Interpersonal Conflict between Clinicians in the Delivery of Palliative and End-of-Life Care for Critically Ill Patients: A Secondary Qualitative Analysis

Tong, Wendy; Murali, Komal Patel; Fonseca, Laura D.; Blinderman, Craig D.; Shelton, Rachel C.; Hua, May

doi:10.1089/jpm.2021.0631

Cited by 3 publications

(5 citation statements)

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“…This service-level initiative, utilizing existing resources, highlights the benefits of early integrated palliative care as an essential component of multimodal oncologic care for complex patients undergoing surgery. 25 Author Contributions: Dr Turaga had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.…”

Section: Discussionmentioning

confidence: 99%

“…After propensity score matching, no significant differences in OS were observed on the basis of palliative care consultation. This service-level initiative, utilizing existing resources, highlights the benefits of early integrated palliative care as an essential component of multimodal oncologic care for complex patients undergoing surgery …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Administrative hurdles to documentation include the lack of standardized systems for reporting and updating ADs . Surgeons may hesitate to facilitate ACP discussions due to time constraints or concerns that AD designation may limit treatment options they consider appropriate . Although ACP is associated with less aggressive and less expensive end-of-life care, health systems bear the cost of developing and delivering ACP interventions …”

Section: Introductionmentioning

confidence: 99%

“…20,21 Surgeons may hesitate to facilitate ACP discussions due to time constraints or concerns that AD designation may limit treatment options they consider appropriate. 16,[22][23][24][25] Although ACP is associated with less aggressive and less expensive end-of-life care, 5,26 health systems bear the cost of developing and delivering ACP interventions. 27,28 Surgical encounters involve establishing substantial trust between stakeholders, presenting an ideal opportunity to facilitate ACP discussions.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Early Integrated Palliative Care Within a Surgical Oncology Clinic

Bansal,

Kim,

Reddy

et al. 2023

JAMA Netw Open

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ImportanceAdvance directive (AD) designation is an important component of advance care planning (ACP) that helps align care with patient goals. However, it is underutilized in high-risk surgical patients with cancer, and multiple barriers contribute to the low AD designation rates in this population.ObjectiveTo assess the association of early palliative care integration with changes in AD designation among patients with cancer who underwent surgery.Design, Setting, and ParticipantsThis cohort study was a retrospective analysis of a prospectively maintained registry of adult patients who underwent elective surgery for advanced abdominal and soft tissue malignant tumors at a surgical oncology clinic in a comprehensive cancer center with expertise in regional therapeutics between June 2016 and May 2022, with a median (IQR) postoperative follow-up duration of 27 (15-43) months. Data analysis was conducted from December 2022 to April 2023.ExposureIntegration of ACP recommendations and early palliative care consultations into the surgical workflow in 2020 using electronic health records (EHR), preoperative checklists, and resident education.Main Outcomes and MeasuresThe primary outcomes were AD designation and documentation. Multivariable logistic regression was performed to assess factors associated with AD designation and documentation.ResultsAmong the 326 patients (median [IQR] age 59 [51-67] years; 189 female patients [58.0%]; 243 non-Hispanic White patients [77.9%]) who underwent surgery, 254 patients (77.9%) designated ADs. The designation rate increased from 72.0% (131 of 182 patients) before workflow integration to 85.4% (123 of 144 patients) after workflow integration in 2020 (P = .004). The AD documentation rate did not increase significantly after workflow integration in 2020 (48.9% [89 of 182] ADs documented vs 56.3% [81 of 144] ADs documented; P = .19). AD designation was associated with palliative care consultation (odds ratio [OR], 41.48; 95% CI, 9.59-179.43; P &lt; .001), palliative-intent treatment (OR, 5.12; 95% CI, 1.32-19.89; P = .02), highest age quartile (OR, 3.79; 95% CI, 1.32-10.89; P = .01), and workflow integration (OR, 2.05; 95% CI, 1.01-4.18; P = .048). Patients who self-identified as a race or ethnicity other than non-Hispanic White were less likely to have designated ADs (OR, 0.36; 95% CI, 0.17-0.76; P = .008). AD documentation was associated with palliative care consulation (OR, 4.17; 95% CI, 2.57- 6.77; P &lt; .001) and the highest age quartile (OR, 2.41; 95% CI, 1.21-4.79; P = .01).Conclusions and RelevanceAn integrated ACP initiative was associated with increased AD designation rates among patients with advanced cancer who underwent surgery. These findings demonstrate the feasibility and importance of modifying clinical pathways, integrating EHR-based interventions, and cohabiting palliative care physicians in the surgical workflow for patients with advanced care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%