Patient-reported symptom profiles: A tool to direct palliative care referral.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 93-93
Author(s):  
Tara L. Kaufmann ◽  
Jesse Y. Hsu ◽  
Kelly D. Getz ◽  
Arif Kamal ◽  
Angela DeMichele
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Multinomial Logistic Regression ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Symptom Profile ◽  
Existential Distress ◽  
Patient Reported

93 Background: Both routine PRO monitoring and specialty palliative care are associated with a survival benefit in advanced cancer patients, yet the integration of these efforts has not been described. As PRO collection becomes standard of care, there is a need to understand how PROs may be leveraged to identify patients who could benefit from palliative care referral. Methods: We applied latent profile analysis (LPA) to PROs from a national palliative care registry collected from 2008 – 2017 on 745 solid tumor patients at the time of initial outpatient palliative care visit. LPA is an established method to identify unobserved groups from variables of interest. We used patients’ responses to 11 questions across 4 palliative care domains (9 ESAS items and 2 items for social and existential distress) to generate “PRO profiles” and examined their clinical and demographic correlates using multinomial logistic regression. Results: Four PRO profiles were identified using 9 ESAS items (Table). Young age, metastatic disease, and tumor type (including breast, GYN, GI) differed across PRO profiles compared to lung. Patients with PPS < 70% were 4.5 times more likely to be in the High vs. Low symptom profile compared to those with PPS > 70%. Subgroup analyses showed correlation of social and existential distress PROs with Mood and High profiles. Conclusions: Cancer patients referred to outpatient palliative care can be differentiated into clinically meaningful PRO profiles using brief, routinely collected data in the real-world setting. PRO profiles provide richer data on patient needs compared to prognosis estimates or cancer stage, and synthesize big data for use in clinical practice and epidemiologic research. PRO profiles should include comprehensive palliative domains and be tested as screening thresholds for palliative care referral. [Table: see text]

scholarly journals Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

2021 ◽  
pp. 104990912098696
Author(s):  
Livia Costa de Oliveira ◽  
Karla Santos da Costa Rosa ◽  
Ana Luísa Durante ◽  
Luciana de Oliveira Ramadas Rodrigues ◽  
Daianny Arrais de Oliveira da Cunha ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Factors Associated ◽  
Reactive Protein

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

scholarly journals Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis

2020 ◽  
Vol 9 (6) ◽  
pp. 1960
Author(s):  
Maria Isabel Carrasco-Zafra ◽  
Rafael Gómez-García ◽  
Ricardo Ocaña-Riola ◽  
Maria Luisa Martín-Roselló ◽  
Encarnación Blanco-Reina
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Multinomial Logistic Regression ◽  
Performance Status ◽  
Current Treatment ◽  
Advanced Cancer Patients ◽  
Multinomial Logistic Regression Analysis ◽  
Logistic Analysis ◽  
High Level ◽  
The Impact

The current treatment approach for patients in palliative care (PC) requires a health model based on shared and individualised care, according to the degree of complexity encountered. The aims of this study were to describe the levels of complexity that may be present, to determine their most prevalent elements and to identify factors that may be related to palliative complexity in advanced-stage cancer patients. An observational retrospective study was performed of patients attended to at the Cudeca Hospice. Socio-demographic and clinical data were compiled, together with information on the patients’ functional and performance status (according to the Palliative Performance Scale (PPS)). The level of complexity was determined by the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal©) and classified as highly complex, complex or non-complex. The impact of the independent variables on PC complexity was assessed by multinomial logistic regression analysis. Of the 501 patients studied, 44.8% presented a situation classed as highly complex and another 44% were considered complex. The highly complex items most frequently observed were the absence or insufficiency of family support and/or caregivers (24.3%) and the presence of difficult-to-control symptoms (17.3%). The complex item most frequently observed was an abrupt change in the level of functional autonomy (47.6%). The main factor related to the presence of high vs. non-complexity was that of performance status (odds ratio (OR) = 10.68, 95% confidence interval (CI) = 2.81–40.52, for PPS values < 40%). However, age was inversely related to high complexity. This study confirms the high level of complexity present in patients referred to a PC centre. Determining the factors related to this complexity could help physicians identify situations calling for timely referral for specialised PC, such as a low PPS score.

Unscheduled hospitalization in advanced cancer patients: Time to rethink about the illness.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23007-e23007
Author(s):  
Lorena Ostios-García ◽  
Jesus Miranda Poma ◽  
Darío Sánchez Cabrero ◽  
Laura Gutiérrez Sainz ◽  
Julia Villamayor Sánchez ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Median Survival ◽  
Gynecological Cancer ◽  
Prognostic Score ◽  
Prognostic Scores ◽  
Birth Date ◽  
Tumor Type ◽  
Advanced Cancer Patients

e23007 Background: The aim of our study was to determine if an unscheduled hospitalization in advanced cancer patients is a good time for palliative care referrals, and if this indicator could be improved with some other prognostic score. Methods: We conducted a retrospective study, which included all patients with unscheduled hospitalization in the medical oncology service from January 2011 to December 2013. In order to improve the accuracy of the analysis we considered only first admissions of each patient. We excluded patients with scheduled and unindicated hospitalization. The main variable was survival after an unscheduled hospitalization. We collected the following variables: demographic (age, sex, date of birth, date of death and place of death), tumor type, clinical variables (reason for admission, date of hospitalization, assessment by the palliative care unit during hospitalization, date of last chemotherapy and ECOG), analytical variables (albumin, lymphocytes and lactate dehydrogenase) and a prognostic nomogram developed by our team. Results: Inclusion criteria were met by 1,180 patients. Table summarizes the main sociodemographic characteristics, the type of tumor, and the functional status of patients according to the ECOG scale. After two years of follow-up, 816 (69%) patients had died. The median overall survival was 188 days (161-214). Patients with breast and gynecological cancer had the longest survival, while patients with melanoma, gastric cancer, lung cancer, and pancreatic cancer had the poorest survival. 676 patients (58%) were readmitted during the following year. Readmissions meant a significant decrease of survival. The stage of the oncological disease and performance status measured by ECOG had a clear relationship with survival time. Prognostic nomogram showed high accuracy to predict the probability of survival. Median survival for different quartile was respectively: 348, 139, 68 and 31 days (p < 0´000). Conclusions: The median survival of patients after an unscheduled hospitalization was around 6 months. Been admitted seems a good indicator to introduce specific palliative care. The use of other prognostic scores, as a prognostic nomogram, could help to select patient’ groups with poorer survivals. [Table: see text]

scholarly journals Phenomenological examinations of delirium in advanced cancer patients: exploratory structural equation modelling and latent profile analysis

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Eun-Jung Shim ◽  
Hyeju Ha ◽  
Won-Hyoung Kim ◽  
Moon-Hee Lee ◽  
Jisun Park ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Factor Structure ◽  
Advanced Cancer ◽  
Structural Equation Modelling ◽  
Structural Equation ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Advanced Cancer Patients ◽  
The Core ◽  
Equation Modelling

Abstract Background This study examined phenomenological manifestations of delirium in advanced cancer patients by examining the factor structure of the Delirium Rating Scale-Revised-98 (DRS-R-98) and profiles of delirium symptoms. Methods Ninety-three patients with advanced cancer admitted to inpatient palliative care units in South Korea were examined by psychiatrists using the DRS-R-98 and the Confusion Assessment Method (CAM). The factor structure of the DRS-R-98 was examined by exploratory structural equation modelling analysis (ESEM) and profiles of delirium were examined by latent profile analysis (LPA). Results CAM-defined delirium was present in 66.6% (n = 62) of patients. Results from the ESEM analysis confirmed applicability of the core and noncore symptom factors of the DRS-R-98 to advanced cancer patients. LPA identified three distinct profiles of delirium characterizing the overall severity of delirium and its core and noncore symptoms. Class 1 (n = 55, 59.1%) showed low levels of all delirium symptoms. Class 2 (n = 17, 18.3%) showed high levels of core symptoms only, whereas Class 3 (n = 21, 22.6%) showed high levels of both core and noncore symptoms except motor retardation. Conclusions Clinical care for delirium in advanced cancer patients may benefit from consideration of the core and noncore symptom factor structure and the three distinct phenomenological profiles of delirium observed in the present study.

Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

2021 ◽  
pp. 104990912110178
Author(s):  
Abigail Sy Chan ◽  
Amit Rout ◽  
Christopher R. D.’Adamo ◽  
Irina Lev ◽  
Amy Yu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Length Of Hospital Stay ◽  
Inpatient Setting ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Early Palliative Care ◽  
Code Status ◽  
Palliative Care Needs

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

Providing instrumental support to older parents of multi-child families in China: are there different within-family patterns?

2021 ◽  
pp. 1-18
Author(s):  
Jia Chen ◽  
Xiaochen Zhou ◽  
Nan Lu
Keyword(s):  
Adult Children ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Multinomial Logistic Regression ◽  
Adult Child ◽  
Instrumental Support ◽  
Older Parents ◽  
Older Mothers ◽  
Family Patterns ◽  
Using Data

Abstract Older parents in China rely heavily on their adult children for instrumental assistance. In different multi-child families, multiple offspring may co-operate in providing instrumental support to older parents in distinct ways in terms of how much support they provide on average and how much differentiation exists between them when they provide such support within a family. We aimed to identify different within-family patterns in relation to multiple offspring's instrumental support to an older parent in Chinese multi-child families, and to investigate potential predictors for different within-family patterns. Using data from the China Family Panel Studies (2016), we had a working sample of 5,790 older adults aged 60+ (mean = 68.54, standard deviation = 6.60). We employed latent profile analysis (LPA) to classify within-family patterns and multinomial logistic regression to investigate predictors. Our findings identified three within-family patterns: dissociated (59.10%), highly differentiated (29.60%) and united-filial (11.30%). Older parents in the highly differentiated families tended to be older, mothers, divorced/widowed and to have poorer physical health compared to their counterparts in the dissociated families. In contrast, the composition characteristics of multiple adult children played more important roles in determining the united-filial within-family pattern. The united-filial families were more likely to have fewer adult children, at least one adult daughter and at least one co-residing adult child.

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