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Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers.

ABSTRACT: BACKGROUND:Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. OBJECTIVE:The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. DESIGN:Retrospective, cross-sectional analysis of data from the National Inpatient Sample. SETTING AND SUBJECTS:Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013. MEASUREMENTS:In-hospital length of stay (LOS), morbidity, mortality, and total charges. RESULTS:A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5%) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4% vs. 9.4%) and were more likely to develop a postoperative complication (28.3% vs. 45.9%, both p?6: OR?=?2.60, 95% CI: 2.48-2.74), and admission to larger hospitals (reference small: OR?=?1.20, 95% CI: 1.14-1.25) were associated with greater odds of receiving PC (all p?

SUBMITTER: Gani F

PROVIDER: S-EPMC6016727 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers.

Gani Faiz F Enumah Zachary O ZO Conca-Cheng Alison M AM Canner Joseph K JK Johnston Fabian M FM

Journal of palliative medicine 20171103 4

<h4>Background</h4>Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable.<h4>Objective</h4>The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC.<h4>Design</h4>Retrospective, cross-sectional analysis of data from the National Inpatient Sample.<h4>Setting and subjects</h4>Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 ...[more]

PMID: 29100002

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Project description:IntroductionPalliative care is beneficial for patients with advanced lung cancer, but the optimal model of palliative care delivery is unknown. We investigated healthcare utilization before and after embedding a palliative care physician within a thoracic medical oncology "onco-pall" clinic.MethodsThis is a retrospective cross-sectional cohort study comparing healthcare outcomes in two cohorts: "pre-cohort" 12 months prior to and "post-cohort" 12-months after the onco-pall clinic start date. Patients were included if they had a new diagnosis of lung cancer and received care at The Ohio State University Thoracic Oncology Center, and resided in Franklin County or 6 adjacent counties. During the pre-cohort time period, access to palliative care was available at a stand-alone palliative care clinic. Palliative care intervention in both cohorts included symptom assessment and management, advance care planning, and goals of care discussion as appropriate. Outcomes evaluated included rates of emergency department (ED) visits, hospital admissions, 30-day readmissions, and intensive care unit (ICU) admissions. Estimates were calculated in rates per-person-years and with Poisson regression models.ResultsIn total, 474 patients met criteria for analysis (214 patients included in the pre-cohort and 260 patients in the post-cohort). Among all patients, 52% were male and 48% were female with a median age of 65 years (range 31-92). Most patients had non-small cell lung cancer (NSCLC - 17% stage 1-2, 20% stage 3, 47% stage 4) and 16% had small cell lung cancer. The post-cohort was older [median age 66 years vs 63 years in the pre-cohort (p-value: < 0.01)]. The post-cohort had a 26% reduction in ED visits compared to the pre-cohort, controlling for age, race, marital status, sex, county, Charlson score at baseline, cancer type and stage (adjusted relative risk: aRR: 0.74, 95% CI: 0.58-0.94, p-value = 0.01). Although not statistically significant, there was a 29% decrease in ICU admissions (aRR: 0.71, 95% CI: 0.41-1.21, p-value = 0.21) and a 15% decrease in hospital admissions (aRR: 0.85, 95% CI: 0.70-1.03, p-value = 0.10). There was no difference in 30-day readmissions (aRR: 1.03, 95% CI: 0.73-1.45, p-value = 0.85).ConclusionsEmbedding palliative care clinics within medical oncology clinics may decrease healthcare utilization for patients with thoracic malignancies. Further evaluation of this model is warranted.

Project description:BackgroundPalliative care specialists are experts in conducting advance care planning (ACP) but are a limited resource. Oncology nurses often have special relationships with their patients and thus may be poised to provide primary palliative care. We sought to determine the impact of a nurse-led primary palliative care intervention on ACP uptake among patients with advanced cancer.MethodsWe performed a secondary analysis of a cluster randomized controlled trial examining the impact of nurse-based primary palliative care. In the parent trial, patients with advanced cancer received either monthly primary palliative care visits with trained nurses within their cancer center or standard care. Nurses in the intervention arm received special training in ACP. ACP uptake was assessed at enrollment and 3 months later evaluating (1) whether an end-of-life conversation (EOLC) occurred with one's oncologist, and (2) completion of an advance directive (AD). Multivariable logistic regression tested differences in ACP uptake by treatment arm adjusted for age, religious importance, education, time with current oncologist, and performance status.ResultsOf 672 patients enrolled, 182/336 (54%) patients in the intervention arm and 196/336 (58%) in the standard care arm lacked an EOLC at baseline and completed the 3-month assessment. Of those, 82/182 (45.1%) patients in the intervention arm and 29/196 (14.8%) in the standard care arm reported having an EOLC at 3 months (adjusted odds ratio, 5.28; 95% CI, 3.10-8.97; P<.001). Similarly, 111/336 (33%) patients in the intervention arm and 105/336 (31%) in the standard care arm lacked an AD at baseline and completed the 3-month assessment. Of those, 48/111 (43.2%) patients in the intervention arm and 19/105 (18.1%) in the standard care arm completed an AD over the study period (adjusted odds ratio, 3.68; 95% CI, 1.89-7.16; P<.001).ConclusionsNurse-led primary palliative care increased ACP uptake among patients with advanced cancer. Training oncology nurses embedded within community cancer centers to provide primary palliative care may help improve ACP access.

Dataset Information

Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers.

Publications

Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers.

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