Differences in Utilization of Life Support and End-of-Life Care for Medical ICU Patients With Versus Without Cancer

Koff, Geoffrey; Vaid, Urvashi; Len, Edward; Crawford, Albert; Oxman, David

doi:10.1097/ccm.0000000000002260

Cited by 14 publications

(12 citation statements)

References 23 publications

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“…It has been shown before that the diagnosis of cancer influences end-of-life care, with cancer patients receiving, generally, less aggressive care and better quality of end-of-life care. ( 5 , 30 , 31 ) It has been hypothesized that some of this difference may be due to misunderstandings about the trajectory of the disease or lack of familiarity with PC by the providers. ( 31 ) It is possible that the implementation of the program had a greater effect in this more vulnerable population of non-cancer patients, as cancer patients may have already been receiving more appropriate end-of-life care, even though this correlation should be carefully examined.…”

Section: Discussionmentioning

confidence: 99%

Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis

Ramos¹,

Tourinho²,

Borrione³

et al. 2018

Revista Brasileira De Terapia Intensiva

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ObjectiveTo assess the effect of the implementation of a palliative care program on do-not-resuscitate orders and intensive care unit utilization during terminal hospitalizations.MethodsData were retrospectively collected for all patients who died in a tertiary hospital in Brazil from May 2014 to September 2016. We analyzed the frequency of do-not-resuscitate orders and intensive care unit admissions among in-hospital deaths. Interrupted time series analyses were used to evaluate differences in trends of do-not-resuscitate orders and intensive care unit admissions before (17 months) and after (12 months) the implementation of a palliative care program.ResultsWe analyzed 48,372 hospital admissions and 1,071 in-hospital deaths. Deaths were preceded by do-not-resuscitate orders in 276 (25.8%) cases and admissions to the intensive care unit occurred in 814 (76%) cases. Do-not-resuscitate orders increased from 125 (20.4%) to 151 (33%) cases in the pre-implementation and post-implementation periods, respectively (p < 0.001). Intensive care unit admissions occurred in 469 (76.5%) and 345 (75.3%) cases in the pre-implementation and post-implementation periods, respectively (p = 0.654). Interrupted time series analyses confirmed a trend of increased do-not-resuscitate order registrations, from an increase of 0.5% per month pre-implementation to an increase of 2.9% per month post-implementation (p < 0.001), and demonstrated a trend of decreased intensive care unit utilization, from an increase of 0.6% per month pre-implementation to a decrease of -0.9% per month in the post-implementation period (p = 0.001).ConclusionThe implementation of a palliative care program was associated with a trend of increased registration of do-not-resuscitate orders and a trend of decreased intensive care unit utilization during terminal hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis

Ramos¹,

Tourinho²,

Borrione³

et al. 2018

Revista Brasileira De Terapia Intensiva

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“…Em relação à caracterização dos estudos, quanto ao desenho metodológico, 38 eram de abordagem quantitativa (Årestedt et al, 2018;Axelsson et al, 2018;Beauverd et al, 2014;Bedell et al, 1986;Camhi et al, 2009;Chang & Brass, 2014;H.-C. Chou et al, 2018;Clarke et al, 2014;Cook et al, 1995;Courtwright et al, 2015;DeMartino et al, 2017;Economos et al, 2019;Farrington et al, 2014;Fu et al, 2018;Gilbar et al, 2019;Hamano et al, 2018;Hiramoto et al, 2019;Koff et al, 2017;Liu et al, 2015;Moffat et al, 2016;Montagnini et al, 2018;Mori et al, 2019;Mroueh et al, 2019;Opstelten et al, 2017;Parpa et al, 2010;Penders et al, 2020;Penrod et al, 2012;Piili et al, 2018;Pugh et al, 2009;Seale, 2010;Steindal et al, 2015;Syed et al, 2017;Taniguchi et al, 2016;Thomas et al, 2014;Tsai et al, 2018;Verhofstede et al, 2017;Wang et al, 2019;Ziegler et al, 2018), 13 qualitativa (Bélanger et al, 2014;W.-Y. S. Chou et al, 2017;De Bal et al, 2006;De W...…”

Section: Resultsunclassified

“…O período de publicação dos estudos variou entre 1986 e 2020, sendo os anos com maior publicação 2017 (W.-Y. S. Chou et al, 2017;De Bal et al, 2006;De Witt Jansen et al, 2017;DeMartino et al, 2017;Guardia-Mancilla et al, 2017;Koff et al, 2017;Kruser et al, 2017;Opstelten et al, 2017;L. Robijn et al, 2017;Sellars et al, 2017;Syed et al, 2017;Verhofstede et al, 2017;Wagemans et al, 2017), 2018 (Årestedt et al, 2018;Axelsson et al, 2018;H.-C. Chou et al, 2018;Fu et al, 2018;Hamano et al, 2018;Montagnini et al, 2018;Piili et al, 2018;Lenzo Robijn et al, 2018;Scott et al, 2018;Tsai et al, 2018;Ziegler et al, 2018(Díez-Manglano et al, 2019Economos et al, 2019;Gilbar et al, 2019;Hiramoto et al, 2019;Mori et al, 2019;Mroueh et al, 2019;Wang et al, 2019), respectivamente.…”

Section: Resultsunclassified

Práticas de cuidado hospitalares no final de vida: revisão integrativa

Moscoso

Cordeiro

Silva

et al. 2021

RSD

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Decisões sobre cuidados às pessoas em final de vida envolvem diversos aspectos, representando desafio e mobilizando médicos e enfermeiros, profissionais que se sobressaem na tomada de decisões. Esta revisão integrativa de literatura objetivou identificar práticas de cuidado de médicos e enfermeiros em final de vida no hospital. A coleta de dados ocorreu entre janeiro e fevereiro de 2020 nas bases de dados Web of Science, Scopus e na Medical Literature and Retrivial System Online (MEDLINE). 58 artigos foram selecionados com os seguintes temas: sedação paliativa, ordem de não reanimação cardiopulmonar, comunicação e tomada de decisão, eutanásia e suicídio assistido, retirada ou limitação de tratamentos mantenedores da vida, tratamentos oncológicos e cuidados terminais. Conclui-se que as práticas de cuidado em final de vida centralizam-se em sintomas físicos e possuem o intuito de aliviar sofrimento. Suspender ou limitar reanimação cardiopulmonar, hidratação, nutrição e hemodiálise, bem como realização de eutanásia ou suicídio assistido apresentam maior controvérsia.

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“…In a French survey interviewing physicians and nurses, there was a strong resistance to terminal extubation, particularly among nursing professionals [16]. It was found that end-of-life patients with non-cancer diseases (particularly chronic respiratory diseases and post-cardiac arrest neurological sequelae) have a longer mechanical ventilation time, more dialysis performed, and longer ICU stay than patients with cancer, and they receive lower quality palliative care [12,24]. In our study, with only 25% of patients with ELM-PC having cancer, this quality-ofassistance gap of palliative care with more adequate end-of-life care for cancer patients was also seen, although the number of patients was very low.…”

Section: Discussionmentioning

confidence: 99%

End-of-life management in intensive care units: a multicentre observational prospective cohort study

Alliprandini¹,

Ferrandin²,

Fernandes³

et al. 2019

ait

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With the impressive improvements in medical care in recent years, it is to be expected that intensive care unit (ICU) care would result (as well as reducing mortality from serious critical illnesses) in increased comfort and dignity for patients and their families, thus reducing their suffering. However, the latter objective is still far from a reality, and the practice of applying futile support therapies is still common in the ICU setting, particularly among patients who eventually die in the hospital [1]. It has been estimated that beds intended for intensive care account for 13.4% of all hospital beds in the USA, representing a cost of 0.56% of the country's gross domestic product (GDP). Despite the greater use of hospices and end-of-life palliative care, approximately one in five Americans die in an ICU [2]. In low-and medium-income countries, there are a lack of data about the rate of hospitalisation and death in

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Differences in Utilization of Life Support and End-of-Life Care for Medical ICU Patients With Versus Without Cancer

Cited by 14 publications

References 23 publications

Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis

Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis

Práticas de cuidado hospitalares no final de vida: revisão integrativa

End-of-life management in intensive care units: a multicentre observational prospective cohort study

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