Early Palliative Care: Taking Ownership and Creating the Conditions

Pereira, José; Chasen, Martin

doi:10.3747/co.23.3461

Cited by 20 publications

(20 citation statements)

References 23 publications

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“…The value and utilization of PC has been increasing over the past decade. 7 However, the use of PC during hospitalization prior to patient death from gynecological cancers has not been extensively studied. In this current report of over 4500 patients, we observed an increase of PC use from 12% to 45% over the 7-year study period.…”

Section: Discussionmentioning

confidence: 99%

“…5 The American Society of Clinical Oncology strongly advocates for PC intervention early in the disease course for patients with cancer, including patients with gynecologic malignancies. 6,7 With the widespread agreement within the field of oncology on the benefits of PC, the number of PC programs in US hospitals has increased over the years. 8,9 However, the adoption of PC in patients with gynecologic cancer has not been well studied, particularly in the inpatient hospital setting.…”

Section: Introductionmentioning

confidence: 99%

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Trends in the Utilization of Palliative Care in Patients With Gynecologic Cancer Who Subsequently Died During Hospitalization

Milki

Mann

Gardner

et al. 2020

Am J Hosp Palliat Care

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Objective: To determine factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized. Methods: Data were abstracted from the National Inpatient Sample database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were used for statistical analyses. Results: Of 4559 women (median age: 65 years; range: 19-102), 1066 (23.4%) utilized PC. Patients were 24.9% low socioeconomic status (SES), 23.9% low-middle, 23.7% middle-high, and 25.1% high SES. Medicare, Medicaid, and private insurance coverage were listed at 46.2%, 37.5%, 11.3% of patients; 36.2%, 21.1%, 18.1%, 24.6% were treated in the South, West, Midwest, and Northeast. Over the 7 year study period, the use of PC increased from 12% to 45%. Older age (odds ratio [OR]: 1.36; 95% CI: 1.11-1.68; P = .003), high SES (OR: 1.41; 95% CI: 1.12-1.78; P = .003), more recent treatment (OR: 9.22; 95% CI: 6.8-12.51; P < .0001), private insurance (OR: 1.81; 95% CI: 1.46-2.25; P < .001), and treatment at large-volume hospitals (OR: 1.36; 95% CI: 1.04-1.77; P = .02), Western (OR: 2.00; 95% CI: 1.61-2.49; P < .001) and Midwestern hospitals (OR: 1.35; 95% CI: 1.08-1.68; P = .001) were associated with higher utilization of PC. Conclusions: The use of inpatient PC for patients with gynecologic cancer increased over time. The lower utilization of PC for terminal illness was associated with younger age, lower SES, government-issued insurance coverage, and treatment in Southern and smaller volume hospitals, and warrants further attention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trends in the Utilization of Palliative Care in Patients With Gynecologic Cancer Who Subsequently Died During Hospitalization

Milki

Mann

Gardner

et al. 2020

Am J Hosp Palliat Care

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“… 38 Indeed receipt of physician home-based visits for palliative care was very low across all disease trajectories in our data, which may be related to inadequate billing fees for home visits. 39 The limited availability of palliative care physician specialists may explain preferential access to patients with terminal illness, who may traditionally be easier to identify as needing palliative care. Considering the growing body of evidence of efficacious palliative care interventions for non-cancer diseases, 17–20 40 the marked disparities in access to patients without cancer ought to be a policy priority and will likely require overcoming the stigma of imminent death and medical failure as well as education on the benefits of early integration.…”

Section: Discussionmentioning

confidence: 99%

Access to palliative care by disease trajectory: a population-based cohort of Ontario decedents

et al. 2018

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ObjectivesTo examine access to palliative care between different disease trajectories and compare to other geographic areas.DesignA retrospective population-based decedent cohort study using linked administrative data.SettingOntario, Canada.ParticipantsOntario decedents between 1 April 2010 and 31 December 2012. Patients were categorised into disease trajectories: terminal illness (eg, cancer), organ failure (eg, chronic heart failure), frailty (eg, dementia), sudden death or other.InterventionsReceipt of palliative care services from institutional and community settings, derived from a validated list of palliative care codes from multiple administrate databases.Outcome measuresReceiving any palliative care services in the last year of life (yes/no), intensity (total days) and time of initiation of palliative care, in hospital and community sectors. Multivariable analysis examined the association between disease trajectory and the receipt of palliative care in the last year of life.ResultsWe identified 235 159 decedents in Ontario. In the last year of life, 88% of terminal illness, 44% of organ failure and 32% of frailty decedents accessed at least one palliative care service. Most care was provided during an inpatient hospitalisation. Terminal illness decedents received twice as many palliative care days (mean of 49 days) compared with organ failure and frailty decedents. Patients with terminal illness initiated palliative care median of 107 days before death compared with median of 19 days among those using the US Medicare hospice benefit.ConclusionsTerminal illness decedents are more likely to receive any palliative care, with increased intensity and earlier before death than organ failure or frailty decedents. These data serve as a useful comparison for other countries with similar and different healthcare systems and eligibility criteria.

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“…As patients progress closer to death, a patient’s growing needs may be met by shared care between palliative care generalists and specialists through consultation or through transfer of care to specialists for complex cases. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

How are physicians delivering palliative care? A population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life

et al. 2018

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Background:To enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets (‘generalist palliative care’). Specialists should have skills for managing complex and difficult cases (‘specialist palliative care’) and co-exist to support generalists through consultation care and transfer of care. Little information exists about the actual mixes of generalist and specialist palliative care.Aim:To describe the models of physician-based palliative care services delivered to patients in the last 12 months of life.Design:This is a population-based retrospective cohort study using linked health care administrative data.Setting/participants:Physicians providing palliative care services to a decedent cohort in Ontario, Canada. The decedent cohort consisted of all adults (18+ years) who died in Ontario, Canada between April 2011 and March 2015 (n = 361,951).Results:We describe four major models of palliative care services: (1) 53.0% of decedents received no physician-based palliative care, (2) 21.2% received only generalist palliative care, (3) 14.7% received consultation palliative care (i.e. care from both specialists and generalists), and (4) 11.1% received only specialist palliative care. Among physicians providing palliative care (n = 11,006), 95.3% had a generalist palliative care focus and 4.7% a specialist focus; 74.2% were trained as family physicians.Conclusion:We examined how often a coordinated palliative care model is delivered to a large decedent cohort and identified that few actually received consultation care. The majority of care, in both the palliative care generalist and specialist models, was delivered by family physicians. Further research should evaluate how different models of care impact patient outcomes and costs.

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Early Palliative Care: Taking Ownership and Creating the Conditions

Abstract: -

Cited by 20 publications

References 23 publications

Trends in the Utilization of Palliative Care in Patients With Gynecologic Cancer Who Subsequently Died During Hospitalization

Trends in the Utilization of Palliative Care in Patients With Gynecologic Cancer Who Subsequently Died During Hospitalization

Access to palliative care by disease trajectory: a population-based cohort of Ontario decedents

How are physicians delivering palliative care? A population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life

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