Analytical study of short- and long-term results of home-based palliative care services to cancer patients

164 Background: Advanced cancer care often lacks a comprehensive approach; in Hawaii most oncology practices do not have access to palliative care teams. This causes high use of acute care services and suboptimal symptom management. Hawaii Medical Service Association (HMSA) created a pilot program called Supportive Care in which home-based palliative care services are offered to members with advanced cancer with goals of improved clinical outcomes and decrease utilization of acute care services Methods: Patients must have stage III or IV malignancy and ECOG PS of 2 or greater. Palliative care services are provided by Medicare-certified hospice agencies, with interdisciplinary teams, 24/7 on-call capacity, and expertise in symptom management. Hospice agencies are paid by HMSA to provide intermittent home visits. DME and pharmaceuticals. Care is coordinated with the patient's treating oncologist and other care providers. Each patient may receive 90 days of Supportive Care services in a 12 month period. Services are suspended during hospitalization or placement in a skilled nursing facility. Results: Patients enrolled in this program utilized hospital services significantly less than other Medicare Beneficiaries during the end-of-life period, suggesting that complex medical and psychosocial needs can be met in the home environment. The table compares findings from cancer patients enrolled in Supportive Care during 2014 with the most recent data available from The Dartmouth Atlas of Health Care. Conclusions: Multiple studies show improved quality of life for cancer patients receiving palliative care. Supportive Care resulted in improved clinical outcomes. Anecdotal feedback indicates high satisfaction among patients, families, and providers. Research to collect data and quantify satisfaction continues. [Table: see text]

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Promoting palliative care access to persons with cancer: A model for mapping statewide services.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.127 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 127-127

Author(s):

Constance Dahlin ◽

Joshua Nyambose ◽

Gail Merriam ◽

Cherline Gene

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Long Term Care ◽

Home Health ◽

Term Care ◽

Care Access ◽

Care Services ◽

Health Agencies ◽

Palliative Care Services

127 Background: The CDC comprehensive cancer initiatives value comprehensive quality care within its mission and program development. Currently, over 75% of hospitals in the United States have palliative care services for cancer patients (CAPC 2011). In order to promote access to quality palliative care in the community outside the hospital, an evaluation is essential. The CDC model of comprehensive cancer care and prevention control structure is an appropriate mechanism to perform such an evaluation. From 2014-2015, the Massachusetts Comprehensive Cancer and Prevention Control Network Palliative Care Workgroup performed a survey to hospitals, home health agencies, hospices, long term care facilities, and community providers to determine palliative care services available to cancer patients across the state. Methods: Using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines, a robust palliative survey tool was created by the Massachusetts Comprehensive Cancer and Prevention Control Palliative Care Workgroup. It was individualized to each of the following settings - hospitals, home health organizations, hospices, skilled nursing facilities, and community health agencies. Follow-up telephonic key informant interviews regarding palliative care services were conducted within the various settings, service organizations, and insurers. Results: The results of qualitative and quantitative data will be concluded in August. Initial results reveal significant disparities in access to palliative care across by geography and setting of care. Hospices and hospitals had the most access to palliative care services. Long term care settings and community health settings had the least access. Conclusions: Data reveals disparities in palliative care access within Massachusetts by geography, race, and setting of cancer care. This data will serve as the basis of regional networks to promote better access to palliative care for cancer patients across all settings. It is hoped this evaluation process will serve as a model for other states to perform a similar evaluation.

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Specialized palliative care services are associated with improved short- and long-term caregiver outcomes

Supportive Care in Cancer ◽

10.1007/s00520-007-0342-8 ◽

2007 ◽

Vol 16 (6) ◽

pp. 585-597 ◽

Cited By ~ 76

Author(s):

Amy P. Abernethy ◽

David C. Currow ◽

Belinda S. Fazekas ◽

Mary A. Luszcz ◽

Jane L. Wheeler ◽

...

Keyword(s):

Palliative Care ◽

Care Services ◽

Palliative Care Services ◽

Specialized Palliative Care ◽

Short And Long Term

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Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211012605 ◽

2021 ◽

pp. 104990912110126

Author(s):

Valeria Cardenas ◽

Anna Rahman ◽

Yujun Zhu ◽

Susan Enguidanos

Keyword(s):

Palliative Care ◽

Controlled Trial ◽

Insurance Coverage ◽

Healthcare Providers ◽

Health Condition ◽

Insurance Companies ◽

Structured Interviews ◽

Care Services ◽

Home Based ◽

Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

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Harnessing New and Existing Virtual Platforms to Meet the Demand for Increased Inpatient Palliative Care Services During the COVID-19 Pandemic: A 5 Key Themes Literature Review of the Characteristics and Barriers of These Evolving Technologies

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211036698 ◽

2021 ◽

pp. 104990912110366

Author(s):

Holly R. Cherniwchan

Keyword(s):

Palliative Care ◽

Control Measures ◽

Inpatient Setting ◽

Overall Acceptability ◽

Care Services ◽

Infection Control Measures ◽

Home Based ◽

Palliative Care Services ◽

Virtual Services ◽

Case Basis

The COVID-19 pandemic has increased the demand for end-of-life services and bereavement support, and in many areas of the world, in-person palliative care is struggling to meet these needs. Local infection control measures result in limited visitation rights in hospital and patients are often dying alone. For many years, virtual platforms have been used as a validated alternative to in-person consults for outpatient and home-based palliative care; however, the feasibility and acceptability of a virtual inpatient equivalent is less studied. Virtual inpatient palliative care may offer a unique opportunity for patients to have meaningful interactions with their care team and family while isolated in hospital or in hospice. This narrative review examines strategies employed during the COVID-19 pandemic to implement virtual palliative care services in the inpatient setting. Five key themes were identified in the literature between January 2020-March 2021 in the LitCovid NCBI database: 1) overall acceptability of virtual inpatient palliative care during the pandemic, 2) important logistical considerations when developing a virtual inpatient palliative care platform, 3) commonly used technologies for delivering virtual services, 4) strategies for harnessing human resources to meet increased patient volume, and 5) challenges of virtual inpatient palliative care implementation. Upon review, telepalliative care can meet the increased demand for safe and accessible inpatient palliative care during a pandemic; however, in some circumstances in-person services should still be considered. The decision for which patients receive what format of care—in-person or virtual—should be decided on a case-by-case basis.

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Factors Influencing the Willingness of Palliative Care Utilization among the Older Population with Active Cancers: A Case Study in Mandalay, Myanmar

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157887 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7887

Author(s):

Aye Tinzar Myint ◽

Sariyamon Tiraphat ◽

Isareethika Jayasvasti ◽

Seo Ah Hong ◽

Vijj Kasemsup

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Rural Areas ◽

Psychosocial Support ◽

Care Utilization ◽

Severe Illness ◽

Cross Sectional Survey ◽

Care Services ◽

Palliative Care Services ◽

Older Cancer Patients

Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.

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Advantages and challenges in using telehealth for home-based palliative care: A systematic mixed studies review protocol (Preprint)

10.2196/preprints.22626 ◽

2020 ◽

Author(s):

Simen A Steindal ◽

Andréa Aparecida Goncalves Nes ◽

Tove E. Godskesen ◽

Susanne Lind ◽

Alfhild Dhle ◽

...

Keyword(s):

Palliative Care ◽

Care Delivery ◽

Patient Centered ◽

Care Services ◽

Home Based ◽

Mixed Studies Review ◽

Palliative Care Services ◽

Meta Analyses ◽

Systematic Mixed Studies Review ◽

At Home

BACKGROUND Due to the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care. OBJECTIVE The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. METHODS This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data and assess methodological quality. The data will then be analyzed using thematic synthesis. RESULTS We described the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. CONCLUSIONS Following the ethos of patient-centered palliative care, this systematic mixed studies review could contribute recommendations for practice and policy enabling the development of telehealth applications and services that align with patients’ preferences and needs when using telehealth applications and services at home.

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FAMILY CAREGIVER SATISFACTION WITH HOME-BASED PALLIATIVE CARE SERVICES IN NORTH RHINE-WESTPHALIA, GERMANY

Central European Journal of Nursing and Midwifery ◽

10.15452/cejnm.2017.08.0025 ◽

2017 ◽

Vol 8 (4) ◽

pp. 723-730

Author(s):

Michael Galatsch ◽

Jian Li ◽

Friederike zu Sayn-Wittgenstein ◽

Wilfried Schnepp

Keyword(s):

Palliative Care ◽

Family Caregiver ◽

Caregiver Satisfaction ◽

Care Services ◽

Home Based ◽

Palliative Care Services

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Prognostic Indicators in Stage IV Surgically Treated Gastric Cancer Patients: A Retrospective Multi-Institutional Study

Digestive Surgery ◽

10.1159/000488775 ◽

2018 ◽

Vol 36 (4) ◽

pp. 331-339

Author(s):

Alberto Biondi ◽

Domenico D’Ugo ◽

Ferdinando Cananzi ◽

Stefano Rausei ◽

Federico Sicoli ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Residual Disease ◽

Stage Iv ◽

Long Term Results ◽

Stage Iv Gastric Cancer ◽

Short And Long Term ◽

Gastric Cancer Patients

Introduction: The role of gastric resection in treating metastatic gastric adenocarcinoma is controversial. In the present study, we reviewed the short- and long-term outcomes of stage IV patients undergoing surgery. Methods: A retrospective review was conducted that assessed patients undergoing elective surgery for incurable gastric carcinoma. Short- and long-term results were evaluated. Results: A total of 122 stage IV gastric cancer patients were assessed. Postoperative mortality was 5.7%, and the overall rate of complications was 35.2%. The overall survival rate at 1 and 3 years was 58 and 19% respectively; the median survival was 14 months. Improved survival was observed for the factors age less than 60 years (p = 0.015), site of metastases (p = 0.022), extended lymph node dissection (p = 0.044), absence of residual disease after surgery (p = 0.001), and administration of adjuvant chemotherapy (p = 0.016). Multivariate analysis showed that residual disease and adjuvant chemotherapy were independent prognostic factors. Conclusions: The results of this study suggest that surgery combined with systemic chemotherapy in selected patients with stage IV gastric cancer can improve survival.

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