Quality improvements in palliative radiotherapy at end of life: The FutRE Study.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 306-306
Author(s):  
Siddhartha Goutam ◽  
Jordan Mark Stosky ◽  
Jackson S.Y. Wu ◽  
Alysa M. Fairchild ◽  
Marc Kerba
Keyword(s):  
End Of Life ◽  
Patient Survival ◽  
Palliative Radiotherapy ◽  
Treatment Decision ◽  
Quality Improvements ◽  
Treatment Decision Making ◽  
Patients With Cancer ◽  
Palliative Radiation Therapy ◽  
Treatment Intent ◽  
Death Data

306 Background: Palliative radiation therapy (RT) is offered to patients with cancer for symptom management. RT planning and delivery is resource intensive. Benefits may take weeks to develop. Palliative RT at the end of life may not be completed due to patient and disease factors. RT courses that are not completed may indicate a need for improved patient selection for RT and choice of RT prescription, minimizing the likelihood of delivering futile treatment. Methods: The FUTile Radiotherapy at End of life survey was implemented in the electronic RT workspace across Alberta in 2018. Radiation oncologists (ROs) were tasked with survey completion, at the time of palliative RT prescription approval, as part of their workflow on domains pertaining to patient and treatment decision-making. This survey data was linked to the cancer registry and date of death. Data association were examined among patients completing RT within 90 days of death for the accuracy of oncologist’s provided survival prognostication estimates, number of RT fractions prescribed, number of RT fractions completed, prescribing physician, including disease factors and treatment intent. Results were explored using descriptive statistics and tests of associations (STATA 11.1) Results: 1963 RT surveys were included in our analysis. Prescribing ROs overestimated patient survival 67% of the time, by a mean of 145 days, and underestimated survival 12% of the time by a mean of 109 days. Multi-fraction RT (1403 courses) was more frequently prescribed over single fraction (SF) RT (560 courses)(one-sample t-test, p≤0.001). SF treatments were more likely to be completed than MF treatments (RR = 10.3, 95% CI = [4.85, 21.7], p < 0.0001). Treatments were less likely to be completed when survival was overestimated by 6 or more months and were over twice as likely to be completed than when patient survival was underestimated (RR = 2.6, 95% CI = [1.04, 6.50], p = 0.04). Conclusions: Survival among end of life patients is overestimated by ROs prescribing palliative MF RT treatments.

scholarly journals Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer

2021 ◽  
pp. 1-8
Author(s):  
Chetna Malhotra ◽  
Rahul Malhotra ◽  
Filipinas Bundoc ◽  
Irene Teo ◽  
Semra Ozdemir ◽  
...  
Keyword(s):  
End Of Life ◽  
Odds Ratio ◽  
Healthcare Costs ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Comprehensive Understanding ◽  
Patients With Cancer ◽  
Multivariable Models ◽  
Hospital Days ◽  
Death Data

Background: Reducing suffering at the end of life is important. Doing so requires a comprehensive understanding of the course of suffering for patients with cancer during their last year of life. This study describes trajectories of psychological, spiritual, physical, and functional suffering in the last year of life among patients with a solid metastatic cancer. Patients and Methods: We conducted a prospective cohort study of 600 patients with a solid metastatic cancer between July 2016 and December 2019 in Singapore. We assessed patients’ psychological, spiritual, physical, and functional suffering every 3 months until death. Data from the last year of life of 345 decedents were analyzed. We used group-based multitrajectory modeling to delineate trajectories of suffering during the last year of a patient’s life. Results: We identified 5 trajectories representing suffering: (1) persistently low (47% of the sample); (2) slowly increasing (14%); (3) predominantly spiritual (21%); (4) rapidly increasing (12%); and (5) persistently high (6%). Compared with patients with primary or less education, those with secondary (high school) (odds ratio [OR], 3.49; 95% CI, 1.05–11.59) education were more likely to have rapidly increasing versus persistently low suffering. In multivariable models adjusting for potential confounders, compared with patients with persistently low suffering, those with rapidly increasing suffering had more hospital admissions (β=0.24; 95% CI, 0.00–0.47) and hospital days (β=0.40; 95% CI, 0.04–0.75) during the last year of life. Those with persistently high suffering had more hospital days (β=0.70; 95% CI, 0.23–1.17). Conclusions: The course of suffering during the last year of life among patients with cancer is variable and related to patients’ hospitalizations. Understanding this variation can facilitate clinical decisions to minimize suffering and reduce healthcare costs at the end of life.

scholarly journals Patients' Preferences for Participation in Treatment Decision-Making at the End of Life: Qualitative Interviews with Advanced Cancer Patients

PLoS ONE ◽  
2014 ◽  
Vol 9 (6) ◽  
pp. e100435 ◽  
Author(s):  
Linda Brom ◽  
H. Roeline W. Pasman ◽  
Guy A. M. Widdershoven ◽  
Maurice J. D. L. van der Vorst ◽  
Jaap C. Reijneveld ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Qualitative Interviews ◽  
Treatment Decision ◽  
Advanced Cancer Patients ◽  
Treatment Decision Making

scholarly journals The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies

2016 ◽  
pp. 185-198 ◽  
Author(s):  
Joseph M. Unger ◽  
Elise Cook ◽  
Eric Tai ◽  
Archie Bleyer
Keyword(s):  
Clinical Trial ◽  
Age Groups ◽  
Treatment Decision ◽  
Cancer Clinical Trial ◽  
Trial Participation ◽  
Treatment Decision Making ◽  
Patients With Cancer ◽  
Global And Local ◽  
To Receive

Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.

The Influence of Patient and Provider Religious and Spiritual Beliefs on Treatment Decision Making in the Cancer Care Context

2021 ◽  
pp. 0272989X2110222
Author(s):  
Elizabeth Palmer Kelly ◽  
Brian Myers ◽  
Brent Henderson ◽  
Petra Sprik ◽  
Kelsey B. White ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Treatment Decision ◽  
Care Planning ◽  
Care Providers ◽  
Treatment Decision Making ◽  
Advance Care ◽  
The Impact

Background Providers often underestimate the influence of patient religious and spiritual (R&S) needs. The current study sought to determine the influence of R&S beliefs on treatment decision making among patients and providers in the context of cancer care. Methods We conducted a systematic review of the literature using web-based search engines and discipline-specific databases. Search terms included a combination of the following Medical Subject Headings and key terms: “cancer,”“spirituality,”“religion,” and “decision making.” We used Covidence to screen relevant studies and extracted data into Microsoft Excel. Results Among 311 screened studies, 32 met inclusion/exclusion criteria. Most studies evaluated the patient perspective ( n = 29), while 2 studies evaluated the provider perspective and 1 study examined both. In assessing patient R&S relative to treatment decision making, we thematically characterized articles according to decision-making contexts, including general ( n = 11), end-of-life/advance care planning ( n = 13), and other: specific ( n = 8). Specific contexts included, but were not limited to, clinical trial participation ( n = 2) and use of complementary and alternative medicine ( n = 4). Within end-of-life/advance care planning, there was a discrepancy regarding how R&S influenced treatment decision making. The influence of R&S on general treatment decision making was both active and passive, with some patients wanting more direct integration of their R&S beliefs in treatment decision making. In contrast, other patients were less aware of indirect R&S influences. Patient perception of the impact of R&S on treatment decision making varied relative to race/ethnicity, being more pronounced among Black patients. Conclusion Most articles focused on R&S relative to treatment decision making at the end of life, even though R&S appeared important across the care continuum. To improve patient-centered cancer care, providers need to be more aware of the impact of R&S on treatment decision making.

Treatment decision‐making at the end of life: a survey of Australian doctors' attitudes towards patients' wishes and euthanasia

1996 ◽  
Vol 165 (10) ◽  
pp. 540-544 ◽  
Author(s):  
Charles Waddell ◽  
Roger M Clarnette ◽  
Michael Smithy ◽  
Lynn Oldham ◽  
Allan Kellehear
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
Patients Wishes
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