Trends in Hospital-Based Specialty Palliative Care in the United States From 2013 to 2017

Schoenherr, Laura; Bischoff, Kara; Marks, Angela; O’Riordan, David; Pantilat, Steven Z.

doi:10.1001/jamanetworkopen.2019.17043

Cited by 46 publications

(48 citation statements)

References 19 publications

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“…In Erlenwein's study, 24% of PCT patients were transferred to a palliative care unit (Erlenwein et al 2014), fewer than in Würzburg (30%). The range of deceased patients during PCT co-management is comparable to other studies: 20.3% in Schoenherr et al (2019) and 12% in Gaertner et al (2012).…”

Section: Team Composition Working Mode Patient Characteristics Andsupporting

confidence: 88%

“…The German study of Erlenwein et al has shown that the PCT was contacted about 6–8 days after admission to hospital with a mean hospitalisation of 13–14 days (0–36 days in surgical departments, and 0–138 days in non-surgical departments, Erlenwein et al 2014 ). In the study of Schoenherr et al, PCT consultations were requested a mean of 4.8 days into the hospital stay (range 1.7–11.1 days, Schoenherr et al 2019 ). In Nagasaki the first PCT contact was earlier and also initiated for patients in better general condition, maybe due to the joint visits.…”

Section: Discussionmentioning

confidence: 99%

“…Harmonisation of items and data elements for further prospective comparative analysis is a desideratum. In the Palliative Care Quality Network (PCQN) in the USA as well as in the German Hospice and Palliative Registry (Nationales Hospiz-und Palliativregister), different core sets of data for the benchmarking of PCTs were defined (Schoenherr et al 2019 ; Nationales Hospiz-und Palliativregister). These could be built on.…”

Section: Discussionmentioning

confidence: 99%

“…The differences between curative and palliative patients were not significant (Körner et al 2017). In the study of Schoenherr et al (2019), 35% of patients reported anxiety. The difference between our data and the literature is perhaps a result of different cutoff points.…”

Section: Symptoms and Psychosocial Needsmentioning

confidence: 97%

“…Hospital-based palliative care teams have a tradition going back to the 1980s, starting in the UK, the USA, Canada and Australia (Dunlop and Hockley 1999 ). A review and actual analysis of US PCTs has shown the benefits of PCTs for cancer patients in regard to pain management, the management of other symptoms, as well as psychosocial and health-care outcomes (Higginson Evans 2010 ; Schoenherr et al 2019 ) also updated in the German S3-LL Palliative Care for Incurable Cancer Patients Guidelines (S3-LL Palliativ, Leitlinienprogramm Onkologie 2019 , Chapter 5).…”

Section: Introductionmentioning

confidence: 99%

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Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

et al. 2020

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In the partnership between the medical departments of Würzburg University, Germany, and Nagasaki University, Japan, palliative care is a relevant topic. The aim of the study was to perform a comparative analysis of the hospital-based palliative care teams in Würzburg (PCT-W) and Nagasaki (PCT-N). Survey of staff composition and retrospective analysis of PCT patient charts in both PCTs were conducted. Patients self-assessed their symptoms in PCT-W and in Radiation Oncology Würzburg (RO-W). The (negative) quality indicator ‘percentage of deceased hospitalised patients with PCT contact for less than 3 days before death’ (Earle in Int J Qual Health Care 17(6):505–509, 2005) was analysed. Both PCTs follow a multidisciplinary team approach. PCT-N saw 410 cancer patients versus 853 patients for PCT-W (22.8% non-cancer patients). The Eastern Cooperative Oncology Group Performance Status at first contact with PCT-N was 3 or 4 in 39.3% of patients versus 79.0% for PCT-W. PCT-N was engaged in co-management longer than PCT-W (mean 20.7 days, range 1–102 versus mean 4.9 days, range 1–48). The most frequent patient-reported psychological symptom was anxiety (family anxiety: 98.3% PCT-W and 88.7% RO-W, anxiety 97.9% PCT-W and 85.9% RO-W), followed by depression (98.2% PCT-W and 80.3% RO-W). In 14 of the 148 deceased patients, PCT-N contact was initiated less than 3 days before death (9.4%) versus 121 of the 729 deceased PCT-W patients (16.6%). Psychological needs are highly relevant in both Germany and Japan, with more than 85% anxiety and depression in patients in the Japanese IPOS validation study (Sakurai in Jpn J Clin Oncol 49(3):257–262, 2019). This should be taken into account when implementing PCTs.

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Section: Team Composition Working Mode Patient Characteristics Andsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Symptoms and Psychosocial Needsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

et al. 2020

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Comparison of Two Methods for Implementing Comfort Care Order Sets in the Inpatient Setting: a Cluster Randomized Trial

et al. 2021

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BACKGROUND: There is an ongoing need for interventions to improve quality of end-of-life care for patients in inpatient settings. OBJECTIVE: To compare two methods for implementing a Comfort Care Education Intervention for Palliative Care Consultation Teams (PCCT) in Veterans Affairs Medical Centers (VAMCs). DESIGN: Cluster randomized implementation trial conducted March 2015-April 2019. PCCTs were assigned to a traditional implementation approach using a teleconference or to an in-person, train-the-champion workshop to prepare PCCTs to be clinical champions at their home sites. PARTICIPANTS: One hundred thirty-two providers from PCCTs at 47 VAMCs. INTERVENTIONS:Both training modalities involved review of educational materials, instruction on using an electronic Comfort Care Order Set, and coaching to deliver the intervention to other providers. MAIN MEASUREMENTS: Several processes of care were identified a priori as quality endpoints for end-of-life care (last 7 days) and abstracted from medical records of veterans who died within 9 months before or after implementation (n = 6,491). The primary endpoint was the presence of an active order for opioid medication at time of death. Secondary endpoints were orders/administration of antipsychotics, benzodiazepines, and scopolamine, do-notresuscitate orders, advance directives, locations of death, palliative care consultations, nasogastric tubes, intravenous lines, physical restraints, pastoral care visits, and family presence at/near time of death. Generalized estimating equations were conducted adjusting for potential covariates. KEY RESULTS: Eighty-eight providers from 23 VAMCs received teleconference training; 44 providers from 23 VAMCs received in-person workshop training. Analyses found no significant differences between intervention groups in any process-of-care endpoints (primary endpoint AOR (CI) = 1.18 (0.74, 1.89). Furthermore, prepost changes were not significant for any endpoints (primary endpoint AOR (CI) = 1.16 (0.92, 1.46). Analyses may have been limited by high baseline values on key endpoints with little room for improvement. CONCLUSION: Findings suggest the clinical effectiveness of palliative care educational intervention was not dependent on which of the two implementation methods was used.

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Creating Effective Models for Delivering Palliative Care in Advanced Liver Disease

Bakitas

2021

Curr Hepatology Rep

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Purpose of Review The current healthcare system is not fully equipped to provide comprehensive support for patients with advanced liver disease (ALD) and their caregivers resulting in concomitant suffering and reduced quality of life (QoL). Integration of palliative care (PC) within routine care has demonstrated benefits in improving symptoms and QoL and reducing healthcare utilization for other serious illnesses but has been underutilized or delayed for ALD care. The purpose of this article is to outline the domains and benefits of PC and discuss the misconceptions and barriers for PC integration, and healthcare delivery models supporting PC integration within ALD care. Recent Findings PC has eight key domains related to physical and mental health, goals for future care, and care of the caregivers. PC offers benefits to improve health outcomes and patient satisfaction and reduce healthcare utilization. To date there have been successful models of PC that are primarily hospital- or community-based; successful models have been PC specialist- or primary/generalist-led. Summary Concurrent PC within oncology has formed the basis for most evidence-based guidelines. PC integration within ALD care is still in its infancy. While amassing evidence in ALD, hepatology organizations can promote consensus-based integrated PC models that can guide research and practice efforts to increase supportive care for these patients in need and their family caregivers.

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Trends in Hospital-Based Specialty Palliative Care in the United States From 2013 to 2017

Abstract: This cohort study characterizes current practice and trends among patients cared for and outcomes achieved by inpatient specialty palliative care services in the United States.

Cited by 46 publications

References 19 publications

Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan

Comparison of Two Methods for Implementing Comfort Care Order Sets in the Inpatient Setting: a Cluster Randomized Trial

Creating Effective Models for Delivering Palliative Care in Advanced Liver Disease

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