Impact of an Inpatient Palliative Care Consultation in Terminally Ill Cancer Patients

Blue, Brandon; Vegunta, Radhakrishna; Rodin, Miriam B.; Patolia, Setu; Poddar, Nishant

doi:10.7759/cureus.3016

Cited by 5 publications

(8 citation statements)

References 10 publications

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“…Perceived time to death or death acting as a mediator on the relationship between race and receipt of IPCC may contribute to the mixed findings of the association between race and IPCC in the literature. [21][22][23][24][25][26] Although several studies have found higher odds of IPCC for hospitalized black patients with cancer, a few have found no difference or higher odds of IPCC for black patients compared to white patients. [21][22][23][24][25][26] However, only one of these studies investigated death as a mediator of receipt of IPCC.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24][25][26] Although several studies have found higher odds of IPCC for hospitalized black patients with cancer, a few have found no difference or higher odds of IPCC for black patients compared to white patients. [21][22][23][24][25][26] However, only one of these studies investigated death as a mediator of receipt of IPCC. 25 The absence of measurement of the potential mediator of death could explain the differences among these studies as highlighted by our findings of a transposed relationship between black race and IPCC when stratified by death.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19][20] Furthermore, studies evaluating the use of nonhospice-based palliative care are often limited to a single center, a single type of malignancy, or do not specifically aim to investigate racial disparities in health care. [21][22][23][24][25][26] Black patients have higher rates of emergency department visits, hospitalizations, and intensive care unit care at EOL compared to white patients. 6,27,28 Inpatient palliative care consultations (IPCC) offer a unique opportunity to introduce black patients and their families to non-hospice-based palliative care services as blacks are more likely to be treated at the EOL in an inpatient setting.…”

Section: Introductionmentioning

confidence: 99%

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Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies

Lee

Gani

Canner

et al. 2020

Am J Hosp Palliat Care

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Background: There is increasing recognition of the importance of early incorporation of palliative care services in the care of patients with advanced cancers. Hospice-based palliative care remains underutilized for black patients with cancer, and there is limited literature on racial disparities in use of non-hospice-based palliative care services for patients with cancer. Objective: The primary objective of this study is to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Design: This retrospective cohort study analyzed 204 175 hospital admissions of patients with advanced cancers between 2012 and 2014. The cohort was identified through the National Inpatient Dataset. International Classification of Disease, Ninth Revision codes were used to identify receipt of a palliative care consultation. Results: Of this, 57.7% of those who died received IPCC compared to 10.5% who were discharged alive. In multivariable logistic regression models, black patients discharged from the hospital, were significantly less likely to receive a palliative care consult compared to white patients (odds ratio [OR] black: 0.69, 95% CI: 0.62-0.76). Conclusions: Death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There are significant racial disparities in the utilization of IPCC for patients with advanced cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies

Lee

Gani

Canner

et al. 2020

Am J Hosp Palliat Care

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“…49 Delay of initiation of outpatient palliative care consultation among non-Hispanic Black cancer patients also highlights a racial disparity. 53 Ahluwalia and colleagues (2018) examined 139 systematic reviews published after 2013, when the third edition of National Consensus Project Clinical Practice Guidelines for Quality Palliative Care was published. The main objective of this comprehensive review was to provide a synthesis of the evidence in palliative care to improve the next (fourth) edition of these guidelines.…”

Section: Methodsmentioning

confidence: 99%

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Bazargan

Bazargan‐Hejazi

2020

Am J Hosp Palliat Care

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Objectives: Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. Methods: The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. Discussion: Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.

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“…29 Given the severity of disease and poor prognosis in this patient cohort, we expected a higher consultation rate. [33][34][35][36][37][38] It is possible that providers did not consider involvement of palliative care until all life-prolonging measures had been attempted or exhausted. This is supported by the low rates of documented GoC discussions, leaving little time to involve palliative care providers prior to a patient's death.…”

Section: Discussionmentioning

confidence: 99%

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

Brooten

Buckenheimer

Hallmark

et al. 2020

WestJEM

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Introduction: Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality. Methods: This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults. Results: We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%. Conclusion: The majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area. [West J Emerg Med. 2020;21(4)935-942.]

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Impact of an Inpatient Palliative Care Consultation in Terminally Ill Cancer Patients

Cited by 5 publications

References 10 publications

Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies

Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

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