The Prevalence of Inpatients at 33 U.S. Hospitals Appropriate for and Receiving Referral to Palliative Care

Szekendi, Marilyn; Vaughn, Jocelyn; Lal, Ashima; Ouchi, Kei; Williams, Mark

doi:10.1089/jpm.2015.0236

Cited by 57 publications

(51 citation statements)

References 31 publications

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“…Of these, in 15 articles – 4 systematic reviews and 11 revision articles – several variables considered as useful factors to initiate PC based on a foreseeable 1-year mortality were selected for subsequent analysis 6,15–31. Additionally, a total of 28 COPD clinical practice guidelines were reviewed.…”

Section: Resultsmentioning

confidence: 99%

Palliative care and prognosis in COPD: a systematic review with a validation cohort

Almagro¹,

Yun²,

Sangil³

et al. 2017

COPD

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Current recommendations to consider initiation of palliative care (PC) in COPD patients are often based on an expected poor prognosis. However, this approach is not evidence-based, and which and when COPD patients should start PC is controversial. We aimed to assess whether current suggested recommendations for initiating PC were sufficiently reliable. We identified prognostic variables proposed in the literature for initiating PC; then, we ascertained their relationship with 1-year mortality, and finally, we validated their utility in our cohort of 697 patients hospitalized for COPD exacerbation. From 24 articles of 499 screened, we selected 20 variables and retrieved 48 original articles in which we were able to calculate the relationship between each of them and 1-year mortality. The number of studies where 1-year mortality was detailed for these variables ranged from 9 for previous hospitalizations or FEV1 ≤30% to none for albumin ≤25 mg/dL. The percentage of 1-year mortality in the literature for these variables ranged from 5% to 60%. In the validation cohort study, the prevalence of these proposed variables ranged from 8% to 64%; only 10 of the 18 variables analyzed in our cohort reached statistical significance with Cox regression analysis, and none overcame an area under the curve ≥0.7. We conclude that none of the suggested criteria for initiating PC based on an expected poor vital prognosis in COPD patients in the short or medium term offers sufficient reliability, and consequently, they should be avoided as exclusive criteria for considering PC or at least critically appraised.

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Section: Resultsmentioning

confidence: 99%

Palliative care and prognosis in COPD: a systematic review with a validation cohort

Almagro¹,

Yun²,

Sangil³

et al. 2017

COPD

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“…First, both patient and physician factors are cited as impeding use of palliative care. Patient factors include: decreased awareness of services, cultural perceptions of palliative care, and a desire to pursue all available treatments when treated at academic medical centres . Physician barriers include: decreased buy‐in and subsequent lack of referral to palliative care, desire to continue managing long‐term patients, and underexposure to the role and scope of palliative care in training .…”

Section: Discussionmentioning

confidence: 99%

“…Patient factors include: decreased awareness of services, cultural perceptions of palliative care, and a desire to pursue all available treatments when treated at academic medical centres . Physician barriers include: decreased buy‐in and subsequent lack of referral to palliative care, desire to continue managing long‐term patients, and underexposure to the role and scope of palliative care in training . Additionally, many surgeons that do refer patients to palliative care report difficulties introducing these concepts to patients .…”

Section: Discussionmentioning

confidence: 99%

Palliative care use amongst patients with bladder cancer

et al. 2019

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ObjectivesTo describe the rate and determinants of palliative care use amongst Medicare beneficiaries with bladder cancer and encourage a national dialogue on improving coordinated urological, oncological, and palliative care in patients with genitourinary malignancies. Patients and methodsUsing Surveillance, Epidemiology, and End Results-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer (MIBC) between 2008 and 2013. Our primary outcome was receipt of palliative care, defined as the presence of a claim submitted by a Hospice and Palliative Medicine subspecialist. We examined determinants of palliative care use using logistic regression analysis. ResultsOver the study period, 7303 patients were diagnosed with MIBC and 262 (3.6%) received palliative care. Of 2185 patients with advanced bladder cancer, defined as either T4, N + , or M + disease, 90 (4.1%) received palliative care. Most patients that received palliative care (>80%, >210/262) did so within 24 months of diagnosis. On multivariable analysis, patients receiving palliative care were more likely to be younger, female, have greater comorbidity, live in the central USA, and have undergone radical cystectomy as opposed to a bladder-sparing approach. The adjusted probability of receiving palliative care did not significantly change over time. ConclusionsPalliative care provides a host of benefits for patients with cancer, including improved spirituality, decrease in diseasespecific symptoms, and better functional status. However, despite strong evidence for incorporating palliative care into standard oncological care, use in patients with bladder cancer is low at 4%. This study provides a conservative baseline estimate of current palliative care use and should serve as a foundation to further investigate physician-, patient-, and system-level barriers to this care.Keywords urinary bladder neoplasms, palliative care, palliative medicine, cystectomy, quality of health care, health services research, Medicare, #BladderCancer, #blcsm

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“…23,28 Most recently, Szekendi, et al estimated that 19% of hospitalized patients had a palliative care need, and about 60% of these patients did not have their need met in the form of specialty-level palliative care services or referral. 29 Delivery of specialist-level palliative care varied widely by site, ranging from only 12% to 90%. Other studies show that palliative care services are provided on an average of 4-5% of acute care admissions across the country, which also suggests a large unmet need.…”

Section: Discussionmentioning

confidence: 99%

Gaps in Provision of Primary and Specialty Palliative Care in the Acute Care Setting by Race and Ethnicity

Chuang

Hope

Allyn

et al. 2017

Journal of Pain and Symptom Management

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Context Previous research has identified a large unmet need in provision of specialist-level palliative care services in the hospital. How much of this gap is filled by primary palliative care provided by generalists or non-palliative specialists has not been quantified. Estimates of racial and ethnic disparities have been inconsistent. Objectives 1) To estimate primary and specialty palliative care delivery and to measure unmet needs in the inpatient setting and 2) to explore racial and ethnic disparities in palliative care delivery. Methods This was a cross-sectional, retrospective study of 55,658 adult admissions to two acute care hospitals in the Bronx in 2013. Patients with palliative care needs were identified by criteria adapted from the literature. The primary outcomes were delivery of primary and specialist-level palliative care. Results 18.5% of admissions met criteria for needing palliative care. Of those, 18% received specialist-level palliative care, an estimated 30% received primary palliative care, and 37% had no evidence of palliative care or advance care planning. Black and Hispanic patients were not less likely to receive specialist-level palliative care (adjusted OR black patients=1.18, 95% CI 0.98, 1.42; adjusted OR Hispanic patients=1.24, 95% CI 1.04, 1.48), but they were less likely to receive primary palliative care (adjusted OR black patients= 0.41, 95% CI 0.20, 0.84; adjusted OR Hispanic patients=0.48, 95% CI 0.25, 0.94). Conclusions Even when considering primary and specialty palliative care, hospitalized patients have a high prevalence of unmet palliative care need. Further research is needed understand racial and ethnic disparities in palliative care delivery.

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The Prevalence of Inpatients at 33 U.S. Hospitals Appropriate for and Receiving Referral to Palliative Care

Abstract: This study provides useful information to guide providers, administrators, researchers, and policy experts in planning for optimal provision of palliative care services to those in need.

Cited by 57 publications

References 31 publications

Palliative care and prognosis in COPD: a systematic review with a validation cohort

Palliative care and prognosis in COPD: a systematic review with a validation cohort

Palliative care use amongst patients with bladder cancer

Gaps in Provision of Primary and Specialty Palliative Care in the Acute Care Setting by Race and Ethnicity

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