Secondary and Tertiary Palliative Care in US Hospitals

Gunten, Charles F. von

doi:10.1001/jama.287.7.875

Cited by 178 publications

(99 citation statements)

References 34 publications

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“…Our model is consistent with the classification of palliative care services proposed by von Gunten, 35 in which lowdemand patients would benefit from primary palliative care delivered by their oncologists, and patients with more severe distress would require secondary and tertiary palliative care provided by a specialist interdisciplinary teams.…”

Section: Figsupporting

confidence: 81%

Conceptual Models for Integrating Palliative Care at Cancer Centers

Bruera

Hui

2012

Journal of Palliative Medicine

115

104

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Palliative care programs are rapidly evolving in acute care facilities. Increased and earlier access has been advocated for patients with life-threatening illnesses. Existing programs would need major growth to accommodate the increased utilization. The objective of this review is to provide an update on the current structures, processes, and outcomes of the Supportive and Palliative Care Program at the University of Texas M.D. Anderson Cancer Center (UTMDACC), and to use the update as a platform to discuss the challenges and opportunities in integrating palliative and supportive services in a tertiary care cancer center. Our interprofessional program consists of a mobile consultation team, an acute palliative care unit, and an outpatient supportive care clinic. We will discuss various metrics including symptom outcomes, quality of end-of-life care, program growth, and financial issues. Despite the growing evidence to support early palliative care involvement, referral to palliative care remains heterogeneous and delayed. To address this issue, we will discuss various conceptual models and practical recommendations to optimize palliative care access.

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Section: Figsupporting

confidence: 81%

Conceptual Models for Integrating Palliative Care at Cancer Centers

Bruera

Hui

2012

Journal of Palliative Medicine

115

104

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“…(5,6) Conceptually, people living with life-limiting illnesses comprise three broad groups. (7) The majority have their care needs met by their support networks and primary care providers, including generalist, specialist, and allied health staff. A second group comprise those with more episodic increases in level of need that require access to PC services while continuing to receive care from their health care team.…”

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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“…7 Although palliative care can be delivered by specialists through a range of clinical models, the predominant delivery model in the United States (outside of hospice) is the hospital palliative care consultation team. 8,9 Palliative care consultation, like other specialist consultation, is typically initiated at the request of the treating physician. Consultation teams communicate their recommendations back to the referring physician for implementation.…”

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confidence: 99%

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

et al. 2011

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Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004-07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. These reductions included $4,098 in hospital costs per admission for patients discharged alive, and $7,563 for patients who died in the hospital. Consistent with the goals of a majority of patients and their families, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than the matched usual care patients. We estimate that the reductions in Medicaid hospital spending in New York State could eventually range from $84 million to $252 million annually (assuming that 2 percent and 6 percent of Medicaid patients discharged from the hospital received palliative care, respectively), if every hospital with 150 or more beds had a fully operational palliative care consultation team.

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Secondary and Tertiary Palliative Care in US Hospitals

Cited by 178 publications

References 34 publications

Conceptual Models for Integrating Palliative Care at Cancer Centers

Conceptual Models for Integrating Palliative Care at Cancer Centers

Barriers to accessing palliative care: A review of the literature

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

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