Impact of timing and setting of palliative care referral on quality of end‐of‐life care in cancer patients

BACKGROUND Limited data are available on how the timing and setting of palliative care (PC) referral can affect end‐of‐life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end‐of‐life care. METHODS All adult...

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Veröffentlicht in:Cancer Jg. 120; H. 11; S. 1743 - 1749
Hauptverfasser: Hui, David, Kim, Sun Hyun, Roquemore, Joyce, Dev, Rony, Chisholm, Gary, Bruera, Eduardo
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Hoboken, NJ Wiley-Blackwell 01.06.2014
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ISSN:0008-543X, 1097-0142, 1097-0142
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Abstract BACKGROUND Limited data are available on how the timing and setting of palliative care (PC) referral can affect end‐of‐life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end‐of‐life care. METHODS All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end‐of‐life care indicators. RESULTS Among 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P < .001), fewer hospitalizations (48% vs 81%; P < .003), and fewer hospital deaths (17% vs 31%; P = .004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P < .001), fewer hospital admissions (52% vs 86%; P < .001), fewer hospital deaths (18% vs 34%; P = .001), and fewer intensive care unit admissions (4% vs 14%; P = .001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28‐0.66; P < .001) was independently associated with less aggressive end‐of‐life care. Men (OR, 1.63; 95% CI, 1.06‐2.50; P = .03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18‐5.59; P = .02) were associated with more aggressive end‐of‐life care. CONCLUSIONS Patients who were referred to outpatient PC had improved end‐of‐life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral. Cancer 2014;120:1743–1749. © 2014 American Cancer Society. In this retrospective cohort study, patients with advanced cancer who have early access to outpatient palliative care receive less aggressive care at the end of life compared with those who have delayed access to palliative care and those who receive inpatient palliative care. These findings support the need to increase the availability of palliative care clinics and to streamline the process of early referral.
AbstractList Limited data are available on how the timing and setting of palliative care (PC) referral can affect end-of-life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end-of-life care.BACKGROUNDLimited data are available on how the timing and setting of palliative care (PC) referral can affect end-of-life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end-of-life care.All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end-of-life care indicators.METHODSAll adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end-of-life care indicators.Among 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P<.001), fewer hospitalizations (48% vs 81%; P<.003), and fewer hospital deaths (17% vs 31%; P5.004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P<.001), fewer hospital admissions (52% vs 86%; P<.001), fewer hospital deaths (18% vs 34%; P5.001), and fewer intensive care unit admissions (4% vs 14%; P5.001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28-0.66; P<.001) was independently associated with less aggressive end-of-life care. Men (OR, 1.63; 95% CI, 1.06-2.50; P5.03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18-5.59; P5.02) were associated with more aggressive end-of-life care.RESULTSAmong 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P<.001), fewer hospitalizations (48% vs 81%; P<.003), and fewer hospital deaths (17% vs 31%; P5.004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P<.001), fewer hospital admissions (52% vs 86%; P<.001), fewer hospital deaths (18% vs 34%; P5.001), and fewer intensive care unit admissions (4% vs 14%; P5.001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28-0.66; P<.001) was independently associated with less aggressive end-of-life care. Men (OR, 1.63; 95% CI, 1.06-2.50; P5.03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18-5.59; P5.02) were associated with more aggressive end-of-life care.Patients who were referred to outpatient PC had improved end-of-life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral.CONCLUSIONSPatients who were referred to outpatient PC had improved end-of-life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral.
Limited data are available on how the timing and setting of palliative care (PC) referral can affect end-of-life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end-of-life care. All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end-of-life care indicators. Among 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P<.001), fewer hospitalizations (48% vs 81%; P<.003), and fewer hospital deaths (17% vs 31%; P5.004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P<.001), fewer hospital admissions (52% vs 86%; P<.001), fewer hospital deaths (18% vs 34%; P5.001), and fewer intensive care unit admissions (4% vs 14%; P5.001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28-0.66; P<.001) was independently associated with less aggressive end-of-life care. Men (OR, 1.63; 95% CI, 1.06-2.50; P5.03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18-5.59; P5.02) were associated with more aggressive end-of-life care. Patients who were referred to outpatient PC had improved end-of-life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral.
In this retrospective cohort study, patients with advanced cancer who have early access to outpatient palliative care receive less aggressive care at the end of life compared with those who have delayed access to palliative care and those who receive inpatient palliative care. These findings support the need to increase the availability of palliative care clinics and to streamline the process of early referral.
BACKGROUND Limited data are available on how the timing and setting of palliative care (PC) referral can affect end‐of‐life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end‐of‐life care. METHODS All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end‐of‐life care indicators. RESULTS Among 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P < .001), fewer hospitalizations (48% vs 81%; P < .003), and fewer hospital deaths (17% vs 31%; P = .004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P < .001), fewer hospital admissions (52% vs 86%; P < .001), fewer hospital deaths (18% vs 34%; P = .001), and fewer intensive care unit admissions (4% vs 14%; P = .001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28‐0.66; P < .001) was independently associated with less aggressive end‐of‐life care. Men (OR, 1.63; 95% CI, 1.06‐2.50; P = .03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18‐5.59; P = .02) were associated with more aggressive end‐of‐life care. CONCLUSIONS Patients who were referred to outpatient PC had improved end‐of‐life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral. Cancer 2014;120:1743–1749. © 2014 American Cancer Society. In this retrospective cohort study, patients with advanced cancer who have early access to outpatient palliative care receive less aggressive care at the end of life compared with those who have delayed access to palliative care and those who receive inpatient palliative care. These findings support the need to increase the availability of palliative care clinics and to streamline the process of early referral.
Author Kim, Sun Hyun
Dev, Rony
Chisholm, Gary
Bruera, Eduardo
Hui, David
Roquemore, Joyce
AuthorAffiliation 2 Department of Family Medicine, Kwandong University, College of Medicine, Republic of Korea
4 Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
1 Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA
3 Clinical Operations Informatics, MD Anderson Cancer Center, Houston, TX, USA
AuthorAffiliation_xml – name: 1 Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA
– name: 3 Clinical Operations Informatics, MD Anderson Cancer Center, Houston, TX, USA
– name: 2 Department of Family Medicine, Kwandong University, College of Medicine, Republic of Korea
– name: 4 Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
Author_xml – sequence: 1
  givenname: David
  surname: Hui
  fullname: Hui, David
  organization: The University of Texas MD Anderson Cancer Center
– sequence: 2
  givenname: Sun Hyun
  surname: Kim
  fullname: Kim, Sun Hyun
  organization: Kwandong University, College of Medicine
– sequence: 3
  givenname: Joyce
  surname: Roquemore
  fullname: Roquemore, Joyce
  organization: The University of Texas MD Anderson Cancer Center
– sequence: 4
  givenname: Rony
  surname: Dev
  fullname: Dev, Rony
  organization: The University of Texas MD Anderson Cancer Center
– sequence: 5
  givenname: Gary
  surname: Chisholm
  fullname: Chisholm, Gary
  organization: The University of Texas MD Anderson Cancer Center
– sequence: 6
  givenname: Eduardo
  surname: Bruera
  fullname: Bruera, Eduardo
  organization: The University of Texas MD Anderson Cancer Center
BackLink http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28522390$$DView record in Pascal Francis
https://www.ncbi.nlm.nih.gov/pubmed/24967463$$D View this record in MEDLINE/PubMed
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Issue 11
Keywords Human
End-of-life care
inpatients
Malignant tumor
chemotherapeutic agents
quality of care
Care
Quality of life
Chemotherapy
Treatment
Cancerology
Palliative care
outpatients
Ambulatory
Hospital
Timing
neoplasms
Cancer
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Snippet BACKGROUND Limited data are available on how the timing and setting of palliative care (PC) referral can affect end‐of‐life care. In this retrospective cohort...
In this retrospective cohort study, patients with advanced cancer who have early access to outpatient palliative care receive less aggressive care at the end...
Limited data are available on how the timing and setting of palliative care (PC) referral can affect end-of-life care. In this retrospective cohort study, the...
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Enrichment Source
Publisher
StartPage 1743
SubjectTerms Adult
Aged
Aged, 80 and over
Biological and medical sciences
chemotherapeutic agents
Female
Humans
inpatients
Male
Medical sciences
Middle Aged
Multiple tumors. Solid tumors. Tumors in childhood (general aspects)
neoplasms
Neoplasms - therapy
outpatients
Palliative Care
quality of care
Quality of Health Care
Referral and Consultation
Terminal Care - standards
Time Factors
Tumors
Title Impact of timing and setting of palliative care referral on quality of end‐of‐life care in cancer patients
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https://www.ncbi.nlm.nih.gov/pubmed/24967463
https://www.proquest.com/docview/1541369826
https://pubmed.ncbi.nlm.nih.gov/PMC4073257
Volume 120
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