A Formal Palliative Care Service Improves the Quality of Care in Patients with Stage IV Cancer and Bowel Obstruction

Abstract

Palliative care consultation improves the quality of care for patients with stage IV cancer and bowel obstruction, with particular benefits in symptom management, end-of-life discussion, and disposition to hospice.

The effects of the interventions on the DNR designation among cancer patients: A systematic review

“…Wiesenthal et al (2017) found that the patients who received the outpatient consultation services had more designation rates of DNR order than the patients who received inpatient consultation services and the patients who did not receive any consultation service within the 6 months before their final admission to the hospital (22% under outpatients consultation, 8% under inpatients consultation; p = 0.002). Gabriel et al (2017) also showed that among the 38 patients with the stage IV colorectal and gynecologic cancers, those who received the palliative care service consultation had more DNR designations (57.9%) than the patients who received the usual care (10.5%) ( p = 0.002). Similarly, Huang et al (2017) found that compared with the control group (37%), the patients in the hospice-share care model group had higher DNR designation rates (95%) ( p < 0.001).…”

“…Table 2 describes the characteristics of the fourteen included studies. They were published between 2007 and 2017 in five countries: Hong Kong, China (Tse et al, 2007), Japan (Sato et al, 2008), United States (Bell et al, 2011; Delgado-Guay et al, 2009; Gabriel et al, 2017; Peltier et al, 2017; Rhondali et al, 2013; Shuman et al, 2013; Wiesenthal et al, 2017), Australia (Stein et al, 2013), and Taiwan (Huang et al, 2017; Kao et al, 2014; Loke et al, 2011; Wu et al, 2016). Of the 14 studies, two adopted randomized controlled trail designs and 12 used retrospective chart review designs.…”

“…There were 7,180 participants in the 14 studies, and they were recruited from public hospitals (Bell et al, 2011; Huang et al, 2017; Kao et al, 2014; Loke et al, 2011; Peltier et al, 2017b18; Stein et al, 2013; Tse et al, 2007; Wu et al, 2016) and cancer centers (Delgado-Guay et al, 2009; Gabriel et al, 2017; Rhondali et al, 2013; Sato et al, 2008; Shuman et al, 2013; Wiesenthal et al, 2017). More participants were male cancer patients (57.8%), and a majority of participants were in advanced and terminal cancer stages.…”

“…Nine retrospective chart review studies with a total of 6,114 cancer patients examined the effects of palliative consultation services (Bell et al, 2011; Delgado-Guay et al, 2009; Gabriel et al, 2017; Huang et al, 2017; Kao et al, 2014; Loke et al, 2011; Shuman et al, 2013; Wiesenthal et al, 2017; Wu et al, 2016). The palliative consultative services consisted of “physical symptom management,” “emotional support and coping,” “spiritual support,” “financial resources and legal advice,” and “end of life care and decision-making.” Delgado-Guay et al (2009) conducted a retrospective review of the DNR status among 88 cancer patients who received palliative care consultation services in the intensive care unit (ICU).…”

“…Table 3 indicated the effects of three types of DNR interventions on DNR designation. Five of the 14 studies indicated that there were the statistically significant effects on DNR designation rate (Bell et al, 2011; Gabriel et al, 2017; Huang et al, 2017; Tse et al, 2007; Wiesenthal et al, 2017) and six of the 14 studies showed the increases in the percentages of DNR after interventions (Delgado-Guay et al, 2009; Kao et al, 2014; Loke et al, 2011; Rhondali et al, 2013; Shuman et al, 2013; Wu et al, 2016). Overall, the three types of the interventions increased the rates of DNR designation; however, the studies for palliative care unit service and patient-physician communication program showed inconsistent results.…”