End-of-Life Preferences, Length-of-Life Conversations, and Hospice Enrollment in Palliative Care: A Direct Observation Cohort Study among People with Advanced Cancer

Gramling, Robert; Ingersoll, Luke T; Anderson, Wendy G.; Priest, Jeff S.; Berns, Stephen; Cheung, Katharine L.; Norton, Sally A.; Alexander, Stewart C.

doi:10.1089/jpm.2018.0476

Cited by 20 publications

(19 citation statements)

References 19 publications

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“…Cancer types included breast, 42 hematological, 35,33 gynecological, 1,34,48 lung or gastrointestinal, 39 and any type. 23,31,32,[36][37][38]40,41,43,45,46,48,51 Sample sizes ranged from 84 to 2752 participants, with a median of 226 participants per study. Two studies featured fewer than 100 participants.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…36,37,43 No studies examined the impact of out-of-pocket costs on patients. Eighteen studies assessed relationships between EOL discussions and health-care utilization near death 1,23,[32][33][34][35][38][39][40][41][42][43][45][46][47][48]51 and 6 studies assessed place of death. 1,33,35,42,47,51 In addition, 6 studies incorporated elements of time in their assessment of EOL discussions, generally referring to these discussions as early (31þ days before death) or late (within 30 days of death), with later conversations typically occurring in inpatient settings.…”

Section: Description Of Studiesmentioning

confidence: 99%

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Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review

Starr

Ulrich

Corey

et al. 2019

Am J Hosp Palliat Care

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Background: Aggressive end-of-life (EOL) care is associated with lower quality of life and greater regret about treatment decisions. Higher EOL costs are also associated with lower quality EOL care. Advance care planning and goals-of-care conversations (“EOL discussions”) may influence EOL health-care utilization and costs among persons with cancer. Objective: To describe associations among EOL discussions, health-care utilization and place of death, and costs in persons with advanced cancer and explore variation in study measures. Methods: A systematic review was conducted using PubMed, Embase, and CINAHL. Twenty quantitative studies published between January 2012 and January 2019 were included. Results: End-of-life discussions are associated with lower health-care costs in the last 30 days of life (median US$1048 vs US$23482; P < .001); lower likelihood of acute care at EOL (odds ratio [(OR] ranging 0.43-0.69); lower likelihood of intensive care at EOL (ORs ranging 0.26-0.68); lower odds of chemotherapy near death (ORs 0.41, 0.57); lower odds of emergency department use and shorter length of hospital stay; greater use of hospice (ORs ranging 1.79 to 6.88); and greater likelihood of death outside the hospital. Earlier EOL discussions (30+ days before death) are more strongly associated with less aggressive care outcomes than conversations occurring near death. Conclusions: End-of-life discussions are associated with less aggressive, less costly EOL care. Clinicians should initiate these discussions with patients having cancer earlier to better align care with preferences.

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Section: Description Of Studiesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review

Starr

Ulrich

Corey

et al. 2019

Am J Hosp Palliat Care

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“…Therefore, it is crucial to understand at what point it is time to talk about the end-of-life (EOL) and how. Research has shown that talking about and planning the EOL is important for how the final days in a patient’s life may play out and is associated with reduced costs as well as a higher quality of care in the final weeks of life [ 2 – 4 ]. A recent Danish study has even shown that patients engaged in EOL planning have a significantly increased life expectancy [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

2020

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Background End-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting. Aim The purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease. Methods This study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents’ thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting. Results This study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients’ everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries. Conclusion The wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions.

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“…For this study, we used data from the Palliative Care Communication Research Initiative (PCCRI), a multi-site cohort study of naturally occurring inpatient palliative care consultations (15,16). The PCCRI was designed to understand the relation between clinical communication and patient-centered outcomes.…”

Section: Datamentioning

confidence: 99%

Exploring Heterogeneity in Moral Terminology in Palliative Care Consultations

Broek-Altenburg¹,

Gramling²,

Gothard³

et al. 2020

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Background High quality serious illness communication requires good understanding of patients' values and beliefs for their treatment at end of life. Natural Language Processing (NLP) offers a reliable and scalable method for measuring and analyzing value- and belief-related features of conversations in the natural clinical setting. We use a validated NLP corpus and a series of statistical analyses to capture and explain conversation features that characterize the complex domain of moral values and beliefs. The objective of this study was to examine the frequency, distribution and clustering of morality lexicon expressed by patients during palliative care consultation using the Moral Foundations NLP Dictionary.Methods We used text data from 231 audio-recorded and transcribed inpatient PC consultations and data from baseline and follow-up patient questionnaires at two large academic medical centers in the United States. With these data, we identified different moral expressions in patients using text mining techniques. We used latent class analysis to explore if there were qualitatively different underlying patterns in the PC patient population. We used Poisson regressions to analyze if individual patient characteristics, EOL preferences, religion and spiritual beliefs were associated with use of moral terminology.Results We found two latent classes: a class in which patients did not use many expressions of morality in their PC consultations and one in which patients did. Age, race (white), education, spiritual needs, and whether a patient was affiliated with Christianity or another religion were all associated with membership of the first class. Gender, financial security and preference for longevity-focused over comfort focused treatment near EOL did not affect class membership.Conclusions This study is among the first to use text data from a real-world situation to extract information regarding individual foundations of morality. It is the first to test empirically if individual moral expressions are associated with individual characteristics, attitudes and emotions.

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End-of-Life Preferences, Length-of-Life Conversations, and Hospice Enrollment in Palliative Care: A Direct Observation Cohort Study among People with Advanced Cancer

Cited by 20 publications

References 19 publications

Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review

Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

Exploring Heterogeneity in Moral Terminology in Palliative Care Consultations

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