Breathlessness and opioid therapy: A retrospective chart analysis in 2,958 patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 192-192
Author(s):  
Benjamin Gronwald ◽  
Michael Wolff ◽  
Jan Gaertner ◽  
Patric Bialas ◽  
Marcus Niewald ◽  
...  
Keyword(s):  
Palliative Care ◽  
Palliative Care Service ◽  
Opioid Therapy ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Prolonged Release ◽  
Common Symptom ◽  
Distressing Symptom

192 Background: Breathlessness is a common and distressing symptom, which increases in many diseases as they progress and is difficult to manage. It is widely accepted that opioids are safe and effective for treating dyspnea, although no single opioid has an authorization for the treatment of breathlessness. The aims of the study were to assess prevalence rates of breathlessness as well as the treatment approaches especially with respect to opioid therapy in all patients cared by a hospital palliative care team in a university hospital over a period of five years. Methods: A systematic review of all electronically available records of patients under palliative care service from April 2010 – April 2015 was performed. Results: Breathlessness was the third most common symptom in our patient group behind fatigue and pain. Furthermore it was classified as the utmost distressing symptom of all. Many patients suffering from breathlessness were opioid-naive before contact with our palliative care team. Many of these patients were put on prolonged-release opioids together with short-acting opioids (mucosal fentanyl) as rescue medication for breathlessness. Opioid therapy was judged to be very effective by the majority of patients suffering from breathlessness however caused (cancer-related or due to a benign disease e.g. chronic obstructive pulmonary disease). Conclusions: In a large cohort of patients breathlessness is a major topic and is clearly positively influenceable by opioids. In our opinion it is longtime overdue to strive for an authorization for opioids against breathlessness.

Bowel obstruction with stage IV cancer: The benefit of introduction of formal palliative care service.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20573-e20573
Author(s):  
Moshim Kukar ◽  
Adrienne Groman ◽  
Yashodhara K. Satchidanand ◽  
Amy I. Alvarez-Perez ◽  
Kelli B. Dunn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Bowel Obstruction ◽  
Care Service ◽  
Palliative Care Service ◽  
Stage Iv ◽  
Palliative Care Team ◽  
Care Team ◽  
Comorbid Conditions ◽  
Stage Iv Cancer

e20573 Background: Patients with stage IV cancer and bowel obstruction (BO) present a complicated management problem. The aim of this study was to evaluate the role of introduction of an organized palliative care service in the management of this complex disease process. Methods: We conducted a retrospective analysis of all patients admitted to the Roswell Park Cancer Institute with stage IV cancer and BO after the institution of formal palliative care service (PS) in 2009. This cohort was compared to a group prior to 2009 (No Palliative care service Group; NPS). The two groups were compared with respect to demographics, comorbid conditions, DNR status, laboratory parameters, medical, surgical management, length of stay and disposition status. Results: 28 patients were identified in PS group as compared to 40 patients in NPS group. The 2 groups were similar in terms of age, gender, race, comorbid conditions, primary site of cancer, chemotherapy, radiation therapy and weight loss. There was a statistically significant difference in the medication regimen provided, as those who had palliative care consults were more likely to receive alternative medications to standard anti-emetics (Table). The palliative care team followed 19/28 patients and 14/19 patients showed improvement in their symptoms (nausea, pain control) in initial 24 hours after the palliative care consult. 50 % ( n=14) of patients in PS group had a formal DNR order in place as compared to 15.4% in NPS group (p<0.001). In 9/14 patients the first discussion regarding DNR was held by palliative care team. A significantly higher percentage of patients were discharged to the hospice care in PS group (42.9% vs. 7.5%, p =0.006). Conclusions: BO in patients with stage IV cancer often poses a dilemma in the choice of surgery versus medical management. Palliative care consults, early in the hospitalization, may help improve symptom management, end of life discussions, better psychosocial support, discharge placements and will eventually translate to shorter length of stay. [Table: see text]

scholarly journals Does a Hospital Palliative Care Team Have the Potential to Reduce the Cost of a Terminal Hospitalization? A Retrospective Case-control Study in a Czech Tertiary University Hospital

2021 ◽  
Author(s):  
Zuzana Kremenova ◽  
Jan Svancara ◽  
Petra Kralova ◽  
Martin Moravec ◽  
Katerina Hanouskova ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Case Control Study ◽  
Case Control ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Insurance Company ◽  
Retrospective Case ◽  
Control Study

Abstract Background: More than 50% of patients worldwide die in hospitals. It is well known that end-of-life hospital care is costly.Our aims were to test whether the support of the palliative team can reduce end-of-life costs and to study the mechanisms of cost reduction.Methods: This was a one-centre descriptive retrospective case-control study. Big data from registries of routine visits were used for case-control matching. We included the expenses billed to the insurance company and added separately charged drugs and materials. We compared the groups over the duration of the terminal hospitalization, ICU days (ICU=intensive care unit), IV antibiotic use (IV=intravenous), MRI/CT scans (MRI/CR=magnetic resonance imaging/computed tomography), oncologic treatment in the last month of life, and documentation of the dying phase.We searched for all in-hospital cases who died in the university hospital in Prague with the support of the hospital palliative team from January 2019 to April 2020 and matched them with similar controls. The controls were matched according to age, sex, Charlson comorbidity index and diagnosis recorded on the death certificate.Results: We identified 213 dyads. The average daily costs were three times lower in the palliative group (4,392.4 CZK per day=171.3 EUR) than in the non-palliative group (13,992.8 CZK per day=545.8 EUR), and the difference was caused by the shorter time spent in the ICU (16% vs 33% of hospital days). This was probably due to better documentation of the dying phase in the medical records.Conclusions: To date, there are sparse hospital data available on the economic aspects of end-of-life care. We showed that the integration of the palliative care team in the dying phase can be cost saving. The evidence that hospital palliative care can save a substantial amount of money can be used to support the integration of palliative care in hospitals in middle- and low-income countries. A multicentre study with the same design is planned in the future to increase the strength of the results.

Implementation of a palliative care team in an Austrian university hospital

2006 ◽  
Vol 14 (8) ◽  
pp. 795-801 ◽  
Author(s):  
Imke Strohscheer ◽  
Julijana Verebes ◽  
Hellmut Samonigg
Keyword(s):  
Palliative Care ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital

scholarly journals Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Rasheed Ofosu-Poku ◽  
Michael Owusu-Ansah ◽  
John Antwi
Keyword(s):  
Palliative Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Clinical Care ◽  
Palliative Care Service ◽  
Palliative Care Team ◽  
Care Team ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Ghana’s chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants—four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients’ expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.

scholarly journals Correction: Palliative care team consultation and quality of death and dying in a university hospital: A secondary analysis of a prospective study

PLoS ONE ◽  
2018 ◽  
Vol 13 (11) ◽  
pp. e0208564 ◽  
Author(s):  
Arianne Brinkman-Stoppelenburg ◽  
Frederika E. Witkamp ◽  
Lia van Zuylen ◽  
Carin C. D. van der Rijt ◽  
Agnes van der Heide
Keyword(s):  
Palliative Care ◽  
Prospective Study ◽  
Death And Dying ◽  
Secondary Analysis ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Quality Of Death ◽  
A Prospective Study

Urgent Creation of a Palliative Care Team in a Small Hospital During the COVID Crisis

2020 ◽  
pp. 104990912097519
Author(s):  
Nydia Martinez ◽  
Hilah Tanev ◽  
Samuel Gurevich ◽  
Candilla Davis ◽  
Mirlande Cazeau ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Essential Element ◽  
Palliative Care Service ◽  
Palliative Care Team ◽  
South Florida ◽  
Care Team ◽  
Small Hospital ◽  
Comfort Care ◽  
Care Experience

The COVID-19 pandemic created a global health emergency that has changed the practice of medicine and has shown the need for palliative care as an essential element of hospital care. In our small South Florida hospital, a palliative care service was created to support the frontline caregivers. Thanks to the hospital support, our team was formed rapidly. It consisted of 3 advanced care practitioners, a pulmonary physician with palliative care experience and the cooperation of community resources such as hospice and religious support. We were able to support patients and their families facilitating communication as visitation was not allowed. We also addressed goals of care, providing comfort care transition when appropriate, and facilitating allocation of scarce resources to patients who were most likely to benefit from them. With this article we describe a simplified framework to replicate the creation of a Palliative Care Team for other hospitals that are experiencing this need.

scholarly journals Palliative care team consultation and quality of death and dying in a university hospital: A secondary analysis of a prospective study

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0201191 ◽  
Author(s):  
Arianne Brinkman-Stoppelenburg ◽  
Frederika E. Witkamp ◽  
Lia van Zuylen ◽  
Carin C. D. van der Rijt ◽  
Agnes van der Heide
Keyword(s):  
Palliative Care ◽  
Prospective Study ◽  
Death And Dying ◽  
Secondary Analysis ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Quality Of Death ◽  
A Prospective Study
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