intervention ◽  
End Of Life Care ◽  
Care Program ◽  
Life Care

Abstract Background Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country. Methods A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals. Results As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program. Conclusions The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.

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