Cultural disparities in end-of-life choices and advanced care planning in cancer patients.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 3-3
Author(s):  
Vatsala Katiyar ◽  
Ishaan Vohra ◽  
Sindhu Janarthanam Malapati ◽  
Sunny Singh ◽  
Prasanth Lingamaneni ◽  
...  
Keyword(s):  
Palliative Care ◽  
African American ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Situation ◽  
Safety Net ◽  
Life Care ◽  
Caucasian American ◽  
Safety Net Hospital ◽  
Hispanic Patients

3 Background: Integration of palliative care early in treatment of malignancy improves quality of life and curbs non-beneficial end of life care. However, there are differences in utilization of palliative services based on cultural background. We aim to identify such differences in a safety net hospital with adiverse patient population. Methods: This is a single institution retrospective study of adults with cancer who had inpatient palliative care encounter (PCE) between 2012-2017. A representative sample of 130 patients from 7 major ethnicities was included. Statistical analysis was performed using STATA. Results: Only 8.4% of all patients had a preceding outpatient PCE. Very few patients had advance directives prior to PCE (range 0-30% for individual ethnicities). As a reflection of their challenging social situation, 5.3% were homeless, 76.1% lived in someone else’s home, <10% had English as primary language (except Caucasian American and African American.) Healthcare utilization in the last 3 months of life varied widely between groups- maximum was in African American and Hispanic patients with ≥3 emergency room visits in 30% and 25% respectively. Table with time to important endpoints and setting of death is attached. Conclusions: Palliative service was involved very late in care, with most having significant challenges to complex care discussions including lack of social support and language barrier. Setting of death (ICU versus home) varied by ethnicity, and some groups had high utilization of aggressive end of life care. Understanding the underlying cultural intricacies leading to these choices will help physicians better navigate care and should be a future focus of study. [Table: see text]

scholarly journals An Examination of End-of-Life Care in a Safety Net Hospital System: A Decade in Review

2013 ◽  
Vol 24 (4) ◽  
pp. 1666-1675 ◽  
Author(s):  
Ramona L. Rhodes ◽  
Lei Xuan ◽  
M. Elizabeth Paulk ◽  
Heather Stieglitz ◽  
Ethan A. Halm
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Safety Net ◽  
Life Care ◽  
Hospital System ◽  
System A ◽  
Safety Net Hospital

Abstract C004: End-of-life care in patients with advanced cancer in an urban safety net hospital

2020 ◽  
Author(s):  
Vina P Nguyen ◽  
Kate Festa ◽  
Minda Gowarty ◽  
Shabatun Islam ◽  
Gregory J Patts ◽  
...  
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Safety Net ◽  
Life Care ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract 12 Assessing the Quality of End-of-Life Care for Patients With End-Stage Liver Disease in a Safety-Net Hospital

2017 ◽  
Vol 153 (2) ◽  
pp. 592
Author(s):  
Zachary P. Fricker ◽  
Anna M. Leszczynski ◽  
Katherine T. Brunner ◽  
Reid Hopkins ◽  
Harini Naidu ◽  
...  
Keyword(s):  
Liver Disease ◽  
End Of Life ◽  
End Of Life Care ◽  
Safety Net ◽  
Life Care ◽  
End Stage Liver Disease ◽  
Safety Net Hospital ◽  
End Stage

scholarly journals The Desires of Their Hearts: The Multidisciplinary Perspectives of African Americans on End-of-Life Care in the African American Community

2016 ◽  
Vol 34 (6) ◽  
pp. 510-517 ◽  
Author(s):  
Ramona L. Rhodes ◽  
Bryan Elwood ◽  
Simon C. Lee ◽  
Jasmin A. Tiro ◽  
Ethan A. Halm ◽  
...  
Keyword(s):  
Palliative Care ◽  
African American ◽  
African Americans ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Advance Care ◽  
Culturally Sensitive Intervention

Background: Studies have identified racial differences in advance care planning and use of hospice for care at the end of life. Multiple reasons for underuse among African American patients and their families have been proposed and deserve further exploration. Objective: The goal of this study was to examine perceptions of advance care planning, palliative care, and hospice among a diverse sample of African Americans with varying degrees of personal and professional experience with end-of-life care and use these responses to inform a culturally sensitive intervention to promote awareness of these options. Methods: Semistructured interviews and focus groups were conducted with African Americans who had varying degrees of experience and exposure to end-of-life care both personally and professionally. We conducted in-depth qualitative analyses of these interviews and focus group transcripts and determined that thematic saturation had been achieved. Results: Several themes emerged. Participants felt that advance care planning, palliative care, and hospice can be beneficial to African American patients and their families but identified specific barriers to completion of advance directives and hospice enrollment, including lack of knowledge, fear that these measures may hasten death or cause providers to deliver inadequate care, and perceived conflict with patients’ faith and religious beliefs. Providers described approaches they use to address these barriers in their practices. Conclusion: Findings, which are consistent with and further elucidate those identified from previous research, will inform design of a culturally sensitive intervention to increase awareness and understanding of advance care planning, palliative care, and hospice among members of the African American community.

Health care utilization and patient-related outcomes in patients with malignant bowel obstruction admitted to a United States safety net hospital.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 50-50
Author(s):  
Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar Mukthinuthalapati ◽  
Aakash Putta ◽  
Ishaan Vohra ◽  
Vatsala Katiyar ◽  
Krishna Moturi ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Surgical Management ◽  
End Of Life Care ◽  
Safety Net ◽  
Care Utilization ◽  
Life Care ◽  
Malignant Bowel Obstruction ◽  
Safety Net Hospital

50 Background: Malignant bowel obstruction (MBO) and gastric outlet obstruction (GOO) can be a late complication of intra-abdominal malignancy with a poor prognosis. Most studies about its outcomes have focused on survival. There is paucity of studies assessing health care utilization and end of life care decisions. Methods: We retrospectively collected data from the electronic medical record of patients admitted with MBO or GOO at a safety-net hospital in Chicago, US between January 2013 and December 2017. The charts were analyzed for outcomes related to end of life care and health care utilization. The outcomes were compared by across three broad treatment arms: those that received surgical intervention, those that received venting gastrostomy (VG) and those that were treated medically alone. Results: Forty-six patients were identified of which 31 were admitted with MBO. 25 (54%) of them were due to stage IV cancers. Mean age of study population was 61 years. Surgical management, VG and medical management were done in 17, 8 and 21 patients respectively. There was no difference in ICU admission rate, length of stay of index admission, 90 day-readmission rate or mean visits to the ER between the groups. Patients receiving venting gastrostomy tube had highest rate of oral solid food tolerability. Twenty-eight patients died or were enrolled in hospice within a median of 115 days. Conclusions: All modalities of treatment had similar health utilization measures in patients with MBO and GOO. Surgical management, if feasible, has the longest time to hospice enrollment or death and should be offered to patients who are suitable. [Table: see text]

Assessing the Quality of End of Life Care for Patients with End Stage Liver Disease in a Safety-Net Hospital

2017 ◽  
Vol 152 (5) ◽  
pp. S97
Author(s):  
Zachary P. Fricker ◽  
Anna M. Leszczynski ◽  
Katherine T. Brunner ◽  
Reid Hopkins ◽  
Harini Naidu ◽  
...  
Keyword(s):  
Liver Disease ◽  
End Of Life ◽  
End Of Life Care ◽  
Safety Net ◽  
Life Care ◽  
End Stage Liver Disease ◽  
Safety Net Hospital ◽  
End Stage

scholarly journals Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-752
Author(s):  
Joan Carpenter ◽  
Winifred Scott ◽  
Mary Ersek ◽  
Cari Levy ◽  
Jennifer Cohen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Multivariate Logistic Regression ◽  
Comfort Care ◽  
Lower Odds ◽  
Medicare Data ◽  
Life Sustaining Treatment

Abstract This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).

Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

2021 ◽  
pp. 104990912110107
Author(s):  
Kate L. M. Hinrichs ◽  
Cindy B. Woolverton ◽  
Jordana L. Meyerson
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Psychosocial Support ◽  
Life Care ◽  
Case Examples ◽  
Increased Risk ◽  
Palliative Care Teams

Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses—Bipolar Disorders, Major Depressive Disorder, and Schizophrenia—are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.

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