The “Surprise Question” in Neurorehabilitation—Prognosis Estimation by Neurologist and Palliative Care Physician; a Longitudinal, Prospective, Observational Study

ObjectivesTo identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions.DesignProspective observational study and two cross-sectional online studies.SettingPhase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes.ParticipantsAll members of the Association of Palliative Medicine (APM) were eligible (n=~1100). 99 doctors completed the prognostic test and were included in the phase I analysis. The top 20% were invited to participate in phase II; 14/19 doctors completed the judgement task and were included in the phase II analysis.MeasuresPhase I: participants were asked to give a probability of death within 72 hours (0%–100%) for all 20 cases. Accuracy on the prognostic test was measured with the Brier score which was used to identify the ‘expert’ group (scale range: 0 (expert)–1 (non-expert)). Phase II: participants gave a probability of death within 72 hours (0%–100%). A mixed model regression analysis was completed using the percentage estimate as the outcome and the patient information included in the vignettes as the predictors.ResultsThe mean Brier score of all participants was 0.237 (95% CI 0.235 to 0.239). The mean Brier score of the ‘experts’ was 0.184 (95% CI 0.176 to 0.192). Six of the seven prognostic variables included in the hypothetical vignettes were significantly associated with clinician predictions of death. The Palliative Performance Score was identified as being the most influential in the doctors’ prognostic decision making (β=0.48, p<0.001).ConclusionsThis study identified six clinical signs and symptoms which influenced the judgement policies of palliative care doctors. These results may be used to teach novice doctors how to improve their prognostic skills.

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374PD Association of cancer related fatigue with other symptoms and impact on quality of life of palliative care patients in a tertiary cancer institute: A prospective observational study

Annals of Oncology ◽

10.1093/annonc/mdv531.07 ◽

2015 ◽

Vol 26 ◽

pp. ix111

Author(s):

A. Ghoshal ◽

A. Damani ◽

M.A. Muckaden

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Observational Study ◽

Prospective Observational Study ◽

Cancer Related Fatigue

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Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors

BMC Palliative Care ◽

10.1186/1472-684x-13-40 ◽

2014 ◽

Vol 13 (1) ◽

Cited By ~ 15

Author(s):

Anna Renom-Guiteras ◽

José Planas ◽

Cristina Farriols ◽

Sergi Mojal ◽

Ramón Miralles ◽

...

Keyword(s):

Palliative Care ◽

Environmental Factors ◽

Observational Study ◽

Prospective Observational Study ◽

Advanced Disease ◽

Palliative Care Unit

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Number of Unused Medications at the Time of Last Admission: A Prospective Observational Study in a Single Palliative Care Unit

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118784004 ◽

2018 ◽

Vol 35 (12) ◽

pp. 1498-1504

Author(s):

Takahito Omae ◽

Nobuyuki Yotani ◽

Akihiro Sakashita ◽

Yoshiyuki Kizawa

Keyword(s):

Palliative Care ◽

Observational Study ◽

Anticancer Drugs ◽

Prospective Observational Study ◽

Low Cost ◽

Palliative Care Unit ◽

Opioid Use ◽

Patients With Cancer ◽

Unused Medications ◽

The Cost

Background: Unused medications (UM) are an important issue, with the waste associated with UM a burden to the health-care system. The aims of this study were to clarify the amount and costs of UM in patients with advanced cancer at the time of their last admission to a palliative care unit and to explore the factors contributing to the cost of UM and how patients dealt with UM. Methods: A prospective observational study was conducted in single palliative care unit. Unused medications were classified into 6 categories and the number and cost of UM by category calculated per patient. Patients were classified into 2 cost groups (high and low) based on the total cost of UM, and the number and cost of UM by category were compared between these 2 groups. Results: Of 194 consecutive hospitalized patients, data were analyzed for 90. The mean number and cost of UM per patient was 440 and US$301, respectively. Opioids accounted for 47% of the cost of UM. Comparing costs by UM category, the proportion of opioids (51% vs 21%; P < .0001) and oral anticancer drugs (14% vs 3%; P = .02) was higher in the high- than in the low-cost group. Conclusion: Based on the results of the present study, the estimated annual waste cost of UM for patients with cancer who died in Japan was approximately US$110 million. Interventions to educate patients regarding UM and to eliminate barriers to opioid use may help reduce the cost of UM, particularly opioids and anticancer drugs.

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Untaming Grief ? For Palliative Care Physicians

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909111406705 ◽

2011 ◽

Vol 28 (8) ◽

pp. 569-572 ◽

Cited By ~ 1

Author(s):

Paul J. Moon

Keyword(s):

Palliative Care ◽

Care Physician ◽

Psychosocial Issues ◽

Self Knowledge ◽

Palliative Care Physician

Little doubt (if any) remains as to the assured importance of physicians possessing praxis regarding psychosocial issues, including grief dynamics, in order to tend to dying and sorrowing people. It stands to reason then that palliative care physicians become knowledgeable enough about the phenomenon of grief. But imperative nuances must also be considered: what sort of knowledge on grief, as well as how much of such knowledge, is enough? This article poses topical queries on the importance of the palliative care physician exercising a deliberate agenda to persistently refine one’s personal framework or beliefs regarding grief. In doing so, it is proposed physicians will engender improved self-knowledge, which will serve to better poise themselves toward being with and purposefully encountering aggrieved others.

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Oncologists’ perceptions of rounding alongside palliative care physicians: Results of a post-intervention survey study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20674 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20674-e20674 ◽

Cited By ~ 1

Author(s):

Thomas William LeBlanc ◽

James A Tulsky ◽

Amy Pickar Abernethy ◽

Christopher A Jones ◽

Anthony N Galanos ◽

...

Keyword(s):

Palliative Care ◽

Solid Tumor ◽

Hospice Care ◽

Care Physician ◽

Lessons Learned ◽

Survey Study ◽

Post Intervention ◽

New Model ◽

Oncology Service ◽

Palliative Care Physician

e20674 Background: In August 2011, a new rounding model was instituted on the inpatient solid tumor oncology service at Duke. This model incorporated a palliative care physician as a second attending on service, alongside the rounding solid tumor oncologist. We sought to assess the oncologists’ perceptions of this model, and of palliative care, 1 year later. Methods: We developed a 15-item survey assessing 3 domains: (1) perceptions about palliative care in general, (2) lessons learned from palliative care colleagues, if any, and (3) changes in the experience of rounding on the solid tumor oncology service. Faculty were invited to participate by e-mail, via an anonymous web link. All oncology faculty who rounded at least 2 weeks since August 2011 were included. Results: Response rate was 73% (8 of 11). 75% (N=6) of respondents had rounded both before and after the new model was instituted. 75% reported a more positive perception of palliative care (N=6), 88% (N=7) reported learning new ways to manage cancer patients’ symptoms, and 100% agreed that the palliative care physician brings a valuable skill set to the team. Only 1 respondent felt that palliative care physicians detract from oncologic issues, and none thought the palliative care physicians discuss hospice too early. 88% (N=7) reported greater willingness to round on the service under the new model, and 100% agreed that rounding was more enjoyable since the addition of the palliative care attending to the team. 100% agreed that palliative care is a necessary component of comprehensive cancer care, and that palliative care should have a presence in the outpatient cancer clinics; 88% (N=7) reported feeling comfortable doing palliative care in their own clinical practice. All agreed that “palliative care” is different from “hospice care.” Conclusions: Rounding alongside palliative care physicians on an inpatient oncology service may improve oncologists’ perceptions of palliative care, teach them new symptom management skills, and improve their willingness to do inpatient rounding. Fears about palliative care physicians inappropriately introducing hospice too early for patients with solid tumors may be unfounded.

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