In high-risk ICU patients, early palliative care consultation increased transition to DNR/DNI status

26 Background: Although the overall survival of children with cancer exceeds 80%, these children experience significant physical, emotional, social and spiritual suffering. That suffering is even more profound for the 20% of children who succumb to their disease. We therefore conducted a prospective study to assess the feasibility and impact of early palliative care involvement for children with high risk malignancies. Objective: To determine if early palliative care involvement for high risk pediatric oncology patients is feasible, acceptable to patients, families and oncology teams, and helps with symptom management and communication. Methods: This was a prospective survey-based study. Children with cancer treated at University of Rochester were eligible to participate if they had a high risk malignancy, defined as (1) having a newly-diagnosed malignancy with an estimated overall survival of < 50%, (2) requiring hematopoietic stem cell transplantation (HSCT), and/or (3) any relapsed, recurrent or progressive cancer. Parents of these children or children >18YO were surveyed upon study entry, and 3 and 6 months later to assess the impact of early and ongoing pediatric palliative care involvement. Results: 20/25 eligible patients received a palliative care consultation at diagnosis; 16 families participated in the study. Six children had a newly diagnosed high risk malignancy, nine had recurrent disease and one child had a HSCT. Median age of the children was 5 years (0.1-20 year).The most frequent symptoms at the time of study entry were pain (75%), nausea/vomiting (69%), constipation (44%), and fatigue (44%). 75%, 73%, 43% and 43% reported successful treatment of pain, nausea/vomiting, constipation, and fatigue respectively. The proportion of children with each symptom decreased at 3 months except for fatigue. There was high satisfaction with the oncology and pediatric palliative care teams at baseline and 3 and 6 months. No families or oncologists declined an early palliative care consultation. Conclusions: Our results suggest that an early palliative care consultation is feasible for high risk children with cancer and that the palliative care team can work successfully with the primary oncology team to foster symptom control and communication.

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Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

Journal of Burn Care & Research ◽

10.1093/jbcr/irab140 ◽

2021 ◽

Author(s):

Heather Carmichael ◽

Hareklia Brackett ◽

Maurice C Scott ◽

Margaret M Dines ◽

Sarah E Mather ◽

...

Keyword(s):

Palliative Care ◽

Small Sample ◽

Quality Improvement Initiative ◽

Comfort Care ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Before And After ◽

Care Consultation ◽

Patient Values ◽

The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (<72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived >24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

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The effect of early palliative care consultation for survival in patients with unresectable pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.131 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 131-131

Author(s):

Kazuhiro Kosugi ◽

Fumio Omata ◽

Yoshiyuki Fujita ◽

Akitoshi Hayashi

Keyword(s):

Pancreatic Cancer ◽

Palliative Care ◽

Rank Test ◽

Unresectable Pancreatic Cancer ◽

Poor Prognostic Factor ◽

Early Palliative Care ◽

Ajcc Stage ◽

Palliative Care Consultation ◽

Care Consultation ◽

Basic Characteristics

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]

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Early palliative care consultation reduces hospital costs

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-018-4939-6 ◽

2018 ◽

Vol 803 (1) ◽

pp. 12-12

Keyword(s):

Palliative Care ◽

Hospital Costs ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation

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Early Palliative Care Consultation in the Medical ICU

Critical Care Medicine ◽

10.1097/ccm.0000000000004016 ◽

2019 ◽

Vol 47 (12) ◽

pp. 1707-1715 ◽

Cited By ~ 13

Author(s):

Jessica Ma ◽

Stephen Chi ◽

Benjamin Buettner ◽

Katherine Pollard ◽

Monica Muir ◽

...

Keyword(s):

Palliative Care ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation

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Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

Palliative Medicine ◽

10.1177/0269216317690098 ◽

2017 ◽

Vol 31 (4) ◽

pp. 378-386 ◽

Cited By ~ 44

Author(s):

Peter May ◽

Melissa M Garrido ◽

J Brian Cassel ◽

Amy S Kelley ◽

Diane E Meier ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Length Of Stay ◽

Advanced Cancer ◽

Intervention Group ◽

Cost Savings ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Consultation Team ◽

Care Consultation

Background: Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. Aim: To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Design: Prospective multi-site cohort study (2007–2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Setting/participants: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Results: Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Conclusion: Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.

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292 Early Palliative Care Consultation Associated With Decreased Length of Stay

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2017.07.270 ◽

2017 ◽

Vol 70 (4) ◽

pp. S115

Author(s):

A. Trtchounian ◽

K. Aberger ◽

J. Nelson

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation

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Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect

Journal of Clinical Oncology ◽

10.1200/jco.2014.60.2334 ◽

2015 ◽

Vol 33 (25) ◽

pp. 2745-2752 ◽

Cited By ~ 123

Author(s):

Peter May ◽

Melissa M. Garrido ◽

J. Brian Cassel ◽

Amy S. Kelley ◽

Diane E. Meier ◽

...

Keyword(s):

Palliative Care ◽

Hospital Stay ◽

Advanced Cancer ◽

Cancer Diagnosis ◽

Research Question ◽

Total Direct Cost ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Palliative Care Teams ◽

Care Consultation

Purpose Previous studies report that early palliative care is associated with clinical benefits, but there is limited evidence on economic impact. This article addresses the research question: Does timing of palliative care have an impact on its effect on cost? Patients and Methods Using a prospective, observational design, clinical and cost data were collected for adult patients with an advanced cancer diagnosis admitted to five US hospitals from 2007 to 2011. The sample for economic evaluation was 969 patients; 256 were seen by a palliative care consultation team, and 713 received usual care only. Subsamples were created according to time to consult after admission. Propensity score weights were calculated, matching the treatment and comparison arms specific to each subsample on observed confounders. Generalized linear models with a γ distribution and a log link were applied to estimate the mean treatment effect on cost within subsamples. Results Earlier consultation is associated with a larger effect on total direct cost. Intervention within 6 days is estimated to reduce costs by −$1,312 (95% CI, −$2,568 to −$56; P = .04) compared with no intervention and intervention within 2 days by −$2,280 (95% CI, −$3,438 to −$1,122; P < .001); these reductions are equivalent to a 14% and a 24% reduction, respectively, in cost of hospital stay. Conclusion Earlier palliative care consultation during hospital admission is associated with lower cost of hospital stay for patients admitted with an advanced cancer diagnosis. These findings are consistent with a growing body of research on quality and survival suggesting that early palliative care should be more widely implemented.

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