Integration of palliative care into the inpatient oncology service.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 46-46
Author(s):  
Sasha Waldstein ◽  
Benjamin Smith ◽  
J. Chris Nunnink
Keyword(s):  
Palliative Care ◽  
Medical Center ◽  
Symptom Control ◽  
Inpatient Setting ◽  
Readmission Rates ◽  
Advanced Malignancy ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Significant Difference ◽  
Care Consultation

46 Background: Research has demonstrated that early palliative care involvement for patients with advanced cancer has multiple benefits, including improved symptom control/quality of life and reduced readmission rates. Based on this data, the American Society of Clinical Oncology (ASCO) has developed guidelines for early palliative care consultation. At the University of Vermont Medical Center, historically 40% of such patients were evaluated by palliative care during hospital admission. The purpose of this study was to better integrate palliative care into the oncology inpatient setting through the use of a standardized admission template. Methods: A specific oncology H&P template, with inclusion of a drop down menu of ASCO based criteria for palliative care consultation, was created. Providers were educated on template use, and data then were collected for oncology admissions from 2/1-8/31/2018 regarding template usage, if criteria was met for palliative care consultation, and whether consultation occurred. Additionally, 30 day post discharge ED visits and readmissions were recorded, extending data collection for this purpose to 9/30/2018. Results: There were 372 medical oncology admissions during the studied time period, with 284 individual patients. The template was used for 95 (26%) admissions. 267 of those patients admitted qualified for palliative care consultation and, of those in which the template was used, 72% had palliative care consulted versus 50% without the template (p= 0.0013). There was no statistically significant difference in readmission rates between those with palliative care consultation and without. Conclusions: Early palliative care consultation for patients with advanced malignancy has been shown to have multiple benefits on an individual and system-wide basis. It was shown in this study that, though the created template was used for a minority of admissions, with template use a significantly greater proportion of appropriate patients had palliative care consulted. This suggests that, with more widespread practice, this strategy could further promote inpatient palliative care involvement for appropriate oncology patients.

scholarly journals Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists

2017 ◽  
Vol 13 (9) ◽  
pp. e703-e711 ◽  
Author(s):  
Alexandre Buckley de Meritens ◽  
Benjamin Margolis ◽  
Craig Blinderman ◽  
Holly G. Prigerson ◽  
Paul K. Maciejewski ◽  
...  
Keyword(s):  
Palliative Care ◽  
Practice Patterns ◽  
Medical Center ◽  
Symptom Control ◽  
Gynecologic Oncology ◽  
Academic Medical Center ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Palliative Care Services ◽  
Care Consultation

Purpose: We sought to describe practice patterns, attitudes, and barriers to the integration of palliative care services by gynecologic oncologists. Methods: Members of the Society of Gynecologic Oncology were electronically surveyed regarding their practice of incorporating palliative care services and to identify barriers for consultation. Descriptive statistics were used, and two-sample z-tests of proportions were performed to compare responses to related questions. Results: Of the 145 respondents, 71% were attending physicians and 58% worked at an academic medical center. The vast majority (92%) had palliative care services available for consultation at their hospital; 48% thought that palliative care services were appropriately used, 51% thought they were underused, and 1% thought they were overused. Thirty percent of respondents thought that palliative care services should be incorporated at first recurrence, whereas 42% thought palliative care should be incorporated when prognosis for life expectancy is ≤ 6 months. Most participants (75%) responded that palliative care consultation is reasonable for symptom control at any stage of disease. Respondents were most likely to consult palliative care services for pain control (53%) and other symptoms (63%). Eighty-three percent of respondents thought that communicating prognosis is the primary team’s responsibility, whereas the responsibilities for pain and symptom control, resuscitation status, and goals of care discussions were split between the primary team only and both teams. The main barrier for consulting palliative care services was the concern that patients and families would feel abandoned by the primary oncologist (73%). Ninety-seven percent of respondents answered that palliative care services are useful to improve patient care. Conclusion: The majority of gynecologic oncologists perceived palliative care as a useful collaboration that is underused. Fear of perceived abandonment by the patient and family members was identified as a significant barrier to palliative care consult.

Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

2021 ◽  
Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Quality Improvement Initiative ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (<72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived >24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

Differential Utilization of Palliative Care Consultation Between Medical and Surgical Services

2019 ◽  
Vol 37 (4) ◽  
pp. 250-257 ◽  
Author(s):  
Minh-Thuy Nguyen ◽  
Timothy Feeney ◽  
Chanmin Kim ◽  
F. Thurston Drake ◽  
Suzanne E. Mitchell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Providers ◽  
Medical Center ◽  
Bayesian Regression ◽  
Median Income ◽  
Medical Specialties ◽  
Surgical Services ◽  
Palliative Care Consultation ◽  
Credible Intervals ◽  
Care Consultation

There is a paucity of data regarding the utilization of palliative care consultation (PCC) in surgical specialties. We conducted a retrospective review of 2321 adult patients (age ≥18) who died within 6 months of admission to Boston Medical Center from 2012 to 2017. Patients were included for analysis if their length of stay was more than 48 hours and if, based on their diagnoses as determined by literature review and expert consensus, they would have benefited from PCC. Bayesian regression was used to estimate the odds ratio (OR) and 99% credible intervals (CrI) of receiving PCC adjusted for age, sex, race, insurance status, median income, and comorbidity status. Among the 739 patients who fit the inclusion criteria, only 30% (n = 222) received PCC even though 664 (90%) and 75 (10%) of these patients were identified as warranting PCC on medical and surgical services, respectively. Of the 222 patients who received PCC, 214 (96%) were cared for by medical services and 8 (4%) were cared for by surgical services. Patients cared for primarily by surgical were significantly less likely to receive PCC than primary patients of medical service providers (OR, 0.19, 99% CrI, 0.056-0.48). At our institution, many surgical patients appropriate for PCC are unable to benefit from this service due to low consultation numbers. Further investigation is warranted to examine if this phenomenon is observed at other institutions, elucidate the reasons for this disparity, and develop interventions to increase the appropriate use of PCC throughout all medical specialties.

scholarly journals Navigating Tensions: Integrating Palliative Care Consultation Services Into an Academic Medical Center Setting

2011 ◽  
Vol 42 (5) ◽  
pp. 680-690 ◽  
Author(s):  
Sally A. Norton ◽  
Bethel Ann Powers ◽  
Madeline H. Schmitt ◽  
Maureen Metzger ◽  
Eileen Fairbanks ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Palliative Care Consultation ◽  
Academic Medical ◽  
Care Consultation ◽  
Consultation Services

The effect of early palliative care consultation for survival in patients with unresectable pancreatic cancer.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 131-131
Author(s):  
Kazuhiro Kosugi ◽  
Fumio Omata ◽  
Yoshiyuki Fujita ◽  
Akitoshi Hayashi
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Rank Test ◽  
Unresectable Pancreatic Cancer ◽  
Poor Prognostic Factor ◽  
Early Palliative Care ◽  
Ajcc Stage ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Basic Characteristics

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]

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