scholarly journals Factors Related to Specialized Palliative Care Use and Aggressive Care at End of Life in Japanese Patients With Advanced Solid Cancers: A Cohort Study

2021 ◽  
Author(s):  
Yusuke Hiratsuka ◽  
Takayuki Oishi ◽  
Mitsunori Miyashita ◽  
Tatusya Morita ◽  
Jennifer W Mack ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Advanced Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Japanese Patients ◽  
University Hospital ◽  
Younger Age ◽  
Specialized Palliative Care ◽  
Aggressive Care

Abstract Purpose:This study aimed to identify factors associated with specialized palliative care (SPC) use and aggressive care at the end of life (EOL) among Japanese patients with advanced cancer. Methods:This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death.Results:We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20–59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30–12.91; p=0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07–17.37; p=0.04) were associated with chemotherapy in the last month before death.Conclusion:Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC.

Is specialized palliative cancer care associated with use of antineoplastic treatment at the end of life? A population-based cohort study

2018 ◽  
Vol 32 (9) ◽  
pp. 1509-1517 ◽  
Author(s):  
Kirstine Skov Benthien ◽  
Mathilde Adsersen ◽  
Morten Aagaard Petersen ◽  
Eva Soelberg Vadstrup ◽  
Per Sjøgren ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Female Gender ◽  
Population Based ◽  
Hospital Units ◽  
Hematological Cancers ◽  
Specialized Palliative Care ◽  
Antineoplastic Treatment ◽  
Breast And Prostate Cancer

Background: The use of chemotherapy in the last 14 days of life should be as low as possible. Aim: To study the factors related to the use of chemotherapy in the last 14 days of life and the factors related to concurrent antineoplastic treatment and specialized palliative care. Design: This was a population-based cohort study. The data were collected from the Danish Register of Causes of Death, the Danish National Patient Register, and the Danish Palliative Care Database. Analyses were descriptive and multivariate logistic regression. Setting/participants: Cancer decedents between 2010 and 2013 in the Capital Region of Denmark. Results: During the study period, 17,246 individuals died of cancer and 33% received specialized palliative care. In the last 14 days of life, 4.2% received chemotherapy. Younger patients and patients with hematological cancers were more likely to receive chemotherapy in the last 14 days of life. Receiving specialized palliative care was associated with a lower risk of receiving chemotherapy in the last 14 days of life—odds ratio 0.15 for hospices and 0.53 for palliative hospital units. A total of 8% of the population received concurrent antineoplastic treatment and specialized palliative care. Female gender, younger age, and breast and prostate cancer were significantly associated with this concurrent model. Conclusion: Overall, the incidence of antineoplastic treatment in the last 14 days of life was low compared to other studies. Patients in specialized palliative care had a reduced risk of receiving chemotherapy at the end of life.

Does Time for (in)Direct Nursing Care Activities at the End of Life for Patients With or Without Specialized Palliative Care in a University Hospital Differ? A Retrospective Analysis

2020 ◽  
Vol 37 (10) ◽  
pp. 844-852
Author(s):  
Monica C. Fliedner ◽  
Monika Hagemann ◽  
Steffen Eychmüller ◽  
Cynthia King ◽  
Christa Lohrmann ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Nursing Care ◽  
Direct Care ◽  
University Hospital ◽  
Before And After ◽  
Indirect Care ◽  
Specialized Palliative Care ◽  
Eol Care ◽  
Insight Into

Background: Nurses’ end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients. Aims: (1) Comparing care time for EoL patients receiving SPC to usual palliative care (UPC);(2) Comparing time spent for direct/indirect care in the SPC group before and after SPC. Methods: Retrospective observational study; nursing care time for EoL patients based on tacs® data using nonparametric and parametric tests. The Swiss data method tacs measures (in)direct nursing care time for monitoring and cost analyses. Results: Analysis of tacs® data (UPC, n = 642; SPC, n = 104) during hospitalization before death in 2015. Overall, SPC patients had higher tacs® than UPC patients by 40 direct (95% confidence interval [CI]: 5.7-75, P = .023) and 14 indirect tacs® (95% CI: 6.0-23, P < .001). No difference for tacs® by day, as SPC patients were treated for a longer time (mean number of days 7.2 vs 16, P < .001).Subanalysis for SPC patients showed increased direct care time on the day of and after SPC ( P < .001), whereas indirect care time increased only on the day of SPC. Conclusions: This study gives insight into nurses’ time for (in)direct care activities with/without SPC before death. The higher (in)direct nursing care time in SPC patients compared to UPC may reflect higher complexity. Consensus-based measurements to monitor nurses’ care activities may be helpful for benchmarking or reimbursement analysis.

Effect of palliative care on aggressiveness of end-of-life care in patients with advanced colon cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 168-168
Author(s):  
Jessica Ann Reifer Hildebrand ◽  
Renuka Bhan
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Medical Center ◽  
Quality Care ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Course Of Illness ◽  
Significant Difference ◽  
Aggressive Care

168 Background: Recent studies have observed that starting Palliative Care (PC) soon after diagnosis for patients with advanced cancer improves quality of life, end of life (EOL) care, and possibly survival. Consequently, it has been recommended that combined standard oncology care and PC should be considered early in the course of illness for patients with advanced cancer. It has been posited that patients enrolled in early PC receive less aggressive care at the EOL and consequently spend fewer healthcare dollars. We sought to compare the aggressiveness of care received by those enrolled in early PC to those enrolled in late PC. Methods: A retrospective chart review of patients diagnosed with stage III or IIII colorectal cancer (CRC) at New Hanover Regional Medical Center between 2009 through 2011 was performed. Patients who were enrolled in PC within 30 days of diagnosis were compared to those enrolled later. Aggressiveness of care given during the last 30 days of life was assessed by: hospitalizations, ED visits, days spent in the ICU, chemotherapy received in the last 14 days of life, and death in the hospital. Results: 186 patients were identified for the study, and 89 met inclusion criteria. We found no significant difference in the aggressiveness of care received by those enrolled in early PC (46.7%) versus later PC (47.8%) (p = 1.00). In fact, almost half of all patients with advanced cancer received some form of aggressive care within the last 30 days of life. While those enrolled in late PC more frequently received chemotherapy, were admitted to the ICU, and died in the hospital, the differences were not statistically significant. Whether or not these differences account for cost savings in the early PC group has yet to be determined. Conclusions: Our study found that patients were just as likely to receive aggressive care at the EOL regardless of whether or not they were enrolled in early PC. This finding was unexpected given the goals and philosophy of PC groups. While early PC has been recommended as a quality care measure, patient and physician factors may limit its effectiveness. For example, patients, while receptive to certain aspects of PC, still desire a cure. Similarly, physicians feel compelled to treat patients aggressively.

End-of-Life Preferences, Length-of-Life Conversations, and Hospice Enrollment in Palliative Care: A Direct Observation Cohort Study among People with Advanced Cancer

2019 ◽  
Vol 22 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Robert Gramling ◽  
Luke T. Ingersoll ◽  
Wendy Anderson ◽  
Jeff Priest ◽  
Stephen Berns ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Advanced Cancer ◽  
Direct Observation ◽  
Length Of Life

scholarly journals Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
C. Lees ◽  
S. Weerasinghe ◽  
N. Lamond ◽  
T. Younis ◽  
Ravi Ramjeesingh
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Potential Effect ◽  
Unresectable Pancreatic Cancer ◽  
Palliative Care Consultation ◽  
Integral Role ◽  
Care Consultation ◽  
Aggressive Care ◽  
Key Indicators

Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.

scholarly journals Assessing the utilization of radiotherapy near end of life at a Finnish University Hospital: a retrospective cohort study

2017 ◽  
Vol 56 (10) ◽  
pp. 1265-1271 ◽  
Author(s):  
Liisa K. Rautakorpi ◽  
Johanna M. Mäkelä ◽  
Fatemeh Seyednasrollah ◽  
Anna M. Hammais ◽  
Tarja Laitinen ◽  
...  
Keyword(s):  
Cohort Study ◽  
End Of Life ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
University Hospital

scholarly journals Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association With End-of-Life Care

2019 ◽  
Vol 57 (2) ◽  
pp. 233-240 ◽  
Author(s):  
Robert Gramling ◽  
Elizabeth Gajary-Coots ◽  
Jenica Cimino ◽  
Kevin Fiscella ◽  
Ronald Epstein ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Cancer Disparities ◽  
Life Care
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