An increase was seen in the percentage of patients with active DNR orders and in hospice referrals after a discussion aid was included in admission packets.
77 Background: Aggressive cancer care at the end of life (EOL) can impact quality of life and have major economic burden. The purpose of this study was to portray the aggressiveness of EOL cancer care, and its relation to race, gender and social factors in Eastern North Carolina with high rural and minority population. Methods: This is a retrospective analysis of 401 stage 4 solid tumor patients who died between 2011 and 2014. Aggressiveness of care was calculated by a composite score adopted from Earle et al. Scores range from 0 to 7 with higher scores indicating more aggressive EOL care. 1 point was given to each indicator of aggressiveness in the last 30 days of life: ED visits ≥2,hospital admissions ≥2,any ICU admission,hospitalized days ≥14,new chemotherapy, hospice care ≤ 3 days, and any chemotherapy in the last 14 days. Results: Among the 401 patients, 217 (54%) were white and 178 (44%) were black. The mean composite score of aggressiveness (CSA) for whites was 1.18 and for blacks it was 1.87. (p<0.001).In the last 30 days of death, a higher proportion of blacks had ≥ 2 ED visits 28% vs 13%(p<.0001), ≥ 2 hospital admission 23% vs 13%(p=0.001), any ICU admission 29% vs 16%(p=0.0002), chemotherapy in the last 14 days 30% vs 20%(p=0.001), ≥ 14 hospitalized days 35% vs 21%(p<0.001), and hospital deaths 46% vs 32%(p=0.001) compared to whites. More whites enrolled in hospice compared to blacks 53% vs 45% (p<0.001). Correlation analysis using Fit Y by X model between CSA (score ≤ 3 and >3) and other variables showed statistically significant difference between whites vs blacks p <0.001, females vs males p=0.0006, not married vs married p<0.0001, and no family support vs family support p<0.0001. Conclusions: Male, unmarried and black patients were associated with higher CSA. Patients who were white, married and with family support had high likelihood of enrolling in hospice. [Table: see text]
Palliative care has become an integral part of today's health care system. Inclusion of palliative care has been shown to positively affect patient satisfaction and can also impact medical costs. One of the ways palliative care can have such influence is through the development of prognostic awareness or a patient's understanding of their likely illness trajectory. Although palliative care programs have multiplied in general, there are still notable discrepancies in program availability, particularly in smaller rural hospitals. Despite numerous health care thought leaders' recommendations regarding the "ideal" palliative care team, this is not always feasible due to resource allocation. This article aims to describe 1 rural hospital's development of and initial outcomes from a hospital-based palliative care program.
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