Home-Based Palliative Care Services for Underserved Populations

Fernandes, Ritabelle; Braun, Kathryn L.; Ozawa, Joseph; Compton, Merlita; Guzman, Crisanta; Somogyi-Zalud, Emese

doi:10.1089/jpm.2009.0216

Cited by 43 publications

(73 citation statements)

References 21 publications

(17 reference statements)

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“…We identified 15 studies and two study protocols [14,15] evaluating palliative care as an intervention in four randomized controlled trials (RCTs) [14,16,17], two nonrandomized controlled studies [18,19], two before and after studies [20,21], three cohort studies [22][23][24] …”

Section: Primary Studies Evaluating Palliative Carementioning

confidence: 99%

Challenges in defining ‘palliative care’ for the purposes of clinical trials

Bausewein

Higginson

2012

Current Opinion in Supportive &Amp; Palliative Care

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Due to the lack of an agreed definition of palliative care and heterogeneity in reporting of components of an SPC intervention comparison of studies remains challenging. Key aspects of palliative care interventions are incurable disease, multidisciplinary approach, focus on symptom management including standardized assessment, psychosocial and family support, and (advance) care planning. Detailed information about all aspects of the intervention should be provided.

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Section: Primary Studies Evaluating Palliative Carementioning

confidence: 99%

Challenges in defining ‘palliative care’ for the purposes of clinical trials

Bausewein

Higginson

2012

Current Opinion in Supportive &Amp; Palliative Care

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“…1–8 Inpatient pain and palliative care consultations enhance end-of-life care for diverse populations. 9–13 However, data comparing palliative care outcomes by ethnicity are limited, 14 particularly for inpatient settings 15 and Asian-American and Pacific Islander populations. 13, 16–18 Research on inpatient palliative care outcomes by ethnicity may clarify the role of palliative care consultations in reducing disparities in end-of-life care.…”

Section: Introductionmentioning

confidence: 99%

Hospice Referrals and Code Status: Outcomes of Inpatient Palliative Care Consultations Among Asian Americans and Pacific Islanders With Cancer

Bell

Kuriya

Fischberg

2011

Journal of Pain and Symptom Management

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Context Intensive palliative care consultations for plan of care may reduce racial differences in end-of-life care. Objectives To compare cancer patients’ hospice referrals and code status changes after inpatient palliative care consultations by patient ethnicity and consultation intensity. Methods This observational cohort study prospectively recorded data for all adult cancer patients receiving palliative care consultations at the largest teaching hospital in Hawaii from 2005 through 2009. Chi-square analyses compared hospice referral and code status changes to “Do Not Attempt Resuscitation” by patient characteristics and consultation intensity (more intensive plan of care versus pain and/or symptom management without plan of care). Multiple logistic regression models analyzed factors associated with hospice referral and code status change. Results The 1362 consultations generated 454 (33.3%) hospice referrals and 234 (17.2%) code status changes. Controlling for age, gender, Karnofsky score and pre-consultation hospital days, Asian, Pacific Islander, and “other” ethnicities demonstrated increased likelihood of hospice referral versus whites (adjusted odds ratios [AOR] 1.46–2.34, P<0.05). Intensive plan of care consultations were strongly associated with hospice referral (AOR 3.08, 95% confidence interval [CI] 2.33–4.07, P<0.0001). Controlling for consultation intensity reduced the association between ethnicity and hospice referral (AORs 1.35–2.06, P=0.03, “other” ethnicity; P=nonsignificant, Asian and Pacific Islander). Intensive consultations were strongly associated with code status change (AOR 2.96; 95%CI 2.08–4.22, P<0.0001). Ethnicity was not significantly associated with code status change. Conclusion Consultation intensity was the strongest predictor of hospice referrals and code status changes, and reduced the ethnic variations associated with hospice referral.

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“…Previous studies including Asian American and Pacific Islander populations receiving consultations for pain or palliative care did not compare pain outcomes by racial categories. [10][11][12] No study has examined pain management by an inpatient hospital-based palliative care consultation service among different races and diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Pain Outcomes of Inpatient Pain and Palliative Care Consultations: Differences by Race and Diagnosis

Bell

Kuriya²,

Fischberg³

2011

Journal of Palliative Medicine

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Background: Pain management disparities exist among patients not receiving palliative care. We examined pain outcomes for disparities among patients receiving palliative care. Results: Study population included 4658 patients. No final pain was reported by more non-white patients (33%-39%) than white (27%, p < 0.0001) and more cancer and noncancer medical patients (45%-54%) than surgical/ other patients (20%-31%, p < 0.0001). Asian (adjusted odds ratio [aOR] 1.24; 95% confidence interval [CI] 1.06-1.46; p = 0.007) and PI (aOR 1.46, 95% CI 1.20-1.77, p = 0.0001) races had increased likelihoods of lower final pain severity versus whites, controlling for age, gender, Karnofsky score, preconsult length of stay, and initial pain severity. Surgical diagnoses had decreased likelihood of lower final pain levels versus cancer (aOR 0.38, 95% CI 0.32-0.46, p < 0.0001). Among 2304 patients reporting moderate/severe initial pain, 1738 (75.4%) reported pain reduction to mild/no final pain. PI race was associated with pain reduction versus whites (aOR 1.57, 95% CI 1.17-2.10, p = 0.003). Surgical diagnoses had decreased likelihood of pain reduction vs. cancer (aOR 0.52, 95% CI 0.39-0.71, p < 0.0001). Conclusion: Pain outcomes were similar or better among non-white races than whites. Surgical patients reported more final pain than cancer patients.

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Home-Based Palliative Care Services for Underserved Populations

Abstract: Data on outcomes and quality indicators of HBPC programs are scant, especially among immigrant Asian and Pacific Islanders patients. Our experience demonstrates the effectiveness of palliative care approaches in this population.

Cited by 43 publications

References 21 publications

Challenges in defining ‘palliative care’ for the purposes of clinical trials

Challenges in defining ‘palliative care’ for the purposes of clinical trials

Hospice Referrals and Code Status: Outcomes of Inpatient Palliative Care Consultations Among Asian Americans and Pacific Islanders With Cancer

Pain Outcomes of Inpatient Pain and Palliative Care Consultations: Differences by Race and Diagnosis

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