Who is at risk for palliative care misconceptions and how do we address them? A mixed-methods study of metastatic lung cancer patients.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 67-67
Author(s):  
Laurie McLouth ◽  
Jennifer Gabbard ◽  
Beverly J Levine ◽  
Chandylen L Nightingale ◽  
Kate Furgurson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
African American ◽  
Mixed Methods ◽  
Health Literacy ◽  
Cancer Patients ◽  
Mixed Methods Study ◽  
Lung Cancer Patients ◽  
Definition Of ◽  
Inadequate Health Literacy

67 Background: A major misperception of palliative care (PC) is that it is only for people who are about to die. We recently identified this misperception as a barrier to PC in metastatic non-small cell lung cancer (mNSCLC) patients, patients who should all receive early PC per guidelines. The goal of this study was to assess patient characteristics associated with misperceptions about PC and to elicit patient perspectives on how to address them. Methods: We conducted a mixed-methods study of mNSCLC patients on immunotherapy or chemo-immunotherapy. A survey assessed sociodemographics, health literacy, and PC misperceptions. Semi-structured interviews queried perceptions of PC, experiences discussing PC with providers, and reactions to our institutional definition of PC. Qualitative data from interviews were analyzed using directed content analysis approach. Results: Sixty patients (Mean age = 63, 40% male; 18% African American, 45% inadequate health literacy) completed the survey. Twelve of the survey participants (Mean age = 65, 50% male, 25% African American, 67% inadequate health literacy; 50% with caregivers participating) also completed a semi-structured interview. Quantitative survey results showed equating PC with death and/or hospice did not differ based on gender, health literacy, rural vs. urban residence, or time since diagnosis (p’s > .05). Qualitative results showed patients and caregivers consistently associated PC with death (e.g., “the next step to the graveyard”) and hospice. Though some patients noted differences between our institution’s definition of PC and their perceptions (e.g., “delivered at any stage”), the definition did not increase interest and sometimes reinforced misperceptions (e.g., “See, that's a death spiral”). To address misconceptions, patients and caregivers suggested distinguishing PC from end of life and hospice, presenting it positively, and discussing it early into treatment. Conclusions: Lung cancer patients may associate PC with death even if they have adequate health literacy. Commonly used definitions of PC may not quell patient fears. PC needs to be presented as a positive service to patients early into treatment.

OP456 Encouraging Shared Decision-Making Of Goals Of Care Discussions In Lung Cancer Patients Using A Smartphone Application

2021 ◽  
Vol 37 (S1) ◽  
pp. 17-17
Author(s):  
Amanda Lovato ◽  
Nisha Almeida
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Focus Groups ◽  
End Of Life ◽  
Cancer Patients ◽  
Smartphone Application ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Goals Of Care ◽  
Lung Cancer Patients

IntroductionAn important reason for receiving non-beneficial treatment at end-of life is the lack of timely discussions on goals of care and end-of-life preferences. A recent randomized clinical trial demonstrated that patients primed with a questionnaire on their end-of-life preferences were more likely to initiate such conversations with their doctors. Our objective is to integrate the questionnaire into a smartphone application to facilitate early goals of care discussions. To achieve this goal, we first plan to undertake a feasibility study to understand stakeholder preferences.MethodsAs part of a quality improvement initiative at our Canadian quaternary-care hospital, we conducted focus groups with oncology and palliative care physicians and patients to understand barriers to early conversations on end-of-life preferences, and to assess feasibility of using smartphone technology in facilitating these conversations. The app would integrate a questionnaire to patients and send prompts to physicians on patient readiness and timing of conversations.ResultsWe conducted separate focus groups with lung cancer patients (n = 6) and clinicians in oncology (n = 6) and palliative care (n = 6). Clinical teams expressed enthusiasm about early conversations but raised several barriers including system (lack of electronic documentation and access to data; multiple physicians), clinician (lack of time) and patient (stigma associated with end-of-life) barriers. Clinicians agreed that an app could overcome some of these barriers such as access to patient and electronic data by making patients the repository of all their data and empowering them to initiate discussions. However, they raised concerns about universal accessibility of such technology, especially among the elderly. Patient focus groups will take place in March 2021 and inform us on feasibility in this population.ConclusionsThere is a consensus among physicians at our hospital that early end-of-life conversations have the potential to mitigate adverse events and that use of a smart phone app could facilitate such conversations.

A comparison of liver cancer and lung cancer patients at two Veteran Affairs Medical Centers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21642-e21642
Author(s):  
Sejal Kothadia ◽  
Zhen Wang ◽  
Sarah Lee ◽  
Victor Tsu-Shih Chang ◽  
Yucai Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Liver Cancer ◽  
Cancer Patients ◽  
Care Service ◽  
Palliative Care Service ◽  
Pooled Analysis ◽  
Lung Cancer Patients ◽  
Medical Centers ◽  
Symptom Prevalence

e21642 Background: Little is known about palliative care for liver cancer. In this study, we examined palliative care for liver cancer and lung cancer patients. Methods: In an IRB approved protocol, we reviewed medical records of patients diagnosed with liver cancer who were seen by the palliative care service between 2006 and 2012 at 2 VA medical centers, and matched them to patients with lung cancer by year, KPS, and stage. Veterans were compared by symptom prevalence with the CMSAS and by palliative care interventions. Statistical analyses were performed with SAS Studio Version 3.5. Results: We analyzed a total of 138 male patients at 2 VA centers; 69 with lung cancer and 69 with liver cancer. The mean age in both groups was 65 years and 60% of patients self-identified as a minority. There was a high prevalence of symptoms in both groups. Symptom prevalence differed significantly between liver and lung cancer pts for weight loss and dyspnea at one site, and for feeling drowsy, constipation, at the other site. These differences disappeared in a pooled analysis. During palliative care evaluation, more lung cancer patients received treatment for constipation (n = 44 in lung, 29 in liver, p = 0.0107) and dyspnea treatment (n = 37 in lung, 22 in liver, p = 0.0167). More patients with lung cancer were evaluated by physical therapy (n = 41 in lung, n = 28 in liver, p = 0.0276) and psychiatry (n = 31 in lung, n = 20 in liver, p = 0.032). Conclusions: Differences between lung and liver cancer patients’ symptom prevalence and treatment by palliative care can vary by site. This reinforces the importance of local surveys of symptom prevalence . Further studies should be replicated in other sites.

Early proactive referral identifies lung cancer patients with significant palliative care needs

Lung Cancer ◽  
2019 ◽  
Vol 127 ◽  
pp. S87
Author(s):  
J. Droney ◽  
Y. Kano ◽  
J. Nevin ◽  
L. Kamal ◽  
A. Kennett ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Care Needs ◽  
Lung Cancer Patients ◽  
Palliative Care Needs

scholarly journals 4355 Impact of Demographic & Racial Differences on DNA Repair Capacity in Lung Cancer

2020 ◽  
Vol 4 (s1) ◽  
pp. 137-137
Author(s):  
Francesca Christina Duncan ◽  
Catherine Sears ◽  
Nawar Al Narallah ◽  
Ahmad Al-Hader
Keyword(s):  
Lung Cancer ◽  
Dna Repair ◽  
African American ◽  
African Americans ◽  
Environmental Factors ◽  
Cancer Patients ◽  
Repair Capacity ◽  
Men And Women ◽  
Lung Cancer Patients ◽  
Dna Repair Capacity

OBJECTIVES/GOALS: Lung cancer is the leading cause of cancer-related mortality in the United States for both men and women. African Americans are disproportionately affected with lung cancer, having higher incidence and mortality rates compared to Caucasian men and women. African American smokers are diagnosed with lung cancer at a lower age with lower cumulative smoking history. Differences in socioeconomic and environmental factors likely contribute to lung cancer disparities, but less is known about acquired biologic alterations that can promote initiation and progression of lung cancer, particularly in African Americans. This is of interest because there may be other biological, genetic, or environmental factors contributing to lung cancer outcomes as it relates to differences in gender and race. One potential biologic variable may be in the DNA repair capacity (DRC), which describes a cell’s ability to repair damage to DNA caused by carcinogens, oxidants, and radiation. Altered DNA repair is a hallmark of cancer, leading to mutations and malignant transformation. We hypothesize that DRC is decreased in African Americans with lung cancer compared to Caucasian Americans with lung cancer, contributing to the disparity that exists in this racial group. We will 1) perform a retrospective chart review to determine demographic differences between African Americans and Caucasians at three central Indiana hospitals and 2) determine the impact of race and lung cancer on DRC amongst African Americans and Caucasians with and without lung cancer. METHODS/STUDY POPULATION: Lung cancer patients are identified in 3 central Indiana hospitals with different payer source and patient populations using ICD codes. Collected demographics include age, gender, pack-years, lung cancer histology, treatment, and mortality. DRC is measured by host-cell reactivation (non-homologous end-joining and nucleotide excision repair pathways) by flow-cytometry. Measurement of DRC is performed on PBMCs obtained from 120 patients (male and female, African Americans and Caucasians with and without lung cancer). Correlation of DRC and lung cancer will be determined by comparing lung cancer diagnosis to quartile DRC, and adjusted for confounders (measured demographics). Correlative measures will include measures of DNA damage and genomic instability. RESULTS/ANTICIPATED RESULTS: 3450 lung cancer patients were diagnosed with lung cancer at Indiana University Hospital between 1/1/2000 – 5/31/2015. Of these, 48.2% were female and 92.7% smokers. African Americans, Caucasians and Other ethnicities represented 12%, 86% and 2%, respectively. Of smokers, 11.4% were African American. The primary payer source was Federal/Medicare. Retrospective review of lung cancer patients from two additional health systems (county and VA hospitals) will be performed as above with outcomes measured. DRC and additional correlative measures will be performed as in Methods. DISCUSSION/SIGNIFICANCE OF IMPACT: If present, altered DRC in African Americans compared to Caucasians may contribute to the disproportional impact of lung cancer on African Americans. If DRC is decreased in African Americans with lung cancer, future studies will focus on identifying potential genetic, epigenetic and environmental causes for this decrease.

Gaps in supportive and survivorship care for lung cancer patients.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 32-32
Author(s):  
Tara Perloff ◽  
Jennifer C. King ◽  
Maureen Rigney
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Palliative Care ◽  
Cancer Patients ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Team ◽  
Care Planning ◽  
Survivorship Care ◽  
Lung Cancer Patients

32 Background: Clinical guidelines increasingly recommend an expansion of multidisciplinary care for oncology patients to include supportive and survivorship care. Despite recommendations, lung cancer patients may not access these services due to implementation challenges among health care delivery systems. Our study goal was to assess treatment and care planning from the perspectives of lung cancer patients and caregivers. Methods: A Community Needs Assessment survey was electronically distributed to lung cancer patients and caregivers. 820 people responded, including 471 patients and 349 caregivers. The overall completion rate was 72.6%. The survey assessed the patient’s care team, values-based discussions in care planning, discussions regarding palliative care, and survivorship care planning. Demographic information was collected to determine if patterns of care correlated with geographical or socioeconomic factors. Results: Less than 50% of patients reported having a conversation about their values and care goals with their treatment team before determining their treatment plan. Less than 30% of patients reported a mental health professional, social worker, palliative care specialist, or nurse navigator as part of their care team. Although research shows a survival benefit to lung cancer patients receiving palliative care, only 26.9% of active patients had discussed palliative care and 20.13% reported receiving it. For caregiver reported data, the patients receiving care had more advanced cancer and had often not survived. Of those who had completed treatment and survived more than 5 years beyond diagnosis, only 22% of patients and 15% of caregivers reported having a survivorship care plan. Conclusions: The majority of lung cancer patients and caregivers reported having not received palliative care, survivorship care plans, psychosocial support, or values-based discussions with their oncologist. Respondents were technology enabled and generally health literate indicating that these problems could be more widespread in rural, lower socioeconomic areas where lung cancer is common. Addressing these problems in health care delivery could positively impact the survivorship of lung cancer patients and their families.

1547 Interdisciplinary palliative care for lung cancer patients and family caregivers

2015 ◽  
Vol 51 ◽  
pp. S220
Author(s):  
M. Koczywas ◽  
V. Sun ◽  
A. Hurria ◽  
M. Cristea ◽  
D.J. Raz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Lung Cancer Patients
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