Identifying barriers to oncologist referral to palliative care: A dual approach.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 121-121 ◽  
Author(s):  
Kyle Whelan
Keyword(s):  
Palliative Care ◽  
Literature Review ◽  
End Of Life ◽  
Cancer Patients ◽  
Tertiary Hospital ◽  
Cancer Center ◽  
Structured Interviews ◽  
Dual Approach ◽  
Wide Range ◽  
Specific Barriers

121 Background: Longitudinal palliative care has demonstrated benefits for cancer patients, and the American Society for Clinical Oncology recommends that palliative care be used along with standard anti-cancer therapy at the diagnosis of serious disease. However, studies have shown that oncologists still often refer to palliative care within days of the end of life, or not at all. This indicates that oncologists face barriers, systems-based or self-imposed, to palliative care referral. This study aims to identify specific barriers that prevent oncologists from referring cancer patients to palliative care services. Methods: Barriers to referral were identified via a dual approach. A literature review was performed using a PubMed search of articles published since 2012, when the ASCO provisional opinion was issued. This was narrowed down to 27 articles that meaningfully commented on barriers that oncologists face in referring to palliative care. Additionally, a qualitative analysis of semi-structured interviews of five practicing oncologists was performed. Oncologists interviewed for the study practice in a cancer center affiliated with an academic tertiary hospital. Results: 20 distinct barriers to referral, both systems-based and at the individual provider level, were enumerated from the literature review and interview analysis. Conclusions: Oncologists face a wide range of specific barriers that prevent appropriate referral to palliative care, related both to the logistics of the healthcare system and to providers’ preconceptions about palliative care. A significant barrier at the oncologist level is a tendency to associate palliative care exclusively with the end of life, despite demonstrated benefits earlier in the course of disease.

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.

Prognostic significance of the “surprise” question in cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9588-9588
Author(s):  
A. H. Moss ◽  
J. R. Lunney ◽  
S. Culp ◽  
M. Auber ◽  
S. Kurian ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Cancer Center ◽  
P Value ◽  
Cancer Type ◽  
Patient Death ◽  
Surprise Question

9588 Background: In patients with advanced cancer, failure to accurately estimate and communicate prognoses can lead to overly aggressive care at the end of life with less attention to important palliative care issues such as pain and symptom management and patients’ values and goals for care. The “surprise” question—would I be surprised if this patient died in the next year?—has been recognized as an innovation to improve end-of-life care in the primary care population by identifying patients with a poor prognosis who are appropriate for palliative care. It has not been previously tested in cancer patients. The purposes of this study were to determine the feasibility and outcomes of the use of the “surprise” question in a cancer center population. Methods: Between July and November 2007, oncologists prospectively classified consecutive breast, lung, and colon cancer patients being seen at the Mary Babb Randolph Cancer Center of West Virginia University into “Yes” and “No” groups based on the surprise question. Patients were followed and their status at the end of one year-alive or dead-was determined along with patient demographics, type of cancer, and stage at presentation. A multivariate Cox proportional hazards regression analysis was used to identify variables associated with patient death. Results: Oncologists classified 826 of 853 prospective patients (97%), with 131 (16%) classified into the “No” group and 695 (84%) into the “Yes” group. At the end of the year, 71 patients had died; 41% of the “No” patients compared to 3% of the “Yes” patients (P <.001). The surprise question ‘No‘ response was more predictive of patient death than stage of cancer, cancer type, or age (hazard ratio 7.53, P value <.001). The “Yes” patients lived longer than the “No” patients (359.8±32.8 days versus 270±131.5 days, P <.001). The sensitivity of the surprise question “No” response was 75% and the specificity was 90%. Conclusions: We conclude that the surprise question is a simple, feasible, and effective tool to identify cancer patients with the worst prognoses who should receive the highest priority for palliative care interventions, particularly advance care planning. No significant financial relationships to disclose.

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]

scholarly journals The silent transition from curative to palliative treatment: a qualitative study about cancer patients’ perceptions of end-of-life discussions with oncologists

2020 ◽  
Author(s):  
A. Kitta ◽  
A. Hagin ◽  
M. Unseld ◽  
F. Adamidis ◽  
T. Diendorfer ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Defense Mechanisms ◽  
Qualitative Methodology ◽  
Transition Process ◽  
Structured Interviews ◽  
Advanced Cancer Patients ◽  
Early Integration ◽  
Disease Trajectory

Abstract Objective The aims of the study were to examine patients’ experiences of end-of-life (EOL) discussions and to shed light on patients’ perceptions of the transition from curative to palliative care. Methods This study was based on a qualitative methodology; we conducted semi-structured interviews with advanced cancer patients admitted to the palliative care unit (PCU) of the Medical University of Vienna. Interviews were recorded digitally and transcribed verbatim. Data were analyzed based on thematic analysis, using the MAXQDA software. Results Twelve interviews were conducted with patients living with terminal cancer who were no longer under curative treatment. The findings revealed three themes: (1) that the medical EOL conversation contributed to the transition process from curative to palliative care, (2) that patients’ information preferences were ambivalent and modulated by defense mechanisms, and (3) that the realization and integration of medical EOL conversations into the individual’s personal frame of reference is a process that needs effort and information from different sources coming together. Conclusions The results of the present study offer insight into how patients experienced their transition from curative to palliative care and into how EOL discussions are only one element within the disease trajectory. Many patients struggle with their situations. Therefore, more emphasis should be put on repeated offers to have EOL conversations and on early integration of aspects of palliative care into the overall treatment.

scholarly journals Changes of End of Life Practices for Cancer Patients and Their Association with Hospice Palliative Care Referral over 2009-2014: A Single Institution Study

2020 ◽  
Vol 52 (2) ◽  
pp. 419-425 ◽  
Author(s):  
Hyun Jung Jho ◽  
Eun Jung Nam ◽  
Il Won Shin ◽  
Sun Young Kim
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Center ◽  
Do Not Resuscitate ◽  
Aggressive Cancer ◽  
Care Practices ◽  
Record Review ◽  
Eol Care ◽  
Hospice Palliative Care

Purpose In Korea, hospice palliative care (HPC) provision for cancer patients has increased recently. However, whether end of life (EoL) care practices have improved along with the development of HPC is unclear. We intended to investigate the changes in EoL care practices and their association with HPC referral. Materials and Methods Retrospective medical record review of adult cancer patients who died at National Cancer Center Korea from 1 January 2009 to 31 December 2014 was performed. Changes of EoL practices including chemotherapy within 2 weeks from death, death in intensive care unit (ICU), documentation of “do not resuscitate (DNR)” within 7 days from death and referral to HPC from 2009 to 2014 were analyzed as well as the association between referral to HPC and other practices. Results A total of 2,377 cases were included in the analysis. Between 2009 and 2014, referral to HPC increased and DNR documentation within 7 days from death decreased significantly. Cases for chemotherapy within 2 weeks from death and death in ICU didn’t change over the study period. Patients referred to HPC were less likely to receive chemotherapy within 2 weeks from death, die in ICU and document DNR within 7 days from death. Conclusion During the study period, EoL practices among cancer patients partly changed toward less aggressive in our institution. HPC referral was associated with less aggressive cancer care at the EoL. Policies to promote EoL discussion are necessary to improve the EoL practices of cancer patients.

Making treatment decisions at end of life in a comprehensive cancer center.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 51-51
Author(s):  
Anna Catherine Beck ◽  
Lee Ellington ◽  
Kathi Mooney
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Palliative Therapy ◽  
Treatment Decisions ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Optimal Timing ◽  
Phone Calls ◽  
Oncology Providers

51 Background: End of life treatment decisions are challenging for cancer patients and oncology providers. Patients must understand their prognosis and options, deciding if and when to increase palliative care and decrease tumor-focused therapy. Cancer centers committed to offering clinical trials and evaluate new therapies add complexity to these decisions. To better define crucial points for decision making, we reviewed the care patients received during the last 6 months of life at one comprehensive cancer center. Methods: A retrospective chart review was conducted of the 301 cancer patients who died during one calendar year and were treated at the Huntsman Cancer Institute. We abstracted the care documented from all clinic visits, phone calls and hospitalizations including referrals and resources utilized during the last 6 months of life. Results: Men and women were equally represented with a mean age of 61at death and a median survival of 13 months after diagnosis. Over 1780 outpatient visits were documented during the last 6 months of life with treatment decision conversations noted at 68% of visits. Results of these discussions included new chemotherapy initiated at 26% of visits, treatment termination at 19% of visits, palliative therapy only at 9% of visits, and no treatment change at 47% of visits. Of the 64% of patients receiving chemotherapy in the last 6 months, 32% continued therapy in the last 30 days of life. Similarly, 34% of patients received radiation therapy in the last 30 days. Hospice was used by 59% of patients, with a mean length from referral to death of 29 days. Conversations about hospice occurred in 65% of patients with a mean/median of 2 conversations/patient. Approximately 37% of these conversations resulted in hospice enrollment, 49% deferred a decision and in 14% the patient requested additional treatment. Conclusions: Defining optimal timing for stopping cancer directed therapy is challenging in medical and radiation oncology, with 1in 3 patients continuing treatment in the last month of life. Goals of care and hospice conversations were required on multiple occasions, underscoring the need for oncology providers to have highly honed communication skills to minimize futile care and maximize palliative care.

scholarly journals Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review

2021 ◽  
pp. 026921632110073
Author(s):  
Christine Lau ◽  
Christopher Meaney ◽  
Matthew Morgan ◽  
Rose Cook ◽  
Camilla Zimmermann ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Performance Status ◽  
Retrospective Chart Review ◽  
Care Needs ◽  
Care Facilities ◽  
Palliative Care Services ◽  
Low Performance ◽  
Electronic Referral

Background: To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. Aim: To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. Design: A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. Setting/participants: Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. Results: A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015–2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%–20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%–40% were associated with decreased rates and/or likelihood of admission. Conclusion: Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are “sicker” with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.

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