Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients

Kistler, Emmett A.; Stevens, Erin; Scott, Erin; Philpotts, Lisa; Greer, Joseph A.; Greenwald, Jeffrey L.

doi:10.1016/j.jpainsymman.2020.02.001

Cited by 48 publications

(70 citation statements)

References 53 publications

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“…Frequently/often 14 [18] 6 [28] 8 [14] 58 [35] 20 [35] 38 [35] Sometimes 20 [26] 5 [24] 15 [26] 54 [33] 22 [39] 32 [30] Rarely/never 44 [56] 10 [48] 34 [60] 53 [32] 15 [26] 38 [35] What is your experience with the PCCT? <0.001 2012 onwards.…”

Section: Discussionmentioning

confidence: 99%

Clinical risk factors for mortality of hospitalized patients with COVID-19: systematic review and meta-analysis

Xiang¹,

Xie²,

Chen³

et al. 2021

Ann Palliat Med

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Background: Within the generalist-plus-specialist palliative care model, palliative care is mainly provided by nurses and physicians of hospital primary care teams. Palliative care consultation teams (PCCTs) support these clinicians in adequately caring for patients with advanced illnesses. Our team started in 2012. The aim of this study was to assess the self-perceived barriers, educational needs and awareness of available palliative care support options among our hospital primary care teams. In addition, palliative care referral patterns were evaluated.Methods: Single-center mixed methods study. Outcomes of two surveys of primary care team clinicians (2012 and 2016) on barriers to palliative care, educational needs and awareness of palliative care support options were compared (chi-square, Mann-Whitney U tests, qualitative analysis). Palliative care referral characteristics were evaluated [2012][2013][2014][2015][2016][2017], including referral timing (survival since referral) (descriptive statistics, Kaplan-Meier methodology). Predictions of survival at referral were analyzed (weighted Kappa).Results: In 2012 and 2016, the most frequently reported barrier was the late initiation of the palliative care approach. Clinicians reported a need for education on physical symptom management and basic palliative care principles. Awareness of support options increased from 2012 to 2016, including improved familiarity with the PCCT (56% vs. 85%, P<0.001) and positive appraisal of the team (8% vs. 40% gave an 'excellent' rating, P<0.001). The use of national symptom management guidelines also improved (23% vs. 53%, P<0.001). Of 1,404 referrals, 86% were for cancer patients. Referrals increased by 28% (mean) per year.Medical oncology clinicians referred most frequently (27%) and increasingly early in the disease trajectory (survival ≥3 months after referral) (P=0.016). Median survival after referral was 0.9 (range, 0-83.3) months.Referring physicians overestimated survival in 44% of patients (kappa 0.36, 95% CI: 0.30-0.42).Conclusions: Primary care team clinicians persistently reported needing support with basic palliative care skills. PCCTs should continuously focus on educating primary care teams and promoting the use of guidelines. Because physicians tend to overestimate survival and usually referred patients late for specialist palliative care, consultation teams should support primary care teams to identify, treat and refer patients with palliative care needs in a timely manner.

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Section: Discussionmentioning

confidence: 99%

Clinical risk factors for mortality of hospitalized patients with COVID-19: systematic review and meta-analysis

Xiang¹,

Xie²,

Chen³

et al. 2021

Ann Palliat Med

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“…In view of the ‘scarcity of palliative care resources, 66 there are a number of potential ways to help identify which head and neck cancer patients would most benefit from palliative care input. Specific ‘triggers’ are recognised to help prompt palliative care consults in the emergency department, in-patient wards 67 and from oncology services. 68 These are generic tools aimed to screen a large population, however, rather than having been specifically validated within the head and neck cancer remit.…”

Section: Discussionmentioning

confidence: 99%

The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review

Mayland

Doughty

et al. 2020

Palliat Med

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Background: The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge. Aim: To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer. Design: A scoping literature review following the methods described by the Joanna Briggs Institute. Data sources: An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019. Results: People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre. Conclusion: This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent.

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“…29 Nowadays, many educational interventional studies have started to focus on increasing awareness about palliative care medicine in the ED, aiming to potentially improve patient care and symptoms, and then measuring the number of palliative care consultations made before and after the educational intervention. [30][31][32][33] In the last few years, many countries such as the USA 34 and Canada 35 have started to implement core palliative care domains in emergency medicine. EPs face palliative care situations much more often than thoracotomies during their careers.…”

Section: Discussionmentioning

confidence: 99%

Harmonising palliative care: a national survey to evaluate the knowledge and attitude of emergency physicians towards palliative care in Kuwait

Al-Ansari

Suroor

AboSerea

et al. 2020

BMJ Support Palliat Care

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Background and aimAlthough the challenges of integrating palliative care practices across care settings are real and well recognised, to date little is known about palliative care practices of emergency physicians (EPs) in Kuwait. Therefore, this study aims to explore the attitude and knowledge of EPs in providing palliative care in all general hospitals in Kuwait.MethodA cross-sectional survey was performed in the emergency rooms of all general hospitals in Kuwait using the Palliative Care Attitude and Knowledge Questionnaire.ResultsOf the total number of physicians working in emergency rooms (n=156), 104 (66.67%) had completed the survey. 76.9% (n=80) of the EPs had an uncertain attitude towards palliative care. Most of the EPs (n=73, 70.28%) did not discuss the patients’ need for palliative care either with the patients or with their families. Only 16 (15.4%) of the EPs responded correctly to most of the questions while nearly half of the EPs (n=51, 49%) had poor knowledge. Experience ≥11 years and better knowledge scores were independent predictors of positive attitude after adjustment of age, sex, qualifications, specialty, position and nationality (OR: 5.747 (CI 1.031 to 25.00), 1.458(CI 1.148 to 1.851); p values: 0.021, 0.002, respectively).ConclusionsDespite recognising palliative care as an important competence, the majority of the EPs in Kuwait had uncertain attitude and poor knowledge towards palliative care. Efforts should be made to enhance physician training and provide palliative care resources to improve the quality of care given to patients visiting emergency departments.

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Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients

Cited by 48 publications

References 53 publications

Clinical risk factors for mortality of hospitalized patients with COVID-19: systematic review and meta-analysis

Clinical risk factors for mortality of hospitalized patients with COVID-19: systematic review and meta-analysis

The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review

Harmonising palliative care: a national survey to evaluate the knowledge and attitude of emergency physicians towards palliative care in Kuwait

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