An EPIC electronic decision support tool to identify percentage of patients with stage IV thoracic or gastrointestinal malignancy who would benefit from concurrent palliative care but do not currently receive it.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 133-133
Author(s):  
Kerin B. Adelson ◽  
Amelia Anne Trant ◽  
Kim Framski ◽  
Mark Swidler ◽  
Nitu Kashyap
Keyword(s):  
Palliative Care ◽  
Decision Support ◽  
Care Service ◽  
Palliative Care Service ◽  
Stage Iv ◽  
Decision Support Tool ◽  
Care Utilization ◽  
Support Tool ◽  
Early Integration ◽  
Stage Iv Disease

133 Background: In 2016 ASCO updated its guideline for early integration of palliative care (PC) into standard oncologic care for all “inpatients and outpatients with advanced cancer.” PC has been shown to improve quality of life, align care at the end of life with patient preferences, and reduce health-care utilization. In preparation for the expansion of our palliative care service into ambulatory disease-based practices at Smilow Cancer Hospital at Yale-New Haven, we sought to create a decision support tool (DST) in the EPIC Electronic Health Record (EHR) that would identify patients for PC referral. Methods: This DST identifies patients with a GI or thoracic malignancy who have had an ICD-10 diagnosis of metastatic or stage IV disease, have not had a palliative care visit in the last 6 months, and are not enrolled in hospice. If the patient meets criteria, the DST will remind providers that “this patient meets ASCO and IOM criteria for concurrent palliative care with oncologic care ” and offers a one-click option to place the referral. To understand the volume of patients this DST would refer, we ran it silently in the EHR background from 7/15/16 through 9/1/16. We tracked how many patients were seen in the clinics, how many were eligible, and how many were referred to PC. Results: See table. Conclusions: Our silent BPA indicated that only 5% of patients eligible for a palliative care consult received it at baseline; this matches national data, which suggests that most patients who would benefit from PC do not receive it. This DST has the potential to dramatically improve PC referral rates and increase adherence with ASCO and IOM guidelines. We plan to move the DST into the live clinical EHR in 2017 after the integrated PC clinics are open. We anticipate that once our BPA is activated, we will see a dramatic increase in the number of eligible patients referred to palliative care. [Table: see text]

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]

A Formal Palliative Care Service Improves the Quality of Care in Patients with Stage IV Cancer and Bowel Obstruction

2016 ◽  
Vol 34 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Emmanuel Gabriel ◽  
Moshim Kukar ◽  
Adrienne Groman ◽  
Amy Alvarez-Perez ◽  
Jaclyn Schneider ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
Bowel Obstruction ◽  
Care Service ◽  
Palliative Care Service ◽  
Stage Iv ◽  
Management Problem ◽  
Do Not Resuscitate ◽  
Stage Iv Cancer

Background: Patients with stage IV cancer and bowel obstruction present a complicated management problem. The aim of this study was to evaluate the role of the palliative care service (PC) in the management of this complex disease process. Methods: A retrospective analysis was conducted of all patients admitted to Roswell Park Cancer Institute with stage IV cancer and bowel obstruction from 2009 to 2012 after the institution of a formal PC. This cohort was matched to similar patients from 2005 to 2008 (no palliative care service or NPC). Patient characteristics and outcomes included baseline demographics, comorbid conditions, do-not-resuscitate (DNR) status, laboratory parameters, medical and surgical management, length of stay, symptom relief, and disposition status. Results: A total of 19 patients were identified in the PC group. Based on the PC group baseline characteristics, 19 patients were identified for the NPC group using matched values. Regarding outcomes, there were significant differences in the medication regimens (narcotics, octreotide, and Decadron) between the 2 groups. In the PC group, 14 of 19 patients showed improvement compared to 9 of 19 in the NPC group. Nearly 60% of patients in the PC group had a formal DNR order versus 10.5% in NPC ( P = .002). A significantly higher percentage of patients were discharged to hospice in the PC group (47.4% vs 0.0%, P = .006). Conclusion: Palliative care consultation improves the quality of care for patients with stage IV cancer and bowel obstruction, with particular benefits in symptom management, end-of-life discussion, and disposition to hospice.

scholarly journals Barriers to Access to Palliative Care

2017 ◽  
Vol 10 ◽  
pp. 117822421668888 ◽  
Author(s):  
Pippa Hawley
Keyword(s):  
Palliative Care ◽  
Health Care Professionals ◽  
Care Service ◽  
Palliative Care Service ◽  
Early Integration ◽  
Care Services ◽  
Life Threatening Illness ◽  
Barriers To Access ◽  
Palliative Care Services ◽  
Life Threatening

Despite significant advances in understanding the benefits of early integration of palliative care with disease management, many people living with a chronic life-threatening illness either do not receive any palliative care service or receive services only in the last phase of their illness. In this article, I explore some of the reasons for failure to provide palliative care services and recommend some strategies to overcome these barriers, emphasizing the importance of describing palliative care accurately. I provide language which I hope will help health care professionals of all disciplines explain what palliative care has to offer and ensure wider access to palliative care, early in the course of their illness.

Developing a decision support tool for responding to patients’ reported levels of information needs, family anxiety, depression, and breathlessness.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 173-173
Author(s):  
Liesbeth van Vliet ◽  
Richard Harding ◽  
Claudia Bausewein ◽  
Sheila Payne ◽  
Irene J. Higginson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Decision Support ◽  
Delphi Study ◽  
Information Needs ◽  
Clinical Care ◽  
Decision Support Tool ◽  
Psychosocial Interventions ◽  
Social Needs ◽  
Support Tool ◽  
Patient Reported

173 Background: Routine clinical use of Patient Reported Outcome Measures (PROMs) such as the Palliative Care Outcome Scale (POS) may be prevented by a lack of guidance on how to respond to reported symptoms. When using POS in clinical care, clinicians encounter the most difficulties with responding to information needs, depression and family anxiety while breathlessness remains a difficult to treat symptom. We aimed to create a Decision Support Tool (DST) on how to respond to different levels of these patient-reported symptoms. Methods: A systematic search for guidelines and systematic reviews on these topics was conducted (in Pubmed, Cochrane and York DARE databases, Googlescholar, NICE, National Guideline Clearinghouse, Canadian Medical Association, Google.com). In a two-round online Delphi study purposefully sampled international experts (clinicians, researchers, patient representatives) judged the appropriateness (1-9 scale + do not know option) of drafted recommendations for each POS answer category (0-4) and provided qualitative remarks. Recommendations with a median of 7-9 and <30% of scores between 1-3 and 7-9 were included in the DST. Quality was assessed using an adapted GRADE approach. Results: Twenty-five out of 38 (66%) experts participated in round 1, 23 out of 37 (62%) in round 2. Higher POS scores were related to more included recommendations. The DST consists of both a manual and flow-charts of included recommendations for each topic. Overall, psychosocial interventions were recommended for lower levels of depression and breathlessness than drug interventions (e.g., goal-setting/coping versus morphine for breathlessness). Good communication and emotional support were recommended for low family anxiety levels, but a social needs assessment only for higher levels. For information needs recommendations were least discriminative; almost all recommendations (e.g., assess patients’ understanding of information, show empathy) seemed always relevant. Conclusions: The developed DST can assist clinical responses to patient-reported symptoms in palliative care. Future work is needed to test the effect of using the DST on patients’ outcomes.

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