Early Integration of Palliative Care for Children with High‐Risk Cancer and Their Families

Kaye, Erica C.; Friebert, Sarah; Baker, Justin N.

doi:10.1002/pbc.25848

Cited by 110 publications

(134 citation statements)

References 55 publications

(72 reference statements)

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“…First, consistent with national data, approximately one third of patients were still regularly referred to hospice less than 1 week before death, despite consistent guidelines for early end-of-life care discussions for all patients with end-stage cancer. 13,[27][28][29] Available data indicate that these discussions are associated with earlier use of hospice and less intensive treatments at the end of life, 8,30,31 especially when taking place earlier in a patient's disease course. 17,32 Furthermore, they are associated with better understanding of prognosis, 33 better family satisfaction with care, 8 and better quality of life.…”

Section: Discussionmentioning

confidence: 99%

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Wang

Knight

Evans

et al. 2017

JOP

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Purpose: The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. Methods: We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Results: Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Conclusion: Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.

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Section: Discussionmentioning

confidence: 99%

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Wang

Knight

Evans

et al. 2017

JOP

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“…Over the past decade, the field of palliative oncology has developed, bolstered by evidence that patients with high‐risk or incurable disease who receive cancer‐directed care in synergy with palliative care (PC) demonstrate improved outcomes . Specifically in the context of pediatric cancer, the value of palliative oncology has gained traction over the past few years . Integration of PC principles and services into routine cancer care for children with high‐risk disease has been associated with improved symptom management for patients and quality of life (QOL) for both children and families .…”

Section: Introductionmentioning

confidence: 99%

Illness and end‐of‐life experiences of children with cancer who receive palliative care

Kaye

Gushue

DeMarsh

et al. 2017

Pediatric Blood & Cancer

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Children with cancer who receive PC experience a high burden of intensive treatments and often die in inpatient intensive care settings. Delayed PC involvement is associated with increased odds of dying in the intensive care unit. Prospective investigation of early PC involvement in children with high-risk cancer is needed to better understand potential impacts on cost-effectiveness, quality of life, and delivery of goal concordant care.

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“…21 While the need for palliative care in this patient population is well documented, prospective evidence supporting concurrent pediatric palliative and oncologic care for children with poor prognoses is lacking. 22–24 However, results from several studies suggest that early palliative care consultations improve the detection of untreated symptoms, enhance communication and documentation of advance care planning, and increase the likelihood of hospice enrollment and avoidance of in-hospital deaths. 25–29 …”

Section: Aca Impact On End-of-life Carementioning

confidence: 99%

The Affordable Care Act and End-of-Life Care for Patients With Cancer

Parikh¹,

Wright²

2017

Cancer J

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The Affordable Care Act (ACA) expanded access to high-quality end-of-life care for Americans with serious illness, including cancer. Before the ACA was enacted in 2010, nearly 715,000 patients died in hospitals annually, 1 despite evidence that most Americans prefer to die at home. 2 Moreover, fewer than half of Medicare beneficiaries used hospice before death, despite evidence that hospice services improve cancer patients’ quality of life near death and caregivers’ bereavement outcomes. 3–6 The ACA-stipulated programs and subsequent efforts were designed to address these deficiencies in access to high-quality end-of-life care. However, important gaps in coverage persist. In this article, we highlight the impact of the ACA on end-of-life care for individuals with and without cancer.

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Early Integration of Palliative Care for Children with High‐Risk Cancer and Their Families

Cited by 110 publications

References 55 publications

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Illness and end‐of‐life experiences of children with cancer who receive palliative care

The Affordable Care Act and End-of-Life Care for Patients With Cancer

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