Place of Death among Hospitalized Patients with Cancer at the End of Life

Wallace, Susannah Kish; Waller, D. Kim; Tilley, Barbara C.; Piller, Linda B.; Price, Kristen; Rathi, Nisha; Haque, Sajid; Nates, Joseph L.

doi:10.1089/jpm.2014.0389

Cited by 15 publications

(9 citation statements)

References 21 publications

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“…The early provision of palliative care has been found to improve patient outcomes, 28 and consultations are associated with reduced intensive care unit admissions during hospitalization. 29 It is possible that palliative care consultations may have influenced some of the care patterns we observed, but we were unable to measure the impact. Finally, because we were unable to access hospice claims, outpatient medication use, or claims on the day of death for patients older than 65 years of age, we reported hospice use, opioid use, and place of death for patients younger than 65 years of age.…”

Section: Discussionmentioning

confidence: 95%

End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims

McDermott

Fedorenko

Kreizenbeck

et al. 2017

JOP

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Section: Discussionmentioning

confidence: 95%

End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims

McDermott

Fedorenko

Kreizenbeck

et al. 2017

JOP

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“…Notably, for patients remaining in a hospital bed as death approaches, even simple measures can increase the likelihood of a better quality of dying, e.g. having a single room, active communication with patients and relatives, providing nurses with training in EOL care and utilisingutilisng palliative care consultation services [19,20]. Percentage of cancer patients, who, at their time of death, had in their medical records a prescription of an injectable drug against pain (analgesic), anxiety (sedative), nausea (antiemetic), or pulmonary secretions (antimuscarinic) to be used as needed (PRN).…”

Section: Discussionmentioning

confidence: 99%

Cancer patients hospitalised in the last week of life risk insufficient care quality – a population-based study from the Swedish Register of Palliative Care

et al. 2019

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Background: One-quarter of all cancer deaths in Sweden occur in hospitals. If the place of death affects the quality of end-of-life (EOL) is largely unknown. Methods: This population-based, retrospective study included all adults cancer deaths reported to the Swedish Register of Palliative Care in 2011-2013 (N ¼ 41,729). Hospital deaths were compared to deaths occurring in general or specialised palliative care, or in nursing homes with respect to care quality indicators in the last week of life. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with specialised palliative home care as reference.Results: Preferred place of death was unknown for 63% of hospitalised patients and consistent with the actual place of death in 25% compared to 97% in palliative home care. Hospitalised patients were less likely to be informed when death was imminent (OR: 0.3; CI: 0.28-0.33) as were their families (OR: 0.51; CI: 0.46-0.57). Validated screening tools were less often used in hospitals for assessment of pain (OR: 0.32; CI: 0.30-0.34) or other symptoms (OR: 0.31; CI: 0.28-0.34) despite similar levels of EOL symptoms. Prescriptions of as needed drugs against anxiety (OR: 0.27; CI: 0.24-0.30), nausea (OR: 0.19; CI: 0.17-0.21), or pulmonary secretions (OR: 0.29; CI: 0.26-0.32) were less prevalent in hospitals. Bereavement support was offered after 57% of hospital deaths compared to 87-97% in palliative care units and 72% in nursing homes. Conclusions: Dying in hospital was associated with inferior end-of-life care quality among cancer patients in Sweden. ARTICLE HISTORY

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“…Palliative care has been shown to decrease the burden of debilitating symptoms, facilitate advanced care planning, prevent readmissions, avoid in-hospital death, and decrease healthcare utilization. [6][7][8][9][10][11] However, palliative care remains underused in patients with ESKD compared with other chronic diseases. 12 Poor knowledge of palliative care options has been reported by a majority of patients on dialysis and patients often continue dialysis until acute medical complications occur.…”

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confidence: 99%

Trends and Racial Disparities of Palliative Care Use among Hospitalized Patients with ESKD on Dialysis

Wen¹,

Jiang²,

Koncicki

et al. 2019

JASN

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BackgroundStudy findings show that although palliative care decreases symptom burden, it is still underused in patients with ESKD. Little is known about disparity in use of palliative care services in such patients in the inpatient setting.MethodsTo investigate the use of palliative care consultation in patients with ESKD in the inpatient setting, we conducted a retrospective cohort study using the National Inpatient Sample from 2006 to 2014 to identify admitted patients with ESKD requiring maintenance dialysis. We compared palliative care use among minority groups (black, Hispanic, and Asian) and white patients, adjusting for patient and hospital variables.ResultsWe identified 5,230,865 hospitalizations of such patients from 2006 through 2014, of which 76,659 (1.5%) involved palliative care. The palliative care referral rate increased significantly, from 0.24% in 2006 to 2.70% in 2014 (P<0.01). Black and Hispanic patients were significantly less likely than white patients to receive palliative care services (adjusted odds ratio [aOR], 0.72; 95% confidence interval [95% CI], 0.61 to 0.84, P<0.01 for blacks and aOR, 0.46; 95% CI, 0.30 to 0.68, P<0.01 for Hispanics). These disparities spanned across all hospital subtypes, including those with higher proportions of minorities. Minority patients with lower socioeconomic status (lower level of income and nonprivate health insurance) were also less likely to receive palliative care.ConclusionsDespite a clear increase during the study period in provision of palliative care for inpatients with ESKD, significant racial disparities occurred and persisted across all hospital subtypes. Further investigation into causes of racial and ethnic disparities is necessary to improve access to palliative care services for the vulnerable ESKD population.

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Place of Death among Hospitalized Patients with Cancer at the End of Life

Cited by 15 publications

References 21 publications

End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims

End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims

Cancer patients hospitalised in the last week of life risk insufficient care quality – a population-based study from the Swedish Register of Palliative Care

Trends and Racial Disparities of Palliative Care Use among Hospitalized Patients with ESKD on Dialysis

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