Promoting Excellence in End-of-Life Care: A Report on Innovative Models of Palliative Care

Byock, Ira; Twohig, Jeanne Sheils; Merriman, Melanie P.; Collins, Karyn

doi:10.1089/jpm.2006.9.137

Cited by 77 publications

(65 citation statements)

References 31 publications

(68 reference statements)

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“…At present, less than 1% of the National Institutes of Health's (NIH) budget is dedicated to palliative care, although there have been substantial increases (240%) in NIH-funded investigators (now 294) and grants (now 391) since 2006 (38). Some foundations have funded innovative research and demonstration projects www.annualreviews.org • Growth of Palliative Care in the US (15), and institutional programs have been created to try to build the research base (71). But more funding support is needed to further the research agenda.…”

Section: Barriers To Further Integration Of Palliative Carementioning

confidence: 99%

The Growth of Palliative Care in the United States

Hughes

Smith

2014

Annu. Rev. Public Health

204

146

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Palliative care has been one of the most rapidly growing fields of health care in the United States in the past decade. The benefits of palliative care have now been shown in multiple clinical trials, with increased patient and provider satisfaction, equal or better symptom control, more discernment of and honoring choices about place of death, fewer and less intensive hospital admissions in the last month of life, less anxiety and depression, less caregiver distress, and cost savings. The cost savings come from cost avoidance, or movement of a patient from a high cost setting to a lower cost setting. Barriers to expanded use include physician resistance, unrealistic expectations of patients and families, and lack of workforce. The future of palliative care includes more penetration into other fields such as nephrology, neurology, and surgery; further discernment of the most effective and cost-effective models; and establishment of more outpatient services.

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Section: Barriers To Further Integration Of Palliative Carementioning

confidence: 99%

The Growth of Palliative Care in the United States

Hughes

Smith

2014

Annu. Rev. Public Health

204

146

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“…The Robert Wood Johnson Foundation's, ''Promoting Excellence in Endof-Life Care'' program funded demonstration projects 23,24 of collaborations between hospices and cancer centers to determine the feasibility of integrating palliative care concepts at the time of diagnosis into the care of patients with advanced cancer. 22 The project was initiated at 3 sites in New Hampshire: a National Cancer Institute (NCI)-designated comprehensive cancer center, a community oncology practice, and a small rural community outreach clinic.…”

Section: Setting and Samplementioning

confidence: 99%

Proxy perspectives regarding end‐of‐life care for persons with cancer

Bakitas

Ahles

Skalla

et al. 2008

Cancer

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BACKGROUNDEach year, greater than a half million people die of cancer in the U.S. Despite progress in increasing access to palliative oncology services, end‐of‐life care still needs improvement. Measuring the quality of the end‐of‐life experience is difficult because of patient debility and reduced consciousness as death approaches. Family proxies have been proposed as valuable informants regarding the quality of end‐of‐life care. This article describes family proxy perspectives concerning care at the end of life in patients who died of advanced cancer.METHODSIn the context of a novel outpatient palliative care demonstration project, 125 family proxy respondents completed a structured survey by telephone 3 months to 6 months after the patient's death from breast, lung, or gastrointestinal cancer. Four key quality of care indicators were measured: decision‐making and physician communication, location of death, hospice involvement, and end‐of‐life symptoms.RESULTSProxies reported that 78% to 81% of patients completed at least 1 form of advance directive and approximately half of them were helpful in guiding care. Communication with physicians regarding end‐of‐life treatment wishes occurred in 67% of cases, but only 57% of the patients actually made a plan with their physician to ensure that their wishes were followed. The majority of patients died in their location of choice, most often at home, and greater than half had hospice involvement for an average of 41.8 days before death. During the last week of life, the majority of patients experienced troublesome physical and emotional symptoms.CONCLUSIONSMeasurement of proxy perspectives is feasible as an indicator of the quality of end‐of‐life care, and the results of the current study provide actionable data for areas of improvement in palliative oncology care. Cancer 2008. © 2008 American Cancer Society.

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“…These programs combine cancer care and palliative care or hospice services and appear to offer many benefits, including increased rates of hospice enrollment and earlier hospice use, [26][27][28][29] decreased emergency room visits and hospitalization, 30 increased retention in studies, 26 improved quality of life, 29,31 and possible cost savings. 27,32 Care coordination provided by a trained palliative care nurse is a common feature of many of these programs. This may be a feasible palliative care service model for advanced cancer patients, including phase 1 participants, who are well enough to receive anticancer treatment.…”

mentioning

confidence: 99%

Do phase 1 patients have greater needs for palliative care compared with other cancer patients?

Finlay

Henderson

et al. 2009

Cancer

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BACKGROUND:Phase 1 oncology trial participants often are excluded from hospice. However, it is not known whether they would benefit from hospice services. The objectives of the current study were to define the palliative care needs of these patients and to determine whether their needs are greater than those of other cancer patients.METHODS:Two hundred ninety‐seven patients who were undergoing cancer therapy and 69 patients who were enrolled in phase 1 trials at 7 oncology clinics in an urban cancer network were recruited and consented to participate in interviews. Interviewers assessed the prevalence and severity of 10 symptoms using the Global Distress Index of the Memorial Symptom Assessment Scale and patients' perceived need for 4 services typically provided through hospice: a chaplain, counselor, home health aide, and visiting nurse.RESULTS:Patients in the 2 groups had a similar symptom burden. However, after adjusting for Eastern Cooperative Oncology Group performance status scores, phase 1 patients were more likely to have 5 of the 10 symptoms and reported greater severity for 6 of the 10 symptoms. Compared with other patients, phase 1 patients were less likely to say they needed a home health aide (4 of 69 patients [6%] vs 198 of 297 patients [67%]), a chaplain (7 of 69 patients [10%] vs 134 of 297 patients [45%]), or a counselor (11 of 69 patients [16%] vs 160 of 297 patients [54%]; chi‐square test: P < .001 for all). They were equally likely to say they needed a visiting nurse (30 of 69 patients [44%] vs 142 of 297 patients [48%]; chi‐square test: P = .516).CONCLUSIONS:Compared with other patients who had cancer, patients who were participating in phase 1 trials were less likely to want several home care services, although they experienced a greater symptom burden. Further research will be needed to define the palliative care needs of this population. Cancer 2009. © 2009 American Cancer Society.

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Promoting Excellence in End-of-Life Care: A Report on Innovative Models of Palliative Care

Cited by 77 publications

References 31 publications

The Growth of Palliative Care in the United States

The Growth of Palliative Care in the United States

Proxy perspectives regarding end‐of‐life care for persons with cancer

Do phase 1 patients have greater needs for palliative care compared with other cancer patients?

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