Discharge Outcomes and Survival of Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit at a Comprehensive Cancer Center

Background. The physical signs of impending death have not been well characterized in cancer patients. A better understanding of these signs may improve the ability of clinicians to diagnose impending death. We examined the frequency and onset of 10 bedside physical signs and their diagnostic performance for impending death. Methods. We systematically documented 10 physical signs every 12 hours from admission to death or discharge in 357 consecutive patients with advanced cancer admitted to two acute palliative care units. We examined the frequency and median onset of each sign from death backward and calculated their likelihood ratios (LRs) associated with death within 3 days. Results. In total, 203 of 357 patients (52 of 151 in the U.S., 151 of 206 in Brazil) died. Decreased level of consciousness, Palliative Performance Scale #20%, and dysphagia of liquids appeared at high frequency and .3 days before death and had

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“…Based on the literature, the presence of these signs indicates a survival of weeks or less [11,20,29].…”

Section: Discussionmentioning

confidence: 99%

“…Both APCUs have access to full arrays of diagnostic and therapeutic measures, such as computed tomography and intravenous antibiotics. The historical in-hospital mortality rate was 30% at MDACC and 70% at BCH [11].…”

Section: Study Setting and Criteriamentioning

confidence: 97%

Clinical Signs of Impending Death in Cancer Patients

et al. 2014

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“…Previous studies have described some of the factors associated with mortality in hospitalized patients receiving palliative care consultation, [6][7][8] however, no study examined factors by site of consultation. We found that factors associated with in-hospital death varied by site of consultation for elderly patients receiving palliative care consultation.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with In-Hospital Death by Site of Consultation among Elderly Inpatients Receiving Pain and Palliative Care Consultations

Sekiguchi

Bell²,

Fischberg³

2014

Journal of Palliative Medicine

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Background: Despite palliative care implementation, most deaths still occur in hospitals. Objectives: To identify factors associated with in-hospital death among elderly patients receiving palliative care, by site of consultation. Design: Prospective observational study. Setting/Subjects: All inpatients aged 65 years and older receiving pain and palliative care consultations in a 533-bed acute tertiary care hospital in Honolulu, Hawaii, from January 2005 through December 2009. Measurements: During consultation, demographics, diagnoses, consultation site (intensive care unit [ICU], non-ICU medical, non-ICU surgical, and rehabilitation floors), consultation indication (assistance with establishing goals of care versus pain and/or symptom management), Karnofsky scores, length of stay (LOS), discharge disposition, and in-hospital death were collected. Multiple logistic regression analyses examined factors associated with in-hospital death. Results: Of 1630 elderly inpatients receiving palliative care, 305 (19%) died in-hospital. In-hospital death among non-ICU medical patients was associated with needing consultation to assist with plan of care (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.27-2.80). Likelihood of in-hospital death increased 2% for each additional hospital day before consultation (OR = 1.02, 95% CI = 1.01-1.03). Among elderly ICU patients, likelihood of in-hospital death increased 8% for each additional hospital day before consultation (OR = 1.08, 95% CI = 1.01-1.16). Conclusion: Among elderly non-ICU medical patients receiving palliative care consultations, the need for a consultation to assist with plan of care was associated with in-hospital death, while length of stay prior to consultation was important among both elderly ICU and non-ICU medical patients. Elderly hospitalized patients may benefit from earlier identification and palliative care consultation for assistance with plan of care to avoid in-hospital death.

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“…The median length of stay is 7 days and approximately 70% of the patients are discharged alive. 12 The median survival from admission to death is 21 days. This unit was established following the structure of the palliative care unit in Edmonton, and it has in turn been a template for multiple other institutions in the United States and around the world.…”

Section: The Acute Palliative Carementioning

confidence: 99%

Conceptual Models for Integrating Palliative Care at Cancer Centers

Bruera

Hui

2012

Journal of Palliative Medicine

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119

104

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Palliative care programs are rapidly evolving in acute care facilities. Increased and earlier access has been advocated for patients with life-threatening illnesses. Existing programs would need major growth to accommodate the increased utilization. The objective of this review is to provide an update on the current structures, processes, and outcomes of the Supportive and Palliative Care Program at the University of Texas M.D. Anderson Cancer Center (UTMDACC), and to use the update as a platform to discuss the challenges and opportunities in integrating palliative and supportive services in a tertiary care cancer center. Our interprofessional program consists of a mobile consultation team, an acute palliative care unit, and an outpatient supportive care clinic. We will discuss various metrics including symptom outcomes, quality of end-of-life care, program growth, and financial issues. Despite the growing evidence to support early palliative care involvement, referral to palliative care remains heterogeneous and delayed. To address this issue, we will discuss various conceptual models and practical recommendations to optimize palliative care access.

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Discharge Outcomes and Survival of Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit at a Comprehensive Cancer Center

Cited by 89 publications

References 32 publications

Clinical Signs of Impending Death in Cancer Patients

Clinical Signs of Impending Death in Cancer Patients

Factors Associated with In-Hospital Death by Site of Consultation among Elderly Inpatients Receiving Pain and Palliative Care Consultations

Conceptual Models for Integrating Palliative Care at Cancer Centers

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