Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses

Wachterman, Melissa; Pilver, Corey E.; Smith, Dawn; Ersek, Mary; Lipsitz, Stuart R.; Keating, Nancy L.

doi:10.1001/jamainternmed.2016.1200

Cited by 270 publications

(297 citation statements)

References 45 publications

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“…https://doi.org/10.14475/kjhpc.2018.21.1.23 comparable or higher symptom burdens (i.e., shortness of breath, fatigue, pain, depression, and anxiety) (6,9-11) and poor QOL (11,12) compared to patients with any other advanced chronic illness.…”

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confidence: 99%

“…Palliative care is well-recognized as an optimal comprehensive approach for critically ill patients, particularly during EOL (12)(13)(14). It has been shown that a hospital-based palliative care service leads to positive patient satisfaction, fewer hospital admissions and in-hospital deaths, less invasive EOL treatments, or fewer hospital expenditures, all of which in turn promote quality of life (13)(14)(15)(16)(17)(18)(19).…”

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confidence: 99%

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Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

Kim

Shen

et al. 2018

Korean J Hosp Palliat Care

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confidence: 99%

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confidence: 99%

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

Kim

Shen

et al. 2018

Korean J Hosp Palliat Care

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“…66,67 Patients with advanced kidney disease receive more aggressive care near the end of life than patients with other chronic illnesses, including death in the hospital and intensive care unit. 17–19 These disparities may negatively affect patient and bereaved caregiver symptoms and mental health at the end of life. 68–70 One approach to identify patients and caregivers who could benefit from advance care planning and supportive care would be the use of validated mortality risk prediction models for non–dialysis-dependent CKD.…”

Section: Discussionmentioning

confidence: 99%

“…11–16 These gaps may also result in the delivery of aggressive life-prolonging care that frequently misaligns with patients’ values and preferences. 13,15,17–19 …”

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confidence: 99%

Reliability and Utility of the Surprise Question in CKD Stages 4 to 5

Javier

Figueroa

Siew

et al. 2017

American Journal of Kidney Diseases

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Background Prognostic uncertainty is one barrier to engaging in goals-of-care discussions in chronic kidney disease (CKD). The surprise question (“Would you be surprised if this patient died in the next 12 months?”) is a tool to assist in prognostication. However, it has not been studied in non–dialysis-dependent CKD and its reliability is unknown. Study Design Observational study Setting & Participants 388 patients at least 60 years of age, with non–dialysis-dependent CKD stages 4–5, who were seen at an outpatient nephrology clinic. Predictor Trinary (i.e., ‘Yes’, ‘Neutral’, ‘No’) and binary (‘Yes’, ‘No’) surprise question response. Outcomes Mortality, test-retest reliability, and blinded inter-rater reliability Measurements Baseline comorbidities, Charlson comorbidity index, cause of CKD, and baseline laboratory values (i.e., serum creatinine/estimated glomerular filtration rate, serum albumin, and hemoglobin). Results The median patient age was 71 years with median follow-up of 1.4 years, during which time 52 (13%) patients died. Using the trinary surprise question, providers responded ‘Yes’, ‘Neutral’, and ‘No’ for 202 (52%), 80 (21%), 106 (27%) patients, respectively. About 5%, 15%, and 27% of ‘Yes’, ‘Neutral’, and ‘No’ patients died, respectively (p<0.001). The trinary surprise question inter-rater reliability was 0.58 (95% CI, 0.42–0.72) and the test-retest reliability was 0.63 (95% CI, 0.54–0.72). The trinary surprise question ‘No’ response had a sensitivity and specificity of 55% and 76%, respectively (95% CIs, 38%-71% and 71%-80%, respectively). The binary surprise question had a sensitivity of 66% (95% CI, 49%-80%; p=0.3 vs trinary) but a lower specificity of 68% (95% CI, 63%-73%; p=0.02 vs trinary). Limitations Single center, small number of deaths. Conclusions The surprise question associates with mortality in CKD stages 4–5 and demonstrates moderate to good reliability. Future studies should examine how best to deploy the surprise question to facilitate advance care planning in advanced non–dialysis-dependent CKD.

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“…This study did not examine patient outcomes separately. Other studies have demonstrated that quality of end-of-life care is significantly better for those with cancer and dementia than for patients with end stage renal failure,4 a phenomenon also observed in chronic lung disease 2. A retrospective audit of deceased patients under the care of a regional interstitial lung disease (ILD) service highlighted that 24% of patients had unmet palliative and supportive care needs 5…”

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confidence: 99%

Development of tools to facilitate palliative and supportive care referral for patients with idiopathic pulmonary fibrosis

Sharp

Lamb

Jordan

et al. 2017

BMJ Support Palliat Care

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Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses

Cited by 270 publications

References 45 publications

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

Reliability and Utility of the Surprise Question in CKD Stages 4 to 5

Development of tools to facilitate palliative and supportive care referral for patients with idiopathic pulmonary fibrosis

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