Palliative Care for Hospitalized Patients With Stroke

Singh, Thakar; Peters, Steven; Tirschwell, David; Creutzfeldt, Claire J.

doi:10.1161/strokeaha.117.016893

Cited by 74 publications

(27 citation statements)

References 33 publications

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“…US-based research has consistently found that women are more likely than men to be enrolled in hospice which is seemingly related to both provider and patient bias. 65 – 69 Saeed and colleagues 67 found that, among 383 patients with metastatic cancer, women were three times more likely than men to consider palliative care, even when controlling for disease factors, age, race, education and financial strain. The study authors explained the results as follows: there is a societal norm that men are supposed to be tough and invulnerable and there is a lot of vulnerability in seeking help and focusing on comfort care instead of always being in fighter mode.…”

Section: Gender and Hospice And Specialist Palliative Carementioning

confidence: 99%

Gender and palliative care: a call to arms

2020

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There has been a systematic and largely unconscious neglect of gender in palliative care research, practice and policy. This is despite significant, although previously uncollated, evidence that gender influences almost all aspects of end-of-life preferences, experiences and care. The social situations of women, transgender people and men often differ from one another while also intersecting in complex ways with sex differences rooted in biology. If palliative care is to meet its aspiration of providing universal benefit, it urgently needs to address a range of gender inequalities currently (re)produced at the level of the laboratory all the way through to government departments. In this call to arms, we spotlight specific instances where gender inequalities have been documented, for example, regarding end-of-life caregiving, end-of-life intervention and palliative care access and benefit. We highlight how gender inequalities intersect with other social determinants of health including ethnicity and economic status to exacerbate situations of marginality. We conclude by offering some practical steps that can be taken to support the discipline to adopt a more critical gender lens to support more equitable research, policy and practice.

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Section: Gender and Hospice And Specialist Palliative Carementioning

confidence: 99%

Gender and palliative care: a call to arms

2020

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“…Four studies, using medical chart reviews, found that there were no racial differences in rate of inpatient palliative care consult (Bhatraju, Friedenberg, Uppal, & Evans, 2014;Burgio et al, 2016), time to inpatient palliative care consult (Worster et al, 2018), or use of outpatient palliative care services (Kumar et al, 2012). However, three studies using the NIS, a nationwide, population-based database of inpatient care in the United States, found that minority patients received fewer palliative care services (Faigle et al, 2017;Rush et al, 2017;Singh et al, 2017). Two studies, examining the rates of palliative care use in cancer patients, found that African American patients actually received more palliative care services than white and other minority patients (Rosenfeld et al, 2018;Sharma et al, 2015).…”

Section: Disparities In Palliative and End-of-life Carementioning

confidence: 99%

Racial and Ethnic Disparities in Palliative Care: A Systematic Scoping Review

Gardner

Doherty

Bates

et al. 2018

Families in Society

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Beginning with the modern hospice movement over a half century ago, palliative care has provided patient-centered, evidence-informed care that reduces symptom burden, limits unnecessary hospitalizations, and increases well-being for individuals and families living with serious illness. Despite well-documented advances in specialist palliative care and the proliferation of programs around the nation (Dumanovsky et al., 2016), significant gaps in access and utilization persist (Goldsmith, Dietrich, Du, & Morrison, 2008; Smith & Brawley, 2014). Reflecting systemic inequities in health and health care, disparities in palliative and end-of-life care are experienced by communities of color; people who are economically disadvantaged; lesbian, gay, bisexual, and transgender individuals; and members of other marginalized groups. African 809083F ISXXX10.

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“…This set off a cascade of initiatives aimed at increasing PC utilization by augmenting PC certification among surgeons, encouraging PC specialist referrals, and providing education about palliative treatment strategies in daily surgical practice. [7–9,11–17]…”

Section: Discussionmentioning

confidence: 99%

“…[45–47] Hospitals that were academic, not-for-profit, and of larger bedsize also had higher rates of use, consistent with multiple prior studies showing higher prevalence of PC programs, and naturally higher utilization of PC, in hospitals with these same features. [17,18,23,44,45]…”

Section: Discussionmentioning

confidence: 99%

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Regional Differences in Palliative Care Utilization Among Geriatric Colorectal Cancer Patients Needing Emergent Surgery

Heller

Jean

Chiu

et al. 2019

Journal of Gastrointestinal Surgery

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Background: The benefits of palliative care (PC) in critical illness are validated across a range of diseases, yet it remains underutilized in surgical patients. This study analyzed patient and hospital factors predictive of PC utilization for elderly patients with colorectal cancer (CRC) requiring emergent surgery. Methods: The National Inpatient Sample was queried for patients aged ≥65 years admitted emergently with CRC from 2009–2014. Patients undergoing colectomy, enterectomy or ostomy formation were included and stratified according to documentation of PC consultation during admission. Chi-squared testing identified unadjusted group differences, and multivariable logistic regression identified predictors of PC. Results: Of 86,573 discharges meeting inclusion criteria, only 3,598 (4.2%) had PC consultation. Colectomy (86.6%) and ostomy formation (30.4%) accounted for the operative majority. PC frequency increased over time (2.9% in 2009 to 6.2% in 2014, P<0.001) and was nearly twice as likely to occur in the West compared with the Northeast (5.7% vs 3.3%, P<0.001) and in not-for-profit compared with proprietary hospitals (4.5% vs 2.3%, P<0.001). PC patients were more likely to have metastases (60.1% vs 39.9%, P<0.001) and die during admission (41.5% vs 6.4%, P<0.001). On multivariable logistic regression, PC predictors (P<0.05) included region outside the Northeast, increasing age, more recent year, and metastatic disease. Conclusions: In the U.S., PC consultation for geriatric patients with surgically-managed complicated CRC is low. Regional variation appears to play an important role. With mounting evidence that PC improves quality of life and outcomes, understanding the barriers associated with its provision to surgical patients is paramount.

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Palliative Care for Hospitalized Patients With Stroke

Abstract: Supplemental Digital Content is available in the text.

Cited by 74 publications

References 33 publications

Gender and palliative care: a call to arms

Gender and palliative care: a call to arms

Racial and Ethnic Disparities in Palliative Care: A Systematic Scoping Review

Regional Differences in Palliative Care Utilization Among Geriatric Colorectal Cancer Patients Needing Emergent Surgery

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