Interval between First Palliative Care Consult and Death in Patients Diagnosed with Advanced Cancer at a Comprehensive Cancer Center

Osta, Badi El; Palmer, J. Lynn; Paraskevopoulos, Timotheos; Pei, Be Lian; Roberts, Lynn; Poulter, V.; Chacko, Ray; Bruera, Éduardo

doi:10.1089/jpm.2007.0103

Cited by 156 publications

(112 citation statements)

References 19 publications

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“…Similar findings have also been reported elsewhere (Lamont and Christakis, 2002;Ahmed et al, 2004;Cheng et al, 2005;Osta et al, 2008). However, the higher survival rate for patients >65 years of age found in the present study contrasts with other results that link earlier referral to palliative care with younger age (Ahmed et al, 2004;Cheng et al, 2005;Osta et al, 2008). This, along with the average age of the patients in the present study (Beccaro et al, 2007;Mercadante and Vitrano, 2010).…”

supporting

confidence: 88%

Transitions between care settings after enrolment in a palliative care service in Italy: a retrospective analysis

D’Angelo

Vellone²,

Alvaro³

et al. 2013

Int J Palliat Nurs

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This study was a retrospective analysis of prospectively collected data that aimed to map patients' care transitions following admission to a specialist palliative care service in Italy called Antea Centre. Patients' data was extracted from the Antea local database from 2007 to 201 I. External transitions were defined as a change in the setting of care, with the patient no longer being cared for by Antea staff. Internal transitions were defined as a change in the setting of care, with the care still being provided by Antea staff. A total of I 123 patients out of 5313 admitted to the palliative service (21%) experienced transitions. Patients who experienced no transitions after their admission to the palliative care service were more likely to have a Karnofsky Performance Scale Index <30, to have been referred by a hospital physician, to have a shorter survival time, and to have home as their place of death (P<0.001).Although the patients with no transitions had worse clinical conditions, organisations should pay attention to reducing the possible negative effects of transitions, such as discontinuity of care and poor coordination.

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supporting

confidence: 88%

Transitions between care settings after enrolment in a palliative care service in Italy: a retrospective analysis

D’Angelo

Vellone²,

Alvaro³

et al. 2013

Int J Palliat Nurs

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“…(3,4) Despite the demonstrated benefits, PC use is often less than optimal and opportunities are frequently missed. Table 1.…”

Section: Referral To Palliative Carementioning

confidence: 99%

“…(3,4) Despite the demonstrated benefits, PC use is often less than optimal and opportunities are frequently missed. (5,6) Conceptually, people living with life-limiting illnesses comprise three broad groups.…”

Section: Referral To Palliative Carementioning

confidence: 99%

Barriers to accessing palliative care: A review of the literature

Love

Liversage

2013

Progress in Palliative Care

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The aim was to review factors affecting patients' access to palliative care. First, the benefits of palliative care for comprehensive care of patients and their families are identified. Despite these benefits, universal standards for access are lacking and referral typically occurs later than is recommended, limiting access to best practice care. Factors relating to access are reviewed in detail. They are grouped conceptually, combining those related to organisational factors, patient and family-related issues, which include characteristics of patients, preferences for curative care, and willingness to discuss and participate in palliative care, and factors attributed to physicians and health professionals, such as communication styles, sense of efficacy, perceptions of patient readiness, and knowledge of palliative care. Despite the accumulated evidence, the existing studies share methodological weaknesses, which are (1) Yet referrals to PC can still be untimely, poorly managed, or delayed. An earlier review of the literature has identified the problems and issues associated with accessing PC.(2) The aim of this paper is to review the literature published in the decade since, addressing factors associated with access to PC services and to suggest aspects of access to PC requiring further investigation. Referral to palliative careMany studies have demonstrated that earlier access to palliative care may have positive benefits, addressing issues such as anticipatory grief and loss throughout the trajectory, facilitating improved symptom management, improved mood, and overall quality of life. (3,4) Despite the demonstrated benefits, PC use is often less than optimal and opportunities are frequently missed. Table 1.Insert Table 1 about here Factors affecting access to palliative care servicesIn order to conceptualise the many interrelated factors that have been identified as affecting access to PC services, a theoretical model was devised (Figure 1). Patients are considered as part of a family system, including carers and other family members. Health care teams are spearheaded by treating physicians and are part of health organisations.Communication factors between patients and families and health care teams create the foundation on which relationships are formed. There is a broader context: the wider health care system and social and cultural factors are important influences on access to PC services.

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“…However, unlike hospice care, which requires that patients have a limited life expectancy and forego many life-prolonging treatments, palliative care may be offered at any stage of a serious illness and can be provided concomitantly with standard oncology care. 3 Accumulating evidence that subspecialty palliative care improves patient and caregiver outcomes, [4][5][6] coupled with the recognition that palliative care services are most often offered too late in the cancer care continuum, 7 has led the National Comprehensive Cancer Network to recommend that oncologists inform all patients and families earlier about the role and benefits of palliative care. 1 Public interest campaigns have focused on increasing patient-driven requests for palliative care services.…”

Section: Introductionmentioning

confidence: 99%

Do Patients with Advanced Cancer and Unmet Palliative Care Needs Have an Interest in Receiving Palliative Care Services?

Schenker¹,

Park

Maciasz

et al. 2014

Journal of Palliative Medicine

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Background: It is not known whether unmet palliative care needs are associated with an interest in palliative care services among patients with advanced cancer receiving ongoing oncology care. Objective: To assess the association between unmet palliative care needs and patient interest in subspecialty palliative care services. Design: Cross-sectional telephone survey. Subjects and setting: One hundred sixty-nine patients with advanced cancer receiving care from 20 oncologists at two academic cancer centers. Measurements: Surveys assessed palliative care needs in six domains. Patients were read a description of palliative care and then asked three questions about their current interest in subspecialty palliative care services (perceived need, likelihood of requesting, willingness to see if their oncologist recommended; all outcomes on 0-10 Likert scale). Results: The vast majority of patients described unmet palliative care needs, most commonly related to psychological/emotional distress (62%) and symptoms (62%). In fully adjusted models accounting for clustering by oncologist, unmet needs in these domains were associated with a higher perceived need for subspecialty palliative care services (psychological/emotional needs odds ratio [OR] 1.30; 95% confidence interval [CI] 1.06-1.58; p = 0.01; symptom needs OR 1.27; 95% CI 1.01-1.60; p = 0.04). There was no significant association between unmet needs and likelihood of requesting palliative care services. Willingness to see palliative care if oncologist recommended was high (mean 8.6/10, standard deviation [SD] 2). Conclusion: Patients with advanced cancer and unmet symptom and psychological/emotional needs perceive a high need for subspecialty palliative care services but may not request them. Efforts to increase appropriate use of subspecialty palliative care for cancer may require oncologist-initiated referrals.

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Interval between First Palliative Care Consult and Death in Patients Diagnosed with Advanced Cancer at a Comprehensive Cancer Center

Cited by 156 publications

References 19 publications

Transitions between care settings after enrolment in a palliative care service in Italy: a retrospective analysis

Transitions between care settings after enrolment in a palliative care service in Italy: a retrospective analysis

Barriers to accessing palliative care: A review of the literature

Do Patients with Advanced Cancer and Unmet Palliative Care Needs Have an Interest in Receiving Palliative Care Services?

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