The Role of Rehabilitation in Palliative Care Services

Kanach, Frances A.; Brown, Lisa M.; Campbell, Robert R.

doi:10.1097/phm.0000000000000005

Cited by 19 publications

(12 citation statements)

References 16 publications

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“…Third, the healthcare providers of amputees generally include general, vascular or orthopaedic surgeons, psychiatrists, podiatrists, cardiologists, endocrinologists and primary‐care providers. Many of these providers focus their efforts on the treatment and prevention of limb, cardiovascular and diabetes‐related complications, as well as maximizing functional status. Their discussions with an amputee may centre around the hope of preventing further disability, without explicitly discussing end‐of‐life wishes and how best to support a patient's inevitable decline.…”

Section: Discussionmentioning

confidence: 99%

End-of-life care following leg amputation in patients with peripheral artery disease or diabetes

Mestral

Hsu

Talarico

et al. 2020

Journal of British Surgery

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Background:The aim was to characterize end-of-life care in patients who have had a leg amputated for peripheral artery disease (PAD) or diabetes.Methods: This was a population-based retrospective cohort study of patients with PAD or diabetes who died in Ontario, Canada, between 2011 and 2017. Those who had a leg amputation within 3 years of death were compared with a control cohort of deceased patients with PAD or diabetes, but without leg amputation. The patients were identified from linked health records within the single-payer healthcare system. Place and cause of death, as well as health services and costs within 90 days of death, were compared between the amputee and control cohorts. Among amputees, multivariable regression models were used to characterize the association between receipt of home palliative care and in-hospital death, as well as time spent in hospital at the end of life.Results: Compared with 213 300 controls, 3113 amputees were less likely to die at home (15⋅5 versus 24⋅9 per cent; P < 0⋅001) and spent a greater number of their last 90 days of life in hospital (median 19 versus 8 days; P < 0⋅001). Amputees also had higher end-of-life healthcare costs across all sectors. However, receipt of palliative care was less frequent among amputees than controls (inpatient: 13⋅4 versus 16⋅8 per cent, P < 0⋅001; home: 14⋅5 versus 23⋅8 per cent, P < 0⋅001). Among amputees, receipt of home palliative care was associated with a lower likelihood of in-hospital death (odds ratio 0⋅49, 95 per cent c.i. 0⋅40 to 0⋅60) and fewer days in hospital (rate ratio 0⋅84, 0⋅76 to 0⋅93). Conclusion: Palliative care is underused after amputation in patients with PAD or diabetes, and could contribute to reducing in-hospital death and time spent in hospital at the end of life. Reference 1 Campbell WB. Non-intervention and palliative care in vascular patients. Br J Surg 2002; 87: 1601.

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Section: Discussionmentioning

confidence: 99%

End-of-life care following leg amputation in patients with peripheral artery disease or diabetes

Mestral

Hsu

Talarico

et al. 2020

Journal of British Surgery

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“…Patients who receive palliative care show many QoL-related problems and activities of daily living (ADL) limitations. For those in hospice palliative care, maintaining QoL and human dignity is imperative [ 7 8 9 ]. However, many palliative care physicians place greater emphasis on pain management so that various ADL problems can be neglected.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation of Advanced Cancer Patients in Palliative Care Unit

et al. 2018

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ObjectiveTo evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit.MethodsAdvanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire.ResultsForty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p<0.05). In the satisfaction survey, patients with performance scales showed a greater satisfaction in Spearman's correlation analysis (p<0.05).ConclusionAdvanced cancer patients admitted to the hospice palliative care unit have many rehabilitation needs. Patients with a longer survival time showed better compliance for GymPT. Patients with a better performance scale showed a higher satisfaction. Comprehensive rehabilitation may be needed to advanced cancer patients in the hospice palliative care unit.

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“…In the future, hospitals and cancer centers will be held more accountable for dual screening as well as the services offered and the outcomes achieved. Access to and reimbursement for this care will evolve as evidenced by a 2013 court ruling in Jimmo versus Sebelius that clarified the “improvement standard” for Medicare reimbursement and paved the way—even for patients who are not expected to improve—to receive rehabilitation care . Moreover, I firmly believe that third‐party payors will increasingly recognize that cancer prehabilitation and rehabilitation are essential components of high‐quality cancer care and will provide financial incentives and disincentives accordingly.…”

mentioning

confidence: 99%

“…Access to and reimbursement for this care will evolve as evidenced by a 2013 court ruling in Jimmo versus Sebelius 27 that clarified the "improvement standard" for Medicare reimbursement and paved the way-even for patients who are not expected to improve-to receive rehabilitation care. 28 Moreover, I firmly believe that third-party payors will increasingly recognize that cancer prehabilitation and rehabilitation are essential components of high-quality cancer care and will provide financial incentives and disincentives accordingly. The future likely will bring about further inclusion of myriad other clinicians, including, but not limited to, primary care providers, nurse navigators, and mental health professionals, who will significantly contribute to better physical and psychological health outcomes in survivors.…”

mentioning

confidence: 99%