Impact of palliative care referral on hospice enrollment: A single center analysis.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 17-17
Author(s):  
Shreya Sinha ◽  
Alina Basnet ◽  
Wajihuddin Syed ◽  
Pallavi Koparthy ◽  
Rashad Khan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Hospice Care ◽  
Univariate Analysis ◽  
Insurance Status ◽  
Disease Course ◽  
Advanced Directives ◽  
Early Palliative Care ◽  
Care Services ◽  
Palliative Care Services

17 Background: Despite ASCO’s recommendation to introduce palliative care services for all patients diagnosed with localized or metastatic pancreatic cancer, most patients’ care does not involve this multimodality approach. Transitioning patients to hospice at an appropriate time is essential in oncologic practice. The purpose of this study is to identify which variables affect acceptance of hospice services by patients. Methods: A retrospective chart review of patients with pancreatic cancer treated at Upstate University Hospital from 2011-2015 was performed. We studied variables including age, sex, race, stage, insurance status, advance directives, performance status and laboratory values. We analyzed patients based on acceptance or rejection of hospice care in their disease course and conducted a univariate analysis on different factors to determine predisposing variables. p-values were calculated using Chi-Square test and t-test. Results: We reviewed 325 patients charts and found statistically significant relation to acceptance of hospice and insurance status, and involvement of palliative care in their care. Patients with Medicare were more likely to decline hospice care whereas patients with Medicaid or no insurance were more likely to accept it. 36.23% of patients saw palliative care services at any point in their treatment course and these patients were more likely to accept hospice care than patients who did not (p = < 0.0001). Patients who were seen by palliative care earlier in their disease course were more likely to accept hospice care, although this did not reach statistical significance (p = 0.0731). Patients with stage IV disease were more likely to accept hospice care (p = 0.0095). Other variables like presence of advanced directives, tumor markers, age, and sex did not have a significant impact. Conclusions: Palliative care involvement is beneficial in patients with pancreatic cancer as they face a rough disease course with multiple treatment and disease related morbidities. Patients with early palliative care involvement during their illness are more likely to decide on hospice care at the end stages of their malignancies. This supports early palliative care introduction as an adjunct to oncologic care.

scholarly journals What do family caregivers know about palliative care? Results from a national survey

2019 ◽  
Vol 17 (6) ◽  
pp. 643-649 ◽  
Author(s):  
J. Nicholas Dionne-Odom ◽  
Katherine A. Ornstein ◽  
Erin E. Kent
Keyword(s):  
Palliative Care ◽  
Chronic Illness ◽  
Family Caregivers ◽  
Hospice Care ◽  
Care Services ◽  
Palliative Care Services ◽  
Level Of Knowledge ◽  
National Trends ◽  
Behavioral Disability ◽  
Family Centered

AbstractObjectiveDespite their key role in caring for individuals with serious, chronic illness, there have been no national studies examining family caregiver awareness and perceptions of palliative care. Hence, our objectives were to ascertain level of knowledge of palliative care among U.S. family caregivers and describe demographic variation in awareness and perceptions of palliative care.MethodUsing the 2018 National Cancer Institute Health Information National Trends Survey, we identified unpaid family caregivers caring or making healthcare decisions for someone with a medical, behavioral, disability, or other condition. Respondents were asked about their awareness of the term “palliative care” and, if aware, how much they agreed with statements representing common (mis)perceptions about palliative care (e.g., “Palliative care is the same as hospice”).ResultMore than one-half of caregivers (55%) had “never heard” of palliative care; 19.2% knew what palliative care was and “could explain it to someone else.” In adjusted models, racial minorities (vs. whites) and those without a college degree were less likely to have heard of palliative care. Among those aware of palliative care, ~40% “strongly” or “somewhat” agreed that “Palliative care is the same as hospice”; another 10.5% “didn't know.” Similarly, 40% reported that “When I think of palliative care, I automatically think of death.”Significance of resultsOne-half of family caregivers of adults with serious chronic illness have never heard of palliative care. Even among those who had heard of palliative care, the majority do not distinguish it from hospice care and death. Given the role family caregivers may play in decisions to access palliative care, public messaging efforts are needed to clarify palliative care services in a way that is patient- and family-centered.

scholarly journals Patients' experiences of attending an adapted cardiac rehabilitation programme for heart failure in a day hospice

2020 ◽  
Vol 26 (6) ◽  
pp. 292-300
Author(s):  
Helen Walthall ◽  
Christie Roberts ◽  
Dan Butcher ◽  
Sue Schutz
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Hospice Care ◽  
Positive Impact ◽  
Post Intervention ◽  
Cardiac Rehabilitation Programme ◽  
Care Services ◽  
Final Sample ◽  
Palliative Care Services ◽  
Poor Outcomes

Background: Heart failure is highly prevalent with poor outcomes, yet only a small proportion of patients receive specialist palliative care services. Aim: To explore if a programme focusing on support and symptom management of people with heart failure in a hospice environment would be acceptable and of benefit to patients. Methods: A pre/post intervention study design using mixed methods was used to evaluate the programme. The programme was delivered in 2-hour time slots over a period of 8 weeks. Participants completed three questionnaires pre- and post- and were interviewed within 1 week of completion. The study was conducted between June 2014 and January 2015. Findings: A response rate of 51.7% (n=15) was narrowed to a final sample size of 12 patients. The questionnaire results showed a positive impact on participants' wellbeing and views regarding the use of a hospice, but a desire for greater focus on emotional support. Four key themes emerged from inductive qualitative analysis: demystifying perceptions about hospice care; positivity about wellbeing; learning together; and consideration of end-of-life preparation. Conclusion: This adapted programme provides a useful model for the increased integration of palliative care into provision for those living with advancing heart failure.

scholarly journals The views of patients with brain cancer about palliative care: a qualitative study

2017 ◽  
Vol 24 (6) ◽  
pp. 374 ◽  
Author(s):  
M. Vierhout ◽  
M. Daniels ◽  
P. Mazzotta ◽  
J. Vlahos ◽  
W.P. Mason ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Brain Cancer ◽  
Chronic Conditions ◽  
Structured Interviews ◽  
Optimal Care ◽  
Early Palliative Care ◽  
Care Services ◽  
Palliative Care Services ◽  
To Receive

Background Palliative care, a specialty aimed at providing optimal care to patients with life-limiting and chronic conditions, has several benefits. Although palliative care is appropriate for neurosurgical conditions, including brain cancer, few studies have examined the views of brain cancer patients about palliative care. We aimed to explore the thoughts of brain cancer patients about palliative care, their opinions about early palliative care, and their preferred care setting.Methods Semi-structured interviews and the qualitative research methodologies of grounded theory were used to explore perceptions of palliative care on the part of 39 brain cancer outpatients.Results Seven overarching actions emerged:Patients would prefer to receive palliative care in the home.Increased time with caregivers and family are the main appeals of home care.Patients express dissatisfaction with brief and superficial interactions with health care providers.Patients believe that palliative care can contribute to their emotional well-being.Patients are open to palliative care if they believe that it will not diminish optimism.There is a preconceived idea that palliative care is directly linked to active dying, and that supposed link generates fear in some patients.Patients prefer to be educated about palliative care as an option early in their illness, even if they are fearful of it.Conclusions Overall, when educated about the true meaning of palliative care, most patients express interest in accessing palliative care services. Although the level of fear concerning palliative care varies in patients, most recognize the associated benefits.

scholarly journals Experiencing place identity and place belongingness at a children’s hospice: Parents’ perspectives

2020 ◽  
pp. 136749352091513
Author(s):  
Helena Dunbar ◽  
Bernie Carter
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Hospice Care ◽  
Place Identity ◽  
Constructivist Grounded Theory ◽  
Care Services ◽  
Key Players ◽  
Palliative Care Services ◽  
Families With Children ◽  
Parents Experiences

Children’s hospices are key players in the provision of palliative care services for families with children with life-limiting conditions (LLCs). However, evidence suggests that some of the negative terminology/language which surrounds the notions of palliative and hospice care may contribute to the lack of uptake of hospice services by families. This article reports two elements of place bonding: parents’ experiences of place identity and place belongingness at a children’s hospice in a region in England. Underpinned by a constructivist grounded theory methodology, focus groups were undertaken with 24 parents of children with LLCs accessing a children’s hospice. Despite initial reservations associated with the identity of the hospice, parents described how and why their view changed and therefore consequently how they were able to experience the hospice differently. This article demonstrates how parents’ views of the identity of the hospice change and how the hospice becomes a place where parents experience a sense of belongingness.

Specialist palliative care along the trajectory of illness

2021 ◽  
pp. 103-110
Author(s):  
Breffni Hannon ◽  
Stein Kaasa ◽  
Camilla Zimmermann
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Optimal Time ◽  
Future Research ◽  
Optimal Timing ◽  
Early Integration ◽  
Early Palliative Care ◽  
Care Services ◽  
Healthcare Settings ◽  
Palliative Care Services

The benefits of early, integrated palliative care have been demonstrated through several randomized controlled trials. These benefits include improved quality of life, satisfaction with care, symptom management, and, in some cases, survival. Despite heterogeneity in study design and execution, as well as limitation to mainly the oncology population, these trials have answered the question of why patients should receive palliative care early in their disease trajectory. Attention must now shift to the practicalities of early integration; these include questions about when is the optimal time to refer to palliative care services, who is best placed to provide palliative care supports, where early palliative care should be provided, and how best to integrate early palliative care services across the care continuum. This chapter summarizes current evidence supporting early integration of palliative care; describes the respective roles of primary, secondary, and tertiary care providers in the delivery of early palliative care; explores the optimal timing and venues for the delivery of early palliative care; and outlines a hierarchy of integration models to best meet the needs of all patients throughout the illness trajectory. Although rooted in evidence primarily from oncology trials conducted in North American and European settings, these options may be adaptable across a variety of healthcare settings, irrespective of available resources and stages of development of palliative care services. Future research should include patients from non-oncology populations, and focus on models of integration that include primary and secondary providers, rather than relying only on tertiary palliative care.

Oncology patients in the health care safety net: Is it too late for early palliative care?

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 128-128
Author(s):  
Heather A. Harris ◽  
Anne Kinderman ◽  
Leslie Safier
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Late Stage ◽  
Safety Net ◽  
Early Palliative Care ◽  
Care Services ◽  
Stage Disease ◽  
Late Stage Disease ◽  
Palliative Care Services

128 Background: Studies have suggested that uninsured and Medicaid patients are more likely to present with late-stage cancer than Medicare patients, and may be more likely to be admitted urgently or emergently. However, studies of palliative care interventions for cancer patients suggest that the greatest impact can be achieved if these services begin “early” (≥ 90 days prior to death). In our urban public hospital, we examined where patients receive their initial cancer diagnosis, and at what stage they are diagnosed, in order to determine how to best implement community-based palliative care services. Methods: Retrospective cohort analysis of cancer patients diagnosed over a five year period. Hospital tumor registry data were used to determine the location of diagnosis (inpatient vs. outpatient), stage and type of cancer at diagnosis, and patient status at the end of the study period (alive vs. deceased). Results: Of the 2,928 patients diagnosed with cancer, 26% of patients (n = 759) were diagnosed while hospitalized. Patients who received their diagnosis while hospitalized were more likely to be diagnosed with stage 3-4 disease (49%, n = 372), vs. stage 0-1 (21%, n = 163). 25% of patients who received their diagnosis in the inpatient setting died within 90 days of initial diagnosis. Patients diagnosed in the outpatient setting were more likely to be diagnosed with stage 0-1 (40%, n = 865), vs. stage 3-4 (32%, n = 688). Patients diagnosed while hospitalized were 2.9 times more likely to be diagnosed with late stage disease, compared to those diagnosed as outpatients (95% CI 2.3-3.5, p < 0.0001). Conclusions: A large minority of patients received their cancer diagnosis while hospitalized, and were more likely to be diagnosed with late-stage disease. Additionally, a significant proportion of these patients died within 90 days of their initial diagnosis. In order to provide "early" palliative care for cancer patients in public hospitals, palliative care programs may need to offer initial consultation visits while patients are hospitalized, and then connect them with prompt outpatient follow-up. Safety net programs with palliative care services for cancer patients should emphasize continuity across inpatient and outpatient settings.

Does Palliative Care Utilization Facilitate Conversion to Hospice Care? A Qualitative Study of the “Soft No”

2020 ◽  
Vol 37 (9) ◽  
pp. 701-706 ◽  
Author(s):  
Karen Lutfey Spencer ◽  
Emily Hammad Mrig ◽  
Ariana Kobra Talaie
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Comparative Method ◽  
Value Added ◽  
Medical Decision ◽  
Care Utilization ◽  
Care Services ◽  
Health Related ◽  
Palliative Care Services ◽  
Depth Interviews

Background: Facilitating patient conversion to hospice at end of life is a prominent clinical concern. Enrollment in outpatient palliative care services is often assumed to encourage seamless transition to hospice care, but this has not been demonstrated. Moreover, decisions to convert from palliative care to hospice are generally treated as dichotomous, thus hampering our ability to understand decision processes. Objective: To examine medical decision-making among patients who are prospectively evaluating whether to convert from palliative care to hospice. Design: Qualitative case study, using in-depth interviews and constant comparative method. Setting/Patients: Terminally ill patients currently enrolled in outpatient palliative care services (N = 26) and their caregivers (N = 16), selected purposely for maximum variation in condition and personal background. Measurements: Themes identified in qualitative in-depth interviews. Results: Patients rarely refused hospice outright but more often postponed using a “soft no,” in which they neither accepted nor overtly refused hospice. Justifications patients and caregivers offered for why hospice was not needed (yet) appeared in these themes: (1) not seeing the value added of hospice, (2) assuming the timing is premature, and (3) relying on extensive health-related support networks that justify or endorse continuation of active care. Conclusions: Despite assumptions to the contrary, benefits associated with utilization of outpatient palliative care services have the potential to incentivize the delay of hospice in some cases. Clinical interactions with outpatient palliative care patients should consider the influence of these broad social support systems when discussing hospice options.

scholarly journals Optimizing the delivery of early palliative care for hematology patients receiving a stem cell transplant: A role for a Nurse Practitioner

2020 ◽  
Vol 30 (4) ◽  
pp. 239-245
Author(s):  
Ellen Lewis
Keyword(s):  
Palliative Care ◽  
Stem Cell ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Early Palliative Care ◽  
Care Services ◽  
Palliative Care Services

A hematopoietic stem cell transplant (HSCT) is an intense treatment approach for patients with a hematologic malignancy and brings a significant risk for morbidity and mortality. HSCT brings hope of cure for patients; however, treatments are lengthy and burdensome from both a physical and psychosocial perspective. As the culture of HSCT has traditionally been cure-oriented, it leaves little room for a potential partnership with palliative care services, and when palliative care services are introduced, it is often too late for significant benefit. The need to standardize palliative care involvement for patients with hematologic malignancies receiving a HSCT has become necessary, yet there are challenges with the best way to create such a partnership. Nurse practitioners are a steadily growing professional body possessing the knowledge and skill necessary to fill the gap in palliative care delivery for HSCT patients. The proposed Nurse Practitioner Early Palliative Care for HSCT patients (NEST) algorithm will seek to provide a pathway in which to foster a partnership between hematology/HSCT teams and palliative services to yield the best care possible for patients.

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