Setting and timing of end-of-life care in cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21502-e21502
Author(s):  
Elisa De Carlo ◽  
Lorenzo Gerratana ◽  
Marika Cinausero ◽  
Maria Grazia Vitale ◽  
Vanessa Buoro ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
Home Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Poor Quality ◽  
Hospital Death ◽  
Eol Care ◽  
The Impact

e21502 Background: Limited data are available on how the setting and timing of palliative care (PC) referral can affect end-of-life (EoL) care and survival in cancer patients (pts). The aim of our study was to evaluate the impact of PC referral (hospice and/or home-care services) versus family physician care (FP-C), in terms of both EoL quality of care and survival in cancer pts. Methods: The study included 337 cancer pts who died between January 2015 and February 2016. We retrieved data on type of EoL care and on poor quality of care indicators in the last 30 days of life. Palliative Care Survival (PCS) was defined as the interval between timing of PC referral and death. The survival after treatment (Treatment-Free Survival, TFS) was defined as the interval between the last administration of anticancer therapy and death. Results: FP-C court included 89 pts and PC services court 248 pts. The 248 PC pts were divided in three groups: 99 assisted by both PC services, 58 only by home-care and 91 only by hospice care. The median PCS was 24 days. TFS was significantly longer for the three groups assisted by PC (105, 95, and 82 days respectively) than for that assisted only by FP-C (49 days, p < 0.0001). Compared to PC services, FP-C was associated with higher frequency of poor quality of care indicators, such as emergency room visits (p < 0.0001), hospitalizations (p < 0.0001), hospital death (p < 0.0001) and chemotherapy administration (p < 0.0001). In addition, earlier PC referral (30-60 and > 60 days before death) versus late referral ( < 30 days before death) was associated with a lower frequency of poor quality indicators. Variables such as age, sex and primary tumor were not associated with a different quality of care. Conclusions: Pts referred to PC services, compared to pts referred only to FP-C, had improved EoL survival and quality of care. A better definition of PC referral timing can affect the quality of EoL care in cancer pts.

Effectiveness of palliative care services: A population-based study of end-of-life care for cancer patients

2018 ◽  
Vol 32 (8) ◽  
pp. 1344-1352 ◽  
Author(s):  
Rossana De Palma ◽  
Daniela Fortuna ◽  
Sarah E Hegarty ◽  
Daniel Z Louis ◽  
Rita Maria Melotti ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Conditional Logistic Regression ◽  
Emergency Department Visits ◽  
Administrative Databases ◽  
Hospital Death ◽  
Care Services ◽  
Palliative Care Services ◽  
The Impact

Background: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. Aim: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. Design: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. Setting/participants: The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015. Results: Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI): 0.04–0.06), emergency department visits (OR = 0.23, 95% CI: 0.21–0.25), intensive care unit stays (OR = 0.29, 95% CI: 0.26–0.32), major operating room procedures (OR = 0.22, 95% CI: 0.21–0.24), and lower in-hospital death (OR = 0.11, 95% CI: 0.10–0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI: 1.21–1.33) ( p < 0.01 for all comparisons). Conclusion: Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.

Palliative Care Unit at Home: Impact on Quality of Life in Cancer Patients at the End of Life in a Rural Environment

2021 ◽  
pp. 104990912110383
Author(s):  
Maria Elena Iriarte Moncho ◽  
Vicente Palomar-Abril ◽  
Teresa Soria-Comes
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Medical Department ◽  
The Impact ◽  
At Home

Introduction: Advanced cancer is accompanied by a substantial burden of symptoms, and palliative care (PC) plays an essential role, especially at the end of life (EOL). In fact, a comprehensive PC through Home Palliative Care Units (HPCU) has been associated with reducing potentially aggressive care at the EOL. We aim to study the impact of HPCU on the quality of assistance of cancer patients at Alcoy Health Department. Methods: A retrospective study was conducted including patients diagnosed with terminal cancer at the Medical Department of Hospital Virgen de los Lirios who died between January 2017 and December 2018. The Multivariate Cox regression model was used to assess the impact of HPCU assistance on the quality of life indicators. Results: 388 patients were included. The median age was 71 years; 65% patients were male, and 68% presented with a 0-2 score on the ECOG scale. On the multivariate analysis, a lack of assistance by HPCU was associated with a higher risk of consulting in the emergency department (OR = 1.29, 95% CI: 1.02-1.67), of hospital admissions (OR = 4.72, 95% CI: 2.45-9.09), a higher probability of continuing active treatment (OR = 2.59, 95% CI: 1.44-4.67), and a greater probability of dying in hospital (OR = 6.52, 95% CI: 3.78-11.27). Conclusions: Patients receiving HPCU assistance have a lower number of emergency room visits and hospital admissions, and are more likely to die at home. Taken together, these results support the relevance of HPCU providing a high quality attention of cancer patients.

Assessing quality of end-of-life hospital care in a southern European regional health service

2005 ◽  
Vol 21 (4) ◽  
pp. 464-470 ◽  
Author(s):  
Elena Aldasoro ◽  
Adelina Pérez Alonso ◽  
Laureano Ribacoba ◽  
Santiago Esnaola ◽  
Maite Olaizola ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Care ◽  
Symptom Control ◽  
Hospital Services ◽  
Palliative Care Units ◽  
Clinical Records

Objectives:During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain.Methods:A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied.Results:End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment.Conclusions:End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.

Interpreting in palliative care: A systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients with limited English proficiency.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 123-123 ◽  
Author(s):  
Milagros Silva ◽  
Margaux Genoff ◽  
Alexandra Zaballa ◽  
Stacy Marie Stabler ◽  
Francesca Gany ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Quality Of Care ◽  
End Of Life ◽  
Limited English Proficiency ◽  
Goals Of Care ◽  
Care Services ◽  
Palliative Care Services ◽  
The Impact

123 Background: According to the 2011 U.S. Census 60% of people living in the U.S. speak a language other than English at home, and of these approximately 40% have limited English proficiency (LEP). Language barriers can affect the health outcomes of LEP patients and the use of trained interpreters can improve patient-physician communication. Since effective communication is the cornerstone of delivering adequate palliative care, a systematic review was conducted to determine the impact of interpreters on the delivery of palliative care services to LEP patients with cancer. Methods: We conducted a systematic review of the literature search in all available languages of 6 databases from 1966 and 2013. Studies evaluated interpreter interventions for LEP patients receiving palliative care services. Of 38 references, 11 articles were found by multiple reviewers to meet inclusion criteria. Data were collected on the study design, size, comparison groups, outcomes, and interpreter characteristics. Results: A total of 6 qualitative and 5 quantitative studies assessed the use of interpreters. All studies found that the quality of care provided to LEP patients receiving palliative services is affected by communication. Most studies showed that when no trained interpreters were used, LEP patients and families had inadequate understanding about their diagnosis or prognosis during goals of care conversations, and worse symptom management at end of life including pain and anxiety. Half of the studies concluded that trained interpreters are not utilized adequately and several suggested that pre-meetings between clinicians and interpreters are important to discuss topics and terminology to be used during goals of care conversations. Conclusions: Published studies show worse outcomes during end of life care and goals of care discussions when trained interpreters are not used. Moreover, trained interpreters are not being used appropriately in the field. More clinically relevant studies are needed to improve the quality of care provided to LEP patients and families receiving palliative services.

Impact of specialist palliative care delivered over three months prior to death on a colorectal cancer patient’s risk of experiencing aggressive end-of-life care.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6614-6614
Author(s):  
Aynharan Sinnarajah ◽  
Madalene Earp ◽  
Pin Cai ◽  
Andrew Fong ◽  
Kelly Blacklaws ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Quality Care ◽  
Population Level ◽  
Hospital Death ◽  
Specialist Palliative Care ◽  
Short Disease Duration ◽  
Eol Care ◽  
The Impact

6614 Background: More patients are experiencing aggressive end-of-life (EOL) care. This is concerning as aggressive EOL care, on a population level, is associated with poor quality care. Specialist palliative care (PC) has been shown to help relieve EOL symptoms, improve patient quality of life, and reduce aggressive EOL care. This study aimed to estimate the impact of the timing of specialist PC, specifically PC delivered at least 3 months prior to death, on a colorectal cancer (CRC) patient’s risk experiencing aggressive care in the last 30 days of life. Methods: A population-based retrospective cohort study of adult patients who died from CRC in Alberta, Canada from 2011-2015. The Alberta Cancer Registry was used to identify the cohort, which was linked to healthcare resource use data in local, provincial, and national databases. Individuals who died < 30 days from CRC diagnosis were excluded. Patients who accessed any of the provinces specialist PC services were deemed exposed to specialist PC (includes PC consult team, intensive PC unit, palliative home care, hospice). Aggressive EOL care was defined as having experienced at least one of: hospital death, > 1 emergency department visit, > 1 hospital admission, > 14 days of hospitalization, ≥1 intensive care unit admission, ≥1 new chemotherapy program (or any treatment in the last 14 days of life). Logistic regression was used to model factors (specialist PC timing and clinical characteristics) associated with aggressive EOL care. Results: The cohort comprised 2979 patients. Most patients received specialist PC before death (58%); 60% had ≥1 indicator of aggressive EOL care. Relative to patients who received specialist PC > 3 months before death, patients who received specialist PC < 3 months before death were 1.5 times more likely to experience aggressive EOL care (CI: 1.2-1.9). Patients who received no specialist PC were 2.1 times more likely to experience aggressive EOL care (CI: 1.7-2.8). Short disease duration ( < 1 year from diagnosis to death), younger age at death, living in a rural area, and male sex, were also associated with higher odds of experiencing aggressive EOL care. Conclusions: Specialist PC delivered > 3 months before death reduces a CRC patient’s risk of experiencing aggressive EOL care over PC delivered < 3 months before death.

Hypodermoclysis as a Strategy for Patients With End-of-Life Cancer in Home Care Settings

2020 ◽  
Vol 37 (9) ◽  
pp. 675-682 ◽  
Author(s):  
Tatiana A. Coelho ◽  
Alberto J. A. Wainstein ◽  
Ana P. Drummond-Lage
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
End Of Life ◽  
Care Setting ◽  
Place Of Death ◽  
Quality Of Death ◽  
Belo Horizonte ◽  
The Impact ◽  
At Home

Background: The increase in the elderly population associated with a higher incidence of cancer strongly endorses palliative care (PC). Hypodermoclysis (HDC) is a feasible technique for drugs and fluids delivery at the home care setting. Objectives: To assess the use and benefits of HDC in patients with end-of-life cancer assisted by a single home-based palliative care program (HPCP) in Belo Horizonte, Brazil. Methods: This was a retrospective study that analyzed medical charts from patients with end-of-life cancer who were assisted by an HPCP in a 1-year period of time. Results: A total of 333 patients, 81.7% with advanced cancer, were included. The most frequent symptoms were fatigue (44.4%) and pain (43.2%). Hypodermoclysis was used in 77.5% of the patients for the administration of fluids or medicines. Continuous palliative sedation was applied to 70.5% of patients. The place of death was home for 90.2% of the patients. Conclusion: Receiving home care assistance with palliative intention may decrease the need for dying patients with cancer to visit emergency units, as their symptoms were well controlled. Hypodermoclysis was a safe and effective alternative for hydration and drug delivery when provided and supervised by an experienced team. The place of death is a reliable indicator of the quality of death, and, in this study, the HPCP allowed patients to die at home with their families. It is essential for PC professionals to understand the impact of HDC use at home care setting for patients with end-of-life cancer allowing the increase of quality of death indicators.

Medical oncologist’s commitment in the end of life (EoL) care of cancer patients: The caregiver's perspective.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9098-9098
Author(s):  
Romeo Bascioni ◽  
Francesca Giorgi ◽  
Barbara Esperide ◽  
Farnoosh Basirat ◽  
Maria Rosaria Borriello ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Cancer Patients ◽  
Continuity Of Care ◽  
Care Pathway ◽  
Psychological Support ◽  
Oncology Unit ◽  
Eol Care ◽  
The Impact ◽  
At Home

9098 Background: Optimizing the impact of EoL care on cancer patients (pts) and their caregivers should be a primary goal of an oncology unit. In this study we evaluated satisfaction of family caregivers when the medical oncology team assisted pts until death. Methods: Two oncology units were reorganized to ensure continuity of care; oncologists trained in palliative care medicine assisted pts until EoL. The model assumes that the medical oncologist (MO) is the physician in charge throughout the entire disease trajectory. Relatives of pts assisted at home or at an inpatient hospice underwent a semistructured phone interview conducted by a psychologist or a social worker > 1 month after pts' death. Satisfaction was evaluated for symptoms control, communication, psychological support, overall quality of care and continuity of therapeutic relationship with the MO. A final open-ended question was included for any additional comment. Satisfaction was measured using a five-point Likert scale ranging from very dissatisfied to very satisfied and converted to a 0-to-100 scale. Results: Relatives of 65 pts were contacted, 55 accepted the interview (27 spouses, 22 sons, 5 in-laws, 1 parent); 50/55 were the leader caregiver. Patients were followed at home (41) or at an inpatient hospice (14), for 1-24 wks. Satisfaction mean scores were: symptoms control 76/100, communication 85, psychological support 82 and overall quality of care 87; a specific question on the relevance of the MO in EoL care produced a score of 87, with no negative or neutral responses recorded for this item. Of note, a common perception among caregivers was the appreciation of the MO's commitment during EoL in addition to the technical quality of the intervention. The overall satisfaction score was higher than in our previous study in which a continuity of care model was not formally adopted, with a score improvement from 55 to 87/100. Conclusions: A care pathway where the MO is involved in EoL management of cancer pts improved satisfaction of caregivers.When a longstanding and trusting relationship has been established, the pts-MO connection should not be lost to prevent feelings of abandonment.

Community-based palliative care and end-of-life care in elderly patients with pancreatic cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 70-70
Author(s):  
Zhanni Lu ◽  
Cecilia M Ganduglia Cazaban ◽  
Luis G LeonNovelo ◽  
Sriram J. Yennu ◽  
Sadie H Conway ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Linear Regression ◽  
End Of Life ◽  
Cancer Patients ◽  
Linear Regression Models ◽  
Exact Matching ◽  
Community Based ◽  
Eol Care ◽  
The Impact

70 Background: No population-based studies have evaluated the impact of community-based palliative care (CBPC) on aggressive end-of-life (EOL) care use and Medicare charges for elderly pancreatic cancer patients. We analyzed the impact of CBPC on aggressive EOL care use in the last 30 days of life and on emergency department (ED) and intensive care unit (ICU) Medicare charges using the SEER-Medicare data. Methods: 12399 elderly pancreatic cancer patients survived for at least 1 month after diagnosis from 2007 to 2013 were identified. CBPC and hospital-based palliative care (HBPC) users were identified by diagnosis codes and place of services and matched by the coarsened exact matching [786:786; age, sex, residence urbanization level, comorbidities, illness duration, palliative care (PC) exposure]. Zero-inflated Poisson and multivariable logistic/linear regression models examined the variations of aggressive EOL care use in the matched patients. Generalized linear regression with a gamma distribution determined how CBPC impacted ED and ICU Medicare charges. Results: 22.1% eligible patients (median age: 76 years) used PC in the 6 years, including 7.7% who used CBPC and 14.5% who used HBPC. The median duration from cancer diagnosis to death of CBPC, HBPC and Non-PC users was 11 months, 6 months and 8 months (P < .001). Matched CBPC users were less likely than HBPC users to be admitted to ICU (risk ratio [RR], 0.64; 95% CI, 0.50-0.81), ED (RR, 0.63; 95% CI, 0.53-0.73), and hospital (RR, 0.50; 95% CI, 0.35-0.72). Compared to matched HBPC users, CBPC users utilized less life-extending care (OR, 0.59; 95% CI, 0.43-0.80) and had shorter hospital (Coef., −0.42; 95% CI, −0.65- −0.18) and ICU stays (Coef., −0.35; 95% CI, −0.59 - −0.10). They tended to die at home (OR, 1.46; 95% CI, 1.19-1.78) and not in ED/ICU/hospital settings (OR, 0.62; 95% CI, 0.45-0.83). CBPC users’ adjusted mean ED and ICU Medicare charges were 0.2% (P = .80) and 1.1% (P < .001) lower than those of Non-PC users and 4.5% (P = .43) and 21.0% (P = .08) lower than those of matched HBPC users. Conclusions: CBPC users utilized less aggressive EOL care than HBPC users, implying CBPC's potential to reduce aggressive EOL care use. Their ICU Medicare charge was lower than that of Non-PC users.

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