End-of-Life Care Characteristics for Young Adults with Cancer Who Die in the Hospital

Keim‐Malpass, Jessica; Erickson, Jeanne M.; Malpass, Howard Charles

doi:10.1089/jpm.2013.0661

Cited by 41 publications

(48 citation statements)

References 20 publications

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“…Demographic data and information related to each patient’s treatment and EOL experiences were collected by chart review. A data abstraction tool (supplemental material) was created based on a literature review (10, 11, 23–25) in consultation with oncology and palliative care experts. Two researchers (JS, JL) worked together to collect data on a standardized form for the first 20 patients.…”

Section: Methodsmentioning

confidence: 99%

Treatment intensity and symptom burden in hospitalized adolescent and young adult hematopoietic cell transplant recipients at the end of life

Snaman

Talleur

et al. 2017

Bone Marrow Transplant

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Adolescent and young adult (AYA) oncology patients experience many physical and psychological symptoms at the end of life (EOL); however, data on these experiences for AYA patients that have undergone hematopoietic cell transplantation (HCT) remains sparse. We sought to investigate the characteristics of AYA patients aged 15 − 25 who received allogeneic HCT and subsequently died while inpatient at our institution between the years 2008 − 2014. A standardized data extraction tool was used to collect information about patient demographics, treatment, and symptoms. We found that during this time frame, 34 AYA patients had received HCT and died while inpatient at our institution, 23 (68%) of which were due to treatment-related complications. Compared to non-HCT AYA oncology patients (n = 35), patients who received HCT (n=34) were more likely to have died in the intensive care unit (71% vs. 23%, P < .0001) and to have received mechanical ventilation (68% vs. 17%, P < .0001) or hemodialysis (53% vs. 0%, P < .0001) in the last 30 days of life. These findings demonstrate that AYA patients who receive allogeneic HCT receive intensive EOL treatment, suggesting that these patients may benefit from early integration of expert interdisciplinary services to prospectively assess and manage distressing symptoms.

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Section: Methodsmentioning

confidence: 99%

Treatment intensity and symptom burden in hospitalized adolescent and young adult hematopoietic cell transplant recipients at the end of life

Snaman

Talleur

et al. 2017

Bone Marrow Transplant

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“…Nearly three-forths of young people who die do so in an acute or intensive care setting without comprehensive palliative or hospice care management and are at risk for numerous burdensome transitions between multiple providers at the end of life. 3,5,7–11 To this end, the holistic model of care that hospice provides represents an opportunity for patient- and family-centered end-of-life care for young people. 12–14 Hospice care offers a comprehensive approach to end of life for those with life expectancy of 6 months or less, which incorporates symptom management, psychosocial and spiritual needs, life review, and continued goal setting.…”

Section: Introductionmentioning

confidence: 99%

End-of-Life Transitions and Hospice Utilization for Adolescents

Keim‐Malpass

Lindley

2017

J Hosp Palliat Nurs

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Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15–20 years with a life-limiting illness. A retrospective cohort design used 2007–2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

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“…Furthermore, the patients referred to our program were younger and were more likely to have Medicaid or no insurance, characteristics that have been shown to be correlated with decreased use of hospice services and/or increased likelihood of in-hospital death in prior studies. [34][35][36][37] It is also possible that physicians who referred patients to the CARE Track program had a practice pattern of less aggressive care and early hospice referral as well. However, controlling for tumor type did not alter the differences between groups, and in this academic setting controlling for tumor type essentially controlled for provider as well.…”

Section: Figmentioning

confidence: 99%

CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic

Blackhall

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Stukenborg

et al. 2016

Journal of Palliative Medicine

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Background: Studies suggest that outpatient palliative care can reduce hospitalization and increase hospice utilization for patients with cancer, however there are insufficient resources to provide palliative care to all patients from time of diagnosis. It is also unclear whether inpatient consultation alone provides similar benefits. A better understanding of the timing, setting, and impact of palliative care for patients with cancer is needed. Objectives: The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care. Design: The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program is a phased intervention integrating outpatient palliative care into cancer care. In Year 1 patients were referred at the discretion of their oncologist. Setting: Academic medical center. Measurements: We compared EOL hospitalization, hospice utilization, and costs of care for CARE Track patients compared to those never seen by palliative care or seen only in hospital. Results: Patients were referred a median of 72.5 days prior to death. CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups. Inpatient consultation alone did not impact these variables. However, only approximately half of patients with incurable cancers were referred to this program. Conclusion: Referral outpatient palliative care within 3 months of death improved EOL care and reduced costs, benefits not seen with inpatient care only. However, many patients were never referred, and methods of systematically identifying appropriate patients are needed.

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End-of-Life Care Characteristics for Young Adults with Cancer Who Die in the Hospital

Cited by 41 publications

References 20 publications

Treatment intensity and symptom burden in hospitalized adolescent and young adult hematopoietic cell transplant recipients at the end of life

Treatment intensity and symptom burden in hospitalized adolescent and young adult hematopoietic cell transplant recipients at the end of life

End-of-Life Transitions and Hospice Utilization for Adolescents

CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic

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