Early palliative care involvement for children with cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 26-26
Author(s):  
Laila Mahmood ◽  
Ann Dozier ◽  
James Dolan ◽  
Denise Casey ◽  
David Nathan Korones
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
High Risk ◽  
Study Entry ◽  
Pediatric Palliative Care ◽  
Newly Diagnosed ◽  
Children With Cancer ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

26 Background: Although the overall survival of children with cancer exceeds 80%, these children experience significant physical, emotional, social and spiritual suffering. That suffering is even more profound for the 20% of children who succumb to their disease. We therefore conducted a prospective study to assess the feasibility and impact of early palliative care involvement for children with high risk malignancies. Objective: To determine if early palliative care involvement for high risk pediatric oncology patients is feasible, acceptable to patients, families and oncology teams, and helps with symptom management and communication. Methods: This was a prospective survey-based study. Children with cancer treated at University of Rochester were eligible to participate if they had a high risk malignancy, defined as (1) having a newly-diagnosed malignancy with an estimated overall survival of < 50%, (2) requiring hematopoietic stem cell transplantation (HSCT), and/or (3) any relapsed, recurrent or progressive cancer. Parents of these children or children >18YO were surveyed upon study entry, and 3 and 6 months later to assess the impact of early and ongoing pediatric palliative care involvement. Results: 20/25 eligible patients received a palliative care consultation at diagnosis; 16 families participated in the study. Six children had a newly diagnosed high risk malignancy, nine had recurrent disease and one child had a HSCT. Median age of the children was 5 years (0.1-20 year).The most frequent symptoms at the time of study entry were pain (75%), nausea/vomiting (69%), constipation (44%), and fatigue (44%). 75%, 73%, 43% and 43% reported successful treatment of pain, nausea/vomiting, constipation, and fatigue respectively. The proportion of children with each symptom decreased at 3 months except for fatigue. There was high satisfaction with the oncology and pediatric palliative care teams at baseline and 3 and 6 months. No families or oncologists declined an early palliative care consultation. Conclusions: Our results suggest that an early palliative care consultation is feasible for high risk children with cancer and that the palliative care team can work successfully with the primary oncology team to foster symptom control and communication.

Feasibility of Early Palliative Care Consultation for Children With High-Risk Malignancies

2016 ◽  
Vol 63 (8) ◽  
pp. 1419-1422 ◽  
Author(s):  
Laila A. Mahmood ◽  
Denise Casey ◽  
James G. Dolan ◽  
Ann M. Dozier ◽  
David N. Korones
Keyword(s):  
Palliative Care ◽  
High Risk ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

2021 ◽  
Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Quality Improvement Initiative ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (&lt;72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived &gt;24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

scholarly journals 1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

2018 ◽  
Vol 14 (12) ◽  
pp. e775-e785 ◽  
Author(s):  
Anjali V. Desai ◽  
Virginia M. Klimek ◽  
Kimberly Chow ◽  
Andrew S. Epstein ◽  
Camila Bernal ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Outpatient Clinic ◽  
Core Values ◽  
Newly Diagnosed ◽  
Care Needs ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Palliative Care Needs

Background: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. Methods: We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. Results: All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Conclusion: Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.

The effect of early palliative care consultation for survival in patients with unresectable pancreatic cancer.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 131-131
Author(s):  
Kazuhiro Kosugi ◽  
Fumio Omata ◽  
Yoshiyuki Fujita ◽  
Akitoshi Hayashi
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Rank Test ◽  
Unresectable Pancreatic Cancer ◽  
Poor Prognostic Factor ◽  
Early Palliative Care ◽  
Ajcc Stage ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Basic Characteristics

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]

scholarly journals Components and Principles of a Pediatric Palliative Care Consultation: Results of a Delphi Study

2014 ◽  
Vol 17 (11) ◽  
pp. 1206-1213 ◽  
Author(s):  
Natalie Bradford ◽  
Anthony Herbert ◽  
Christine Mott ◽  
Nigel Armfield ◽  
Jeanine Young ◽  
...  
Keyword(s):  
Palliative Care ◽  
Delphi Study ◽  
Pediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

scholarly journals A conceptual model of barriers and facilitators to primary clinical teams requesting pediatric palliative care consultation based upon a narrative review

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jennifer K. Walter ◽  
Douglas L. Hill ◽  
Concetta DiDomenico ◽  
Shefali Parikh ◽  
Chris Feudtner
Keyword(s):  
Palliative Care ◽  
Conceptual Model ◽  
Treatment Plan ◽  
Research Literature ◽  
Pediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Communication Challenges ◽  
Care Consultation ◽  
The Individual

Abstract Background Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. Discussion Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition “clinician regoaling”. Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians’ willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. Conclusions Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.

Sign in / Sign up

Export Citation Format

Share Document