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

Bell, Christina; Kuriya, Meiko; Fischberg, Daniel

doi:10.1016/j.jpainsymman.2011.01.010

Cited by 37 publications

(54 citation statements)

References 31 publications

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“…In another previous study, almost 40% of the spouse caregivers reported depressive symptoms in a range that was likely to be clinically significant, a prevalence that was almost two-fold than their ill partners (Rittenberger et al, 2011). Previous studies have demonstrated that caregivers of patients with cancer have increased health problems and psychosocial stress (Bergen-Jackson et al, 2009;Kiely et al, 2010;Zhou et al, 2010;Bell et al, 2011;Gilbertson-White et al, 2011;Legler et al, 2011;Stevens et al, 2011). Therefore, in palliative care, care burden could have a bad impact on caregivers.…”

Section: Discussionmentioning

confidence: 97%

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

Chang

Kwon

Lee

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Objectives: Terminal cancer patients and their caregivers often experience traumatic stress and need many types of assistance. In the present study we interviewed terminally ill cancer patients and caregivers to determine how much burden they experienced and to find out what factors are most important for satisfaction. Design: We constructed a questionnaire including overall care burden and needs experienced, and administered it to 659 terminal cancer patients and 659 important caregivers at 11 university hospitals and 1 national cancer center in Korea. Results: Finally, 481 terminal cancer patients and 381 caregivers completed the questionnaire. Care burden was not insubstantial in both and the caregiver group felt more burden than the patient group (P<0.001). While the patient group needed financial support most (39.0%), the caregiver group placed greatest emphasis on discussion about further treatment plans (44.8%). Stepwise multiple logistic regression analyses showed that in the patient group, patient's health status (OR, 2.03; 95%CI, 1.16-3.56) and burden (OR, 2.82; 95%CI, 1.76-4.50) influenced satisfaction about overall care, while in the caregiver group, high education level (OR, 1.84; 95%CI, 1.76-4.50), burden (OR, 2.94; 95%CI, 1.75-4.93) and good family function (OR, 1.94; 95%CI, 1.24-3.04) were important. Conclusions: Our study showed that burden was great in both terminal cancer patients and their caregivers and was perceived to be more severe by caregivers. Our study also showed that burden was the factor most predicting satisfaction about overall care in both groups.

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Section: Discussionmentioning

confidence: 97%

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

Chang

Kwon

Lee

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…11,12 In our team's experience, many elderly patients in the hospital have an unstated plan of care that seeks cure and life prolongation. As a patient with serious or complex illness worsens, it may become clear to the health care team that the curative, life-prolonging plan of care is no longer achievable.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with In-Hospital Death by Site of Consultation among Elderly Inpatients Receiving Pain and Palliative Care Consultations

Sekiguchi

Bell²,

Fischberg³

2014

Journal of Palliative Medicine

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Background: Despite palliative care implementation, most deaths still occur in hospitals. Objectives: To identify factors associated with in-hospital death among elderly patients receiving palliative care, by site of consultation. Design: Prospective observational study. Setting/Subjects: All inpatients aged 65 years and older receiving pain and palliative care consultations in a 533-bed acute tertiary care hospital in Honolulu, Hawaii, from January 2005 through December 2009. Measurements: During consultation, demographics, diagnoses, consultation site (intensive care unit [ICU], non-ICU medical, non-ICU surgical, and rehabilitation floors), consultation indication (assistance with establishing goals of care versus pain and/or symptom management), Karnofsky scores, length of stay (LOS), discharge disposition, and in-hospital death were collected. Multiple logistic regression analyses examined factors associated with in-hospital death. Results: Of 1630 elderly inpatients receiving palliative care, 305 (19%) died in-hospital. In-hospital death among non-ICU medical patients was associated with needing consultation to assist with plan of care (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.27-2.80). Likelihood of in-hospital death increased 2% for each additional hospital day before consultation (OR = 1.02, 95% CI = 1.01-1.03). Among elderly ICU patients, likelihood of in-hospital death increased 8% for each additional hospital day before consultation (OR = 1.08, 95% CI = 1.01-1.16). Conclusion: Among elderly non-ICU medical patients receiving palliative care consultations, the need for a consultation to assist with plan of care was associated with in-hospital death, while length of stay prior to consultation was important among both elderly ICU and non-ICU medical patients. Elderly hospitalized patients may benefit from earlier identification and palliative care consultation for assistance with plan of care to avoid in-hospital death.

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“…Indeed, a recent observational cohort study of patients with cancer who received palliative care consults found that comprehensive consults (involving a plan of care discussion as well as symptom management) were associated with an increased likelihood of hospice referral. 43 Ensuring access to palliative care, particularly when a patient has not yet met the eligibility requirements for hospice, may help to increase hospice use in this population.…”

Section: Discussionmentioning

confidence: 99%

Documentation and Discussion of Preferences for Care Among Patients With Advanced Cancer

Ahluwalia

Chuang

Antonio

et al. 2011

JOP

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9. Wright AA, Zhang B, Ray A, et al: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300: [1665][1666][1667][1668][1669][1670][1671][1672][1673] 2008 10. Temel JS, Greer JA, Admane S, et al: Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small cell lung cancer: Results of a randomized study of early palliative care. J Clin Methods:We prospectively abstracted the medical records of 118 patients receiving care at a Veterans Administration (VA) facility from diagnosis of stage IV disease to 12 months postdiagnosis or death. We used univariate statistics to describe the type and frequency of documentation of patient preferences and palliative care/hospice referral. We calculated the time from diagnosis to the first documentation of preferences and the time from first documentation to death. We compared documentation of patient preferences between decedents and nondecedents using 2 tests. Results:The majority of patients (81%) had some documentation of their care preferences recorded, although decedents were significantly more likely to have had their preferences documented than nondecedents (96% v 60%; P Ͻ .000). Most (53%) patients did not have a formal advance directive documented in the medical record. The mean time from diagnosis to the first documentation of preferences was approximately 2 months. More than half of all patients (53%) and almost threequarters of decedents (73%) had a palliative care consultation. Conclusion:Despite high rates of preference documentation, there remains room for improvement. Providers may need to be helped to identify patients earlier in their trajectory for appropriate palliative care services, and future work should focus on developing useful alternatives to advance directives for adequately documenting patient preferences.

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

Cited by 37 publications

References 31 publications

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

Factors Associated with In-Hospital Death by Site of Consultation among Elderly Inpatients Receiving Pain and Palliative Care Consultations

Documentation and Discussion of Preferences for Care Among Patients With Advanced Cancer

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