Progress and trends in the utilization and adoption of palliative care in patients with terminal gynecologic cancer in the United States: A study of 4,264 women.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11606-11606
Author(s):  
Anthony Milki ◽  
Amandeep Kaur Mann ◽  
Daniel Stuart Kapp ◽  
John K. Chan
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Private Insurance ◽  
Gynecologic Cancer ◽  
The United States ◽  
Cancer Type ◽  
Median Income ◽  
Logistic Regression Models ◽  
Lower Socioeconomic ◽  
Chi Squared

11606 Background: To determine the factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized. Methods: Data were extracted from the National Inpatient Sample (NIS) database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were employed for statistical analyses. Results: Of 4264 women with gynecologic cancer, 983 (23.0%) utilized PC (median age: 66 years). 2633 (61.8%), 1034 (24.3%), and 597 (14.0%) patients had ovarian, uterine, and cervical cancer, respectively. The majority were white (57.9%), and the remainder were black (12.6%), Hispanic (7.8%), and Asian (3.1%). 24.9, 23.9, 23.6, and 25.2% were low, low-middle, middle-high, and high with respect to median income. Medicare, Medicaid, and private insurance was found in 46.7, 10.8, and 37.6% of patients. 36.9, 21.0, 18.0, and 24.1% of patients were treated in hospitals in the South, West, Midwest, and Northeast. 11.3, 23.9, and 64.2% of patients were treated in small, medium, and large hospitals, designated as teaching (53.1%) and nonteaching (46.3%) institutions. The utilization of PC increased from 5.2% in 2005 to 30.4% in 2011. Older age (OR: 1.34; 95% CI: 1.10-1.64; P = 0.01), high SES (OR: 1.37; 95% CI: 1.09-1.72; P = 0.01), privately insured (OR: 1.81; 95% CI: 1.46-2.24; P < 0.001), treatment at Western (OR: 1.94; 95% CI: 1.56-2.41; P < 0.001) and Midwestern hospitals (OR: 1.43; 95% CI: 1.15-1.77; P = 0.001), and depression (OR: 1.34; 95% CI: 1.00-1.80; P = 0.05) were associated with higher PC use. However, race, cancer type, hospital teaching status, and hospital location were not associated with PC use. Conclusions: The use of inpatient palliative care has increased significantly over the study period. The lower utilization of palliative care for terminal illness associated with younger, lower socioeconomic status, Southern and smaller volume hospitals warrants further attention.

Trends in the Utilization of Palliative Care in Patients With Gynecologic Cancer Who Subsequently Died During Hospitalization

2020 ◽  
Vol 38 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Anthony Milki ◽  
Amandeep Kaur Mann ◽  
Austin Gardner ◽  
Daniel Stuart Kapp ◽  
Diana English ◽  
...  
Keyword(s):  
Palliative Care ◽  
Low Socioeconomic Status ◽  
Terminal Illness ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Gynecologic Cancer ◽  
Low Socioeconomic ◽  
Logistic Regression Models ◽  
Younger Age ◽  
Chi Squared

Objective: To determine factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized. Methods: Data were abstracted from the National Inpatient Sample database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were used for statistical analyses. Results: Of 4559 women (median age: 65 years; range: 19-102), 1066 (23.4%) utilized PC. Patients were 24.9% low socioeconomic status (SES), 23.9% low-middle, 23.7% middle-high, and 25.1% high SES. Medicare, Medicaid, and private insurance coverage were listed at 46.2%, 37.5%, 11.3% of patients; 36.2%, 21.1%, 18.1%, 24.6% were treated in the South, West, Midwest, and Northeast. Over the 7 year study period, the use of PC increased from 12% to 45%. Older age (odds ratio [OR]: 1.36; 95% CI: 1.11-1.68; P = .003), high SES (OR: 1.41; 95% CI: 1.12-1.78; P = .003), more recent treatment (OR: 9.22; 95% CI: 6.8-12.51; P < .0001), private insurance (OR: 1.81; 95% CI: 1.46-2.25; P < .001), and treatment at large-volume hospitals (OR: 1.36; 95% CI: 1.04-1.77; P = .02), Western (OR: 2.00; 95% CI: 1.61-2.49; P < .001) and Midwestern hospitals (OR: 1.35; 95% CI: 1.08-1.68; P = .001) were associated with higher utilization of PC. Conclusions: The use of inpatient PC for patients with gynecologic cancer increased over time. The lower utilization of PC for terminal illness was associated with younger age, lower SES, government-issued insurance coverage, and treatment in Southern and smaller volume hospitals, and warrants further attention.

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

2021 ◽  
pp. 000348942110157
Author(s):  
Jennifer L. McCoy ◽  
Ronak Dixit ◽  
R. Jun Lin ◽  
Michael A. Belsky ◽  
Amber D. Shaffer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Private Insurance ◽  
Chronic Otitis Media ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Median Income ◽  
Public Insurance ◽  
Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

Utilization of palliative care in patients with genitourinary malignancies.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 669-669
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Rashmi Verma
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Terminal Illness ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Private Insurance ◽  
Malignant Neoplasm ◽  
The West ◽  
Factors Affecting

669 Background: Palliative care provides support and improves the quality of life of patients who has terminal illness such as cancer. Studies have shown that integrating palliative care into cancer care soon after the diagnosis of metastatic cancer can improve the quality of life and also prolong survival. The objective of the study was to analyze the acceptance of palliative care and to determine the factors affecting the utilization of palliative care in patients with genitourinary (GU) cancers. Methods: The National Inpatient Sample Database for the year 2016 was queried for the data. Patients who were admitted with a principal diagnosis of Malignant Neoplasm of Prostate (MNP), Renal Cell Carcinoma (RCC), Malignant Neoplasm of Ureter (MNU) were identified using ICD-10 codes and those who had Encounter for Palliative Care (PC) was also identified. Results: A total of 58765 hospitalizations were identified with MNP (n=39853), RCC (n=17786), MNU (n= 1126) during the study period. The total PC utilization for the above patients were 6.4% (n= 3785). Among those, 6.7% (n=1186), 6.3% (n=2531), 6.03% (n=68) from the groups RCC, MNP, MNU respectively received PC. The mean age for the PC utilization was 73 years (MNP= 72 yrs, RCA= 63 yrs, UCC= 73 yrs). Females received more PC when compared to males (6.7% vs 6.4%). Among those who had PC 27.4% (n=1029) died in the hospital. Interestingly, patients who had Medicare and Medicaid had more PC encounters when compared to those with private insurance (OR= 1.21, P= 0.001). Patients admitted on the weekend received more PC when compared to those who admitted during weekdays (OR= 1.12, P= 0.001). Patients admitted to hospitals in the West received more PC than other regions (OR= 1.42, P=0.03). Impact of race, teaching vs non-teaching hospital admissions were not found to be statistically significant in the utilization of PC in the above GU cancers. Conclusions: Medicare and Medicaid patients, weekend admissions, admissions to hospitals in the West received more palliative care. Further studies are needed to reveal the role of socioeconomic status and insurance in the utilization of palliative care in GU malignancies.

scholarly journals THE RECEPTION OF C.G. JUNG IN US DEATH AND DYING STUDIES

2018 ◽  
pp. 83-110
Author(s):  
Jelena Martinovic
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
William James ◽  
Death And Dying ◽  
The United States ◽  
Humanistic Psychology ◽  
Death Experience ◽  
The Dead ◽  
Book Of The Dead ◽  
Near Death Experience

C.G. Jung’s work has had a noticeable impact on conceptions about death and the dying experience, as well as on the therapeutic work methods that deal with anxiety, depression or terminal illnesses. This article analyses the reception of C.G. Jung’s work in the United States during the time period 1960-80. It examines ways in which Jung’s concepts were discussed and applied by psy practitioners who worked in fields related to death and dying studies (thanatology, palliative care, suicide and near- death studies). Following an examination of Jung’s ‘Americanisation’ in the 1950s and the reception of his commentaries on death, discussed in relation to the reception of The Tibetan Book of the Dead, I will analyse four examples: 1) a psychiatric interpretation of Jung’s account of a near- death experience and its comparison with William James’ mystical states of consciousness; 2) psychedelic therapies conducted with LSD, in which ‘symbolic dying processes’ are provoked; 3) suicide studies done on suicide survivors; 4) parapsychological investigation of near-death experience. The examples show that Jung’s work was pivotal, allowing psychologists to link it to concepts and approaches to terminal illness and positive or transpersonal psychology. Within the period under consideration, Jung’s reception has to be read and understood in relation to the more general reception of James’ work, in particular his psychology of religion. KEYWORDS William James, near-death experience, thanatology, palliative care, Tibetan Book of the Dead, LSD therapy, suicide studies, humanistic psychology

The Healthcare Journey of Women With Advanced Gynecological Cancer From Diagnosis Through Terminal Illness: Qualitative Analysis of Progress Note Data

2021 ◽  
pp. 104990912110642
Author(s):  
Ellis C. Dillon ◽  
Vidita Chopra ◽  
Elizabeth Mesghina ◽  
Anthony Milki ◽  
Ava Chan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Hospice Care ◽  
Gynecological Cancer ◽  
Gynecologic Cancer ◽  
Stage Iv ◽  
Urgent Care ◽  
Psychosocial Needs ◽  
Goals Of Care ◽  
Progress Notes

Objective To examine women’s journeys with gynecologic cancer from before diagnosis through death and identify elements of their healthcare experience that warrant improvement. Methods This exploratory study used longitudinal progress notes data from a multispecialty practice in Northern California. The sample included women with stage IV gynecological cancer diagnosed after 2011 and who died before 2018. Available progress notes from prior to diagnosis to death were qualitatively analyzed. Results We identified 32 women, (median age 61 years) with mostly uterine (n=17) and ovarian (n=9) cancers and median survival of 9.2 months (min:2.9 and max:47.5). Sixteen (50%) received outpatient palliative care and 18 (56%) received hospice care. The analysis found wide variation in documentation about communication about diagnosis, prognosis, goals of care, stopping treatment, and starting hospice care. Challenges included escalating/severe symptoms, repeated urgent care/emergency department/hospital encounters, and lack of or late access to palliative and hospice care. Notes also illustrated how patient background and goals influenced care trajectory and communication. Documentation styles varied substantially, with palliative care notes more consistently documenting conversations about goals of care and psychosocial needs. Conclusion This analysis of longitudinal illness experience of women with advanced gynecological cancer suggests that clinicians may want to (1) prioritize earlier discussion about goals of care; (2) provide supplemental support to patients with higher needs, possibly through palliative care or navigation; and (3) write notes to enhance patient understanding now that patients may access all notes.

scholarly journals Medicaid Health Insurance Status Limits Patient Accessibility to Rehabilitation Services Following ACL Reconstruction Surgery

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876335 ◽  
Author(s):  
Miranda J. Rogers ◽  
Ian Penvose ◽  
Emily J. Curry ◽  
Anthony DeGiacomo ◽  
Xinning Li
Keyword(s):  
Health Insurance ◽  
Acl Reconstruction ◽  
Metropolitan Area ◽  
Private Insurance ◽  
The United States ◽  
The State ◽  
Median Income ◽  
Insurance Type ◽  
Insured Patients ◽  
Privately Insured

Background: In the senior author’s (X.L.) orthopaedic sports medicine clinic in the United States (US), patients appear to have difficulty finding physical therapy (PT) practices that accept Medicaid insurance for postoperative rehabilitation. Purpose: To determine access to PT services for privately insured patients versus those with Medicaid who underwent anterior cruciate ligament (ACL) reconstruction in the largest metropolitan area in the state of Massachusetts, which underwent Medicaid expansion as part of the Affordable Care Act. Study Design: Cross-sectional study. Methods: Locations offering PT services were identified through Google, Yelp, and Yellow Pages internet searches. Each practice was contacted and queried about health insurance type accepted (Medicaid [public] vs Blue Cross Blue Shield [private]) for postoperative ACL reconstruction rehabilitation. Additional data collection points included time to first appointment, reason for not accepting insurance, and ability to refer to a location accepting insurance type. Median income and percentage of households living in poverty were also noted through US Census data for the town in which the practice was located. Results: Of the 157 PT locations identified, contact was made with 139 to achieve a response rate of 88.5%. Overall, 96.4% of practices took private insurance, while 51.8% accepted Medicaid. Among those locations that did not accept Medicaid, only 29% were able to refer to a clinic that would accept it. “No contract” was the most common reason why Medicaid was not accepted (39.4%). Average time to first appointment was 5.8 days for privately insured patients versus 8.4 days for Medicaid patients ( P = .0001). There was no significant difference between clinic location (town median income or poverty level) and insurance type accepted. Conclusion: The study results reveal that 43% fewer PT clinics accept Medicaid as compared with private insurance for postoperative ACL reconstruction rehabilitation in a large metropolitan area. Furthermore, Medicaid patients must wait significantly longer for an initial appointment. Access to PT care is still limited despite the expansion of Medicaid insurance coverage to all patients in the state.

Disparities in Palliative Care in Patients With Cancer

2020 ◽  
Vol 38 (9) ◽  
pp. 974-979 ◽  
Author(s):  
Jennifer J. Griggs
Keyword(s):  
Palliative Care ◽  
Ethnic Minorities ◽  
The United States ◽  
Cross Sectional ◽  
Racial And Ethnic Minorities ◽  
Lower Socioeconomic ◽  
Optimal Health ◽  
Qualitative Work ◽  
Patient Groups ◽  
Interpersonal Barriers

In the United States, racial and ethnic minorities and people with lower socioeconomic status (SES) face structural, health system, and interpersonal barriers to optimal health care, including palliative care. Much of the available data on palliative care in racial and ethnic minorities and people with lower SES have identified disparities according to race, ethnicity, and SES. Limitations to understanding disparities in palliative care include the fact that much of the available data are cross-sectional, drawn from administrative or claims data, or based on qualitative work in limited geographic areas. To advance our knowledge and achieve health equity with respect to palliative care in patient groups that have been understudied or that are known to receive disparate care, gaining a deeper understanding of the barriers to palliative care is necessary from patients, families, referring providers, and communities. In addition, cultural competency training for all members of the palliative care team and referring providers needs to be changed from being obligatory to being intentional and assessed continuously. Finally, concerted changes in coordination of care, payment structures, and policy are needed.

scholarly journals Racial Disparity in Mortality Rates Among Black and White Americans with Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 5009-5009
Author(s):  
Oluwasegun Austine Akinyemi ◽  
Oluwaseun B Ogunbona ◽  
Faith O Abodunrin ◽  
Olanrewaju Oni
Keyword(s):  
Multiple Myeloma ◽  
Racial Disparity ◽  
Hematologic Malignancy ◽  
Private Insurance ◽  
The United States ◽  
Mortality Rates ◽  
Survival Outcomes ◽  
Control Group ◽  
Median Income ◽  
Income Quartile

Abstract Background: In the United States, Multiple myeloma (MM) is the second most common hematologic malignancy and the most common hematologic malignancy in blacks. It is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. Different studies have highlighted a racial disparity in survival outcomes between Blacks and Whites patients' population with MM. However, the reason for the observed racial disparity in survival outcomes is not clearly understood. Aim: To explore the role of socioeconomic variables including access to insurance and, median Income on the racial disparity in outcome among patients with MM. Method: We conducted a retrospective analysis of all hospitalizations associated with the primary diagnosis of MM in the National Inpatient Sample (NIS 2008-2014) database using the relevant International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study outcome was the mortality rates between black patients and a propensity score matched control group of white patients with MM. Result: There were 185,000 MM associated hospitalization in the NIS (2008-2014). Among the study population, 66.7% were whites, 20.8% were blacks, and 7.7% were Hispanics. The mean age was 66.5 years for blacks and 70.2years for whites. Among the Black population, 21.6% had private insurance compared to 25.1% of their White counterparts. Also, 45.6% of Black participants were in the lowest income quartile compared to only 19.6% of Whites. Only 13.5% of Blacks were in the highest income quartile compared to 28.7% of Whites. 73.4% of Blacks were on public insurance compared to 70.9% of Whites. There was no difference in the mortality rate between blacks and a control group of whites matched for insurance, median income, sex and age (49.4% vs 50.6%, p =0.42). Conclusion: Multiple myeloma may not be more deadly in Blacks compared to Whites, and the observed disparity in outcomes in the literature are likely due to the effects of social determinants of health such as income and access to insurance. Disclosures No relevant conflicts of interest to declare.

scholarly journals Medical Cannabis and Utilization of Nonhospice Palliative Care Services: Complements and Alternatives at End of Life

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
James A Croker ◽  
Julie Bobitt ◽  
Kanika Arora ◽  
Brian Kaskie
Keyword(s):  
Palliative Care ◽  
Military Service ◽  
Terminal Illness ◽  
Well Being ◽  
Ordinary Least Squares ◽  
Care Utilization ◽  
Medical Cannabis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Background and Objectives There is a need to know more about cannabis use among terminally diagnosed older adults, specifically whether it operates as a complement or alternative to palliative care. The objective is to explore differences among the terminal illness population within the Illinois Medical Cannabis Program (IMCP) by their use of palliative care. Research Design and Methods The study uses primary, cross-sectional survey data from 708 terminally diagnosed patients, residing in Illinois, and enrolled in the IMCP. We compared the sample on palliative care utilization through logistic regression models, examined associations between palliative care and self-reported outcome improvements using ordinary least squares regressions, and explored differences in average pain levels using independent t-tests. Results 115 of 708 terminally diagnosed IMCP participants were receiving palliative care. We find increased odds of palliative care utilization for cancer (odds ratio [OR] [SE] = 2.15 [0.53], p &lt; .01), low psychological well-being (OR [SE] = 1.97 [0.58], p &lt; .05), medical complexity (OR [SE] = 2.05 [0.70], p &lt; .05), and prior military service (OR [SE] = 2.01 [0.68], p &lt; .05). Palliative care utilization is positively associated with improvement ratings for pain (7.52 [3.41], p &lt; .05) and ability to manage health outcomes (8.29 [3.61], p &lt; .01). Concurrent use of cannabis and opioids is associated with higher pain levels at initiation of cannabis dosing (p &lt; .05). Discussion and Implications Our results suggest that cannabis is largely an alternative to palliative care for terminal patients. For those in palliative care, it is a therapeutic complement used at higher levels of pain.

scholarly journals Modes of Transportation to Medical and Primary Care Among Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 128-128
Author(s):  
Zainab Suntai ◽  
Kefentse Kubanga ◽  
Emmanuel Adanu ◽  
Abhay Lidbe
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Public Transportation ◽  
The United States ◽  
Older Adulthood ◽  
Post Secondary ◽  
Logistic Regression Models ◽  
Care Services ◽  
Lower Socioeconomic ◽  
Transportation Modes

Abstract Transportation is an increasingly meaningful concern for older adults as physical, cognitive, and psychological changes in older adulthood impact mobility and accessibility. While several studies have examined the modes of transportation used among older adults, few have explored specifically how older adults are accessing primary care/medical care services. As such, this study aimed to determine the specific modes of transportation used among older adults for primary care visits. Data were derived from the 2018 National Health and Aging Trends Study (NHATS), an annual longitudinal panel survey of older adults aged 65 and older living in the United States. Descriptive analyses were conducted to examine the prevalence of several modes of access and logistic regression models were used to predict the likelihood of using the two most prevalent transportation modes, based on sociodemographic and socioeconomic factors. Results showed that 70% of older adults drive themselves to their doctor, 34.8% rely on a family member, friend, or paid person, 2.4% have a home visit, 2.1% use public transportation, 1.5% walk to their doctor and 1.1% use a taxi. Additionally, having higher income, being of younger age, being White, and having post-secondary education was associated with driving oneself to the doctor. These results indicate that while most older adults are still self-reliant on transportation to medical providers, those with lower socioeconomic status are particularly at risk of losing driving independence. Transportation-related interventions should therefore consider targeting individuals with lower economic capital by proving financial assistance, ride-share programs, and other innovative approaches.

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