Impact of intensity and timing of integrated home palliative cancer care on end-of-life hospitalization in Northern Italy

Pellizzari, Michele; Hui, David; Pinato, Elisabetta; Lisiero, Manola; Serpentini, Samantha; Gubian, Lorenzo; Figoli, F.; Cancian, Maurizio; Chirico, Cosimo De; Ferroni, Eliana; Avossa, Francesco; Saugo, Mario

doi:10.1007/s00520-016-3510-x

Cited by 22 publications

(19 citation statements)

References 22 publications

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“…Palliative care involvement was associated with less aggressive care, as measured by the use of chemotherapy near death (odds ratio [OR], 0.34), intensive care unit admissions (OR, 0.12), emergency room visits (OR, 0.19), and hospitalizations near death (OR, 0.24); moreover, earlier palliative care was associated with better outcomes . Studies from Italy and the United Kingdom examining the effect of palliative care confirmed similar benefits with earlier referral …”

Section: Defining Key Elements Of Palliative Care Delivery: Team‐basementioning

confidence: 94%

“…The optimal timing of specialist palliative care referral remains unclear but likely depends on the individual patient and the health care system. In addition to a meta‐analysis suggesting that earlier referral was associated with a greater benefit, several nonrandomized studies have also demonstrated the impact of timely palliative care on aggressiveness of care at the end of life . In a retrospective cohort study, patients who were referred to a comprehensive cancer center more than 6 months before death were compared with those who were referred 6 months or less before death.…”

Section: Defining Key Elements Of Palliative Care Delivery: Team‐basementioning

confidence: 99%

“…In addition to a meta-analysis suggesting that earlier referral was associated with a greater benefit, 46 several nonrandomized studies have also demonstrated the impact of timely palliative care on aggressiveness of care at the end of life. 59,[64][65][66] In a retrospective cohort study, patients who were referred to a comprehensive cancer center more than 6 months before death were compared with those who were referred 6 months or less before death. Earlier referrals were associated with significantly better outcomes in the last 30 days of life, with lower rates of emergency room visits (41% vs 63%; P = .002) and hospitalizations (51% vs 75%; P < .001).…”

Section: Figure 3 Conceptual Framework On How Timely Palliative Carementioning

confidence: 99%

“…64 Studies from Italy and the United Kingdom examining the effect of palliative care confirmed similar benefits with earlier referral. 65,66 Although early palliative care referral is generally preferred, some investigators have speculated whether it is ever too early. Many contemporary RCTs involved specialist palliative care referral within 3 months of diagnosis of advanced cancer regardless of symptom burden; however, this model of care is currently infeasible given the limited palliative care infrastructure internationally.…”

Section: Figure 3 Conceptual Framework On How Timely Palliative Carementioning

confidence: 99%

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Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Hui

Hannon

Zimmermann

et al. 2018

CA A Cancer J Clinicians

295

272

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Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-science review directed at the practicing cancer clinician, we will first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. We will then provide conceptual models to support team-based, timely and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multi-dimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventative care to minimize crises at the end-of-life. Targeted palliative care involves identifying patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, we will summarize the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time.

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Section: Defining Key Elements Of Palliative Care Delivery: Team‐basementioning

confidence: 94%

Section: Defining Key Elements Of Palliative Care Delivery: Team‐basementioning

confidence: 99%

Section: Figure 3 Conceptual Framework On How Timely Palliative Carementioning

confidence: 99%

Section: Figure 3 Conceptual Framework On How Timely Palliative Carementioning

confidence: 99%

See 2 more Smart Citations

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Hui

Hannon

Zimmermann

et al. 2018

CA A Cancer J Clinicians

295

272

View full text Add to dashboard Cite

show abstract

“…If the latter two situations just described are true, then HomePal is indeed serving its purpose by providing earlier supportive care in patients’ homes and may reduce the risk of hospitalizations in the last 6 months of life compared with receipt of hospice alone . The risk of hospitalization was 13% (last 6 months) and 20% (last 30 days) lower for the HomePal cohort compared with the HO cohort.…”

Section: Discussionmentioning

confidence: 91%

End‐of‐Life Care in Patients Exposed to Home‐Based Palliative Care vs Hospice Only

Wang

Liu

Lee

et al. 2019

J American Geriatrics Society

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OBJECTIVES The current evidence base regarding the effectiveness of home‐based palliative care (HomePal) on outcomes of importance to multiple stakeholders remains limited. The purpose of this study was to compare end‐of‐life care in decedents who received HomePal with two cohorts that either received hospice only (HO) or did not receive HomePal or hospice (No HomePal‐HO). DESIGN Retrospective cohorts from an ongoing study of care transition from hospital to home. Data were collected from 2011 to 2016. SETTING Kaiser Permanente Southern California. PARTICIPANTS Decedents 65 and older who received HomePal (n = 7177) after a hospitalization and two comparison cohorts (HO only = 25 102; No HomePal‐HO = 22 472). MEASUREMENTS Utilization data were extracted from administrative, clinical, and claims databases, and death data were obtained from state and national indices. Days at home was calculated as days not spent in the hospital or in a skilled nursing facility (SNF). RESULTS Patients who received HomePal were enrolled for a median of 43 days and had comparable length of stay on hospice as patients who enrolled only in hospice (median days = 13 vs 12). Deaths at home were comparable between HomePal and HO (59% vs 60%) and were higher compared with No HomePal‐HO (16%). For patients who survived at least 6 months after HomePal admission (n = 2289), the mean number of days at home in the last 6 months of life was 163 ± 30 vs 161 ± 30 (HO) vs 149 ± 40 (No HomePal‐HO). Similar trends were also noted for the last 30 days of life, 25 ± 8 (HomePal, n = 5516), 24 ± 8 (HO), and 18 ± 11 (No HomePal‐HO); HomePal patients had a significantly lower risk of hospitalizations (relative risk [RR] = .58‐.87) and SNF stays (RR = .32‐.77) compared with both HO and No HomePal‐HO patients. CONCLUSION Earlier comprehensive palliative care in patients’ home in place of or preceding hospice is associated with fewer hospitalizations and SNF stays and more time at home in the final 6 months of life. J Am Geriatr Soc, 2019.

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Palliative Care Approach for Patients with Hematologic Malignancies and Other Serious Blood Disorders

Mo,

Hui

2023

Palliative Care in Hematologic Malignancies and Serious Blood Disorders

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Impact of intensity and timing of integrated home palliative cancer care on end-of-life hospitalization in Northern Italy

Abstract: A greater HPCC program intensity reduces the risk of hospital death and hospital stay in the end-of-life. An early activation of this program can contribute to improve these EOL outcomes.

Cited by 22 publications

References 22 publications

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

End‐of‐Life Care in Patients Exposed to Home‐Based Palliative Care vs Hospice Only

Palliative Care Approach for Patients with Hematologic Malignancies and Other Serious Blood Disorders

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