scholarly journals Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies

2017 ◽  
Vol 13 (9) ◽  
pp. e729-e737 ◽  
Author(s):  
David J. Einstein ◽  
Susan DeSanto-Madeya ◽  
Matthew Gregas ◽  
Jessica Lynch ◽  
David F. McDermott ◽  
...  
Keyword(s):  
Palliative Care ◽  
Usual Care ◽  
End Of Life ◽  
Odds Ratio ◽  
Care Clinic ◽  
Usual Practice ◽  
Embedded Model ◽  
Enrollment Rates ◽  
Oncology Practice ◽  
The Impact

Purpose: Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. Materials and Methods: We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this model’s implementation. Results: Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P < .001). Hospice enrollment rates were similar ( P = .303), but duration was doubled (mean, 57 v 25 days; P = .006), and enrollment > 7 days before death—a core Quality Oncology Practice Initiative metric—was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. Conclusion: A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.

Improving end-of-life care: Palliative care embedded in an outpatient oncology clinic.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 77-77
Author(s):  
David Johnson Einstein ◽  
Susan DeSanto-Madeya ◽  
Matt Gregas ◽  
Jessica A. Lynch ◽  
David F. McDermott ◽  
...  
Keyword(s):  
Palliative Care ◽  
Usual Care ◽  
End Of Life ◽  
Care Clinic ◽  
Usual Practice ◽  
Referral Criteria ◽  
Palliative Care Teams ◽  
Embedded Model ◽  
Oncology Practice ◽  
The Impact

77 Background: Patients with advanced cancer benefit from early involvement of palliative care. Nonetheless, the ideal method of palliative care integration remains to be determined. Prior studies proposed automatic referral criteria and embedding palliative care teams within specialty clinics. Methods: We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic based on automatic referral criteria. Patients seen in this clinic on a specific day had access to the “embedded” model, whereas patients seen on two other days could access a separate palliative care clinic upon oncologist referral (usual care). We abstracted data from the medical records of 118 patients who were cared for in this oncology clinic and died during the 3 years following implementation of the embedded model. Results: Compared with those with access to usual care (n = 88), patients with access to the embedded model (n = 30) encountered palliative care as outpatients more often (p < 0.001) and twice as long before death (mean 223 versus 106 days, p = 0.001). Hospice enrollment rates were similar (p = 0.717) but duration was twice as long (mean 53.5 versus 25.3 days, p = 0.03), and enrollment greater than 7 days before death—a core Quality Oncology Practice Initiative metric—was significantly higher in the embedded model (OR 5.60, p = 0.034). Place of death (p = 0.505) and end-of-life chemotherapy (OR 0.361, p = 0.204) did not differ significantly. Conclusions: A model of embedded palliative care with automatic referral criteria, compared with usual practice, was associated with significant improvements in utilization and timing of palliative care and hospice.

Impact of integrated palliative care model on end-of-life (EOL) quality metrics for patients with kidney cancer (RCC) and melanoma (M).

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 137-137
Author(s):  
Jessica A. Lynch ◽  
Susan DeSanto-Madeya ◽  
Jessica A. Zerillo ◽  
Matt Gregas ◽  
David F. McDermott ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Symptom Assessment ◽  
Integrated Model ◽  
Optimal Timing ◽  
Early Palliative Care ◽  
Location Of Death ◽  
Edmonton Symptom Assessment Scale ◽  
Oncology Practice ◽  
The Impact

137 Background: Early palliative care (PC) improves quality of life (QOL) and enhances end-of-life (EOL) care, but the optimal timing and most effective model for integrating PC into oncologic care is uncertain. To understand the impact of an integrated model with PC providers embedded with oncologists vs. usual care (UC) with referral at the discretion of the same oncologists, we examined the timing and delivery of PC and Quality Oncology Practice Initiative (QPOI) EOL metrics among patients with RCC and M in a single clinic. We hypothesized that integrated PC would result in more referrals, earlier contact with PC and better QOPI EOL metrics compared with UC. Methods: In a retrospective cohort study of patients with RCC and M in the Beth Israel Deaconess Biologics Clinic who expired between 10/1/12 and 12/31/14, we compared patients seen 2 days/week, when referral to PC was discretionary, with a third day when PC providers shared the clinic for real-time consultations. Patients were identified as meeting PC eligibility if they had recurrent, metastatic disease and were on active treatment or had a symptom severity of 7+ on Edmonton Symptom Assessment Scale (ESAS). Two oncologists saw all patients, regardless of day. Results: Seventy-six patients expired, 19 in the Integrated PC model and 57 with UC. Patients were similar with respect to diagnosis and demographics except for smoking. The integrated model substantially improved timing and location of PC. In the integrated PC model, 85% were seen by PC compared with 45% in UC (P = 0.002). All patients in the integrated model began PC as an outpatient compared with 36% in UC (P < 0.001). The mean number of days from first PC contact to death was 28 (SD = 54) for UC and 118 (SD = 120) with integrated PC (P < 0.001). The location of death did not differ significantly between models, occurring outside the hospital with hospice among 71% of patients in the integrated model and 53% in UC (P = 0.25). Results were similar in relative risk models adjusted for smoking. Conclusions: A practice model that integrated PC with oncologic care was associated with more PC referrals, earlier contact, and a nonsignificant trend toward fewer deaths in hospital and ICU.

Impact of augmented intelligence (AI) on utilization of palliative care (PC) services in oncology.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12015-12015
Author(s):  
Ajeet Gajra ◽  
Marjorie Zettler ◽  
Jonathan Kish ◽  
Kelly Miller ◽  
John Frownfelter ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Machine Learning Techniques ◽  
Care Plan ◽  
Patient Specific ◽  
The Mean ◽  
Poor Outcomes ◽  
Oncology Practice ◽  
Practice Methods ◽  
The Impact

12015 Background: Timely integration of palliative care in the management of patients with advanced cancer is a quality benchmark in oncology. However, PC is often underutilized as evidenced by delays in identification of appropriate patients, in referrals to a PC service, and in enrollment to hospice. Jvion has developed a prescriptive analytics solution, the Machine, which combines AI algorithms with machine learning techniques and applies them to clinical and exogenous datasets to identify patients with a propensity for poor outcomes. The Machine was applied to risk for patients’ mortality within next 30 days, and recommended patient-specific, dynamic, and actionable insights. Use of the Machine requires no additional documentation within the electronic health record (EHR) and the insights generated can be integrated back in to any EHR to help inform the care plan. Herein, we report the results of a study evaluating the impact of AI-driven insights on PC utilization at a large community oncology practice. Methods: All patients were scored weekly using the Machine PC vector. The Machine risk stratified the patients and generated recommendations for the provider to consider as they developed a care plan. Patients identified as “at risk” by the Machine were assessed for a supportive care visit (PC referral) and then were referred as deemed clinically appropriate. The average monthly rates of PC consults and hospice referrals were calculated 5 months prior to and for 17 months after the launch of the Machine in the practice. Results: The oncology practice has 21 providers managing an average of 4329 unique patients per month (PPM). The mean rate of PC consults increased from 17.3 to 29.1 per 1000 PPM pre and post Machine deployment respectively (+168%). The mean monthly rate of hospice referrals increased by 8-fold from 0.2 to 1.6 per 1000 PPM pre and post deployment respectively. Eliminating the first 6 months of Machine deployment to account for user learning curve, the mean rates of monthly PC consults nearly doubled over baseline to 33.0, and hospice referrals rose 12-fold to 2.4 per 1000 patients in months 7-17 post Machine deployment. Conclusions: This oncology practice found deployment of this novel AI solution to be feasible and effective at generating actionable insights. These AI driven insights could be incorporated into workflow and improved the decision-making for whether and when a patient should be referred to PC and/or hospice services for end of life care. Further study is needed to confirm the value of AI for management of cancer patients at end of life.

A Case–Control Study Evaluating the Impact of Dedicated Palliative Care Training on Critical Care Interventions at the end of Life

2021 ◽  
pp. 082585972110374
Author(s):  
Jee Y. You ◽  
Lie D. Ligasaputri ◽  
Adarsh Katamreddy ◽  
Kiran Para ◽  
Elizabeth Kavanagh ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
High Risk ◽  
End Of Life ◽  
Poor Prognosis ◽  
Medical Interventions ◽  
Risk Of Death ◽  
Before And After ◽  
The Difference ◽  
The Impact

Many patients admitted to intensive care units (ICUs) are at high risk of dying. We hypothesize that focused training sessions for ICU providers by palliative care (PC) certified experts will decrease aggressive medical interventions at the end of life. We designed and implemented a 6-session PC training program in communication skills and goals of care (GOC) meetings for ICU teams, including house staff, critical care fellows, and attendings. We then reviewed charts of ICU patients treated before and after the intervention. Forty-nine of 177 (28%) and 63 of 173 (38%) patients were identified to be at high risk of death in the pre- and postintervention periods, respectively, and were included based on the study criteria. Inpatient mortality (45% vs 33%; P = .24) and need for mechanical ventilation (59% vs 44%, P = .13) were slightly higher in the preintervention population, but the difference was not statistically significant. The proportion of patients in whom the decision not to initiate renal replacement therapy was made because of poor prognosis was significantly higher in the postintervention population (14% vs 67%, P = .05). There was a nonstatistically significant trend toward earlier GOC discussions (median time from ICU admission to GOC 4 vs 3 days) and fewer critical care interventions such as tracheostomies (17% vs 4%, P = .19). Our study demonstrates that directed PC training of ICU teams has a potential to reduce end of life critical care interventions in patients with a poor prognosis.

scholarly journals Healing at the End of Life: The Voice of the Patient

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Cory Ingram
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Life Story ◽  
Patient Centered ◽  
Whole Person ◽  
Centered Care ◽  
The Impact

In palliative care we have the privilege to care for seriously ill people and their families. Some people value capturing their life story or illness journey on film. I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives. The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing. Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories. The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care. The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

11 Filling the void: preparing future junior doctors for challenging conversations

2018 ◽  
Vol 8 (3) ◽  
pp. 363.3-364
Author(s):  
Hannah Costelloe ◽  
Alice Copley ◽  
Andrew Greenhalgh ◽  
Andrew Foster ◽  
Pratik Solanki
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
Small Group ◽  
End Of Life ◽  
Communication Skills ◽  
Skills Training ◽  
Junior Doctors ◽  
List Type ◽  
The Impact

Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufman et al. 2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Noble et al. 2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.References. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance. Academic Medicine [online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]

First steps: Health and social care professionals beginning to address the palliative and end of life care needs of people with diverse gender identities and sexual orientations in Lebanon

Sexualities ◽  
2020 ◽  
pp. 136346072093238
Author(s):  
Claude Chidiac
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Stigma ◽  
Life Care ◽  
Care Needs ◽  
Mena Region ◽  
Healthcare Needs ◽  
Health And Social Care ◽  
The Impact

The available evidence demonstrates that lesbian, gay, bisexual, and transgender (LGBT) people face challenges when accessing palliative care services, and receive suboptimal care at the end of life. This is mainly attributed to assumed heterosexuality, lack of knowledge and understanding of LGBT issues and specific healthcare needs, discrimination, homophobia, and transphobia. In Lebanon, legal and institutional support for LGBT individuals is minimal, and palliative care provision remains scarce and fragmented. This compounds the impact of social stigma and marginalisation, and results in unrecognised palliative and end of life care needs for the LGBT individual. This short commentary discusses the development of an LGBT palliative care workshop in Lebanon, which was the first initiative of its kind in the Middle East and North Africa (MENA) region. It also explores how this initiative has led to further developments, and how these efforts can be replicated in other countries in the MENA region.

scholarly journals Integration of palliative care into the neuro-oncology practice: patterns in the United States

2014 ◽  
Vol 1 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Tobias Walbert
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Brain Tumor ◽  
End Of Life ◽  
Symptom Control ◽  
Tumor Patients ◽  
Life Phase ◽  
Improve Symptom ◽  
Oncology Practice

Abstract Background Between 80%–85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life. Methods A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice. Results Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey. Conclusions Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.

Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database

2016 ◽  
Vol 34 (7) ◽  
pp. 685-691 ◽  
Author(s):  
Motoko Sano ◽  
Kiyohide Fushimi
Keyword(s):  
Palliative Care ◽  
Elderly Patients ◽  
End Of Life ◽  
Hospital Setting ◽  
Geriatric Oncology ◽  
National Database ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern. Objective: To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database. Methods: We conducted a multicenter cohort study of patients aged ≥65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage ≥3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using χ2 and logistic regression analyses. Results: We included 26 012 patients in this analysis. The mean age was 75.74 ± 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young–old, and patients with primary cancer. Conclusion: Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.

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