Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland

Lucey, Michael R.; O'Reilly, Martina; Currow, David C.; Eagar, Kathy; Walsh, Declan; Conroy, Marian; Twomey, Feargal; O’Reilly, Val; Doherty, Mairéad; Coffey, Siobhain; Sheridan, J.J.; Moran, Sue

doi:10.1089/jpm.2019.0295

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Weerakkody et al [57], in a study involving 100 bereaved caregivers of people who died in a Toronto (Canada) hospice, found that quality (measured by the Quality of Dying and Death-QODD) was average to above average and that higher scores were reported by those whose relative had been admitted for more than one week. A possible explanation can be inferred from the evaluation by Lucey et al [58] of patients admitted to Milford Hospice, Limerick, Eire. They found nearly half were unstable on admission, and it took three days for 70% of these patients to be stabilised.…”

Section: Residential Hospicementioning

confidence: 99%

Palliative and End-of-Life Care Service Models: To What Extent Are Consumer Perspectives Considered?

Rumbold

Aoun

2021

Healthcare

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This article presents evidence found in a search of national and international literature for patient preferences concerning settings in which to receive palliative care and the appropriateness of different models of palliative care. The purpose was to inform end-of-life care policy and service development of the Western Australian Department of Health through a rapid review of the literature. It was found that consumer experience of palliative care is investigated poorly, and consumer contribution to service and policy design is limited and selective. Most patients experience a mix of settings during their illness, and evidence found by the review has more to do with qualities and values that will contribute to good end-of-life care in any location. Models of care do not make systematic use of the consumer data that are available to them, although an increasingly common theme is the need for integration of the various sources of care supporting dying people. It is equally clear that most integration models limit their attention to end-of-life care provided by health services. Transitions between settings merit further attention. We argue that models of care should take account of consumer experience not by incorporating generalised evidence but by co-creating services with local communities using a public health approach.

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Section: Residential Hospicementioning

confidence: 99%

Palliative and End-of-Life Care Service Models: To What Extent Are Consumer Perspectives Considered?

Rumbold

Aoun

2021

Healthcare

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“…It can be provided by generalist or specialist palliative care providers in both inpatient and community settings, with those with more complex needs generally requiring specialist care. Despite limitations of research studies in the end-of-life context, there is evidence to support the effectiveness of specialist palliative care programmes which have been found to improve quality of life [ 11 – 15 ] and relieve symptoms [ 11 , 16 , 17 ] for patients with advanced disease. In many countries (including Australia), government palliative care policies have emphasised the need to achieve the patient’s preferred place of death and a need to avoid unnecessary hospitalisation, noting the potential cost savings that might be achieved [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…It can be provided by generalist or specialist palliative care providers in both inpatient and community settings, with those with more complex needs generally requiring specialist care. Despite limitations of research studies in the end-oflife context, there is evidence to support the effectiveness of specialist palliative care programmes which have been found to improve quality of life [11][12][13][14][15] and relieve symptoms [11,16,17] for patients with advanced disease. In many Extended author information available on the last page of the article…”

Section: Introductionmentioning

confidence: 99%

Specialist Palliative Care and Health Care Costs at the End of Life

Kenny,

Liu,

Fiebig

et al. 2023

PharmacoEconomics Open

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Background/Aims The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliative care (SPC) for decedents who died from cancer or another life-limiting illness. Methods The decedents were participants in a cohort study of older residents of the state of New South Wales, Australia. Using linked survey and administrative health data from 2007 to 2016, two cohorts were identified: n = 10,535 where the cause of death was cancer; and n = 11,179 where the cause of death was another life-limiting illness. Costs of various types were analysed with separate risk-adjusted linear regression models for the last 1, 3, 6, 9 and 12 months before death and for both cohorts. SPC was categorised according to time to death from first contact with the service as 1–7 days, 7–30 days, 30–180 days and more than 180 days. Results SPC use was higher among the cancer cohort (30.0%) relative to the non-cancer cohort (4.8%). The mean costs over the final year of life were AU$55,037 (SD 45,059) for the cancer cohort and AU$35,318 (SD 41,948) for the non-cancer cohort. Earlier use of SPC was associated with higher costs over the last year of life but lower costs in the last 1 and 3 months for both cohorts. Initiating SPC use more than 180 days before death was associated with a mean difference relative to the no SPC group of AU$15,590 (95% CI 10,617 to 20,562) and AU$13,739 (95% CI 733 to 26,746) over the last year of life for those dying from cancer and another illness, respectively. The same differences over the last month of life were − AU$2810 (95% CI − 3945 to − 1676) and − AU$4345 (95% CI − 6625 to − 2066). Admitted hospital care was the major driver of costs, with longer SPC associated with lower rates of death in hospital for both cohorts. Conclusion Early initiation of SPC was associated with higher costs over the last year of life and lower costs over the last months of life. This was the case for both the cancer and non-cancer cohorts, and appeared to be largely attributed to reduced hospitalisation. Although further investigation is required, our results suggest that expanding the availability of SPC services to provide more equitable access could enable patients to spend more time at their usual place of residence, reduce pressure on inpatient services and facilitate death at home when that is preferred. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-023-00446-7.

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“…However, palliative care needs may change depending on the characteristics of patients admitted to palliative care units 13 14. In addition, the relationship between Phase of Illness and symptoms in patients with advanced cancer admitted to palliative care units is unclear 10 15. We hypothesised that a deeper understanding of the relationship between Phase of Illness and symptoms could enable healthcare providers to consider a palliative care plan based on the phases.…”

Section: Introductionmentioning

confidence: 99%

Symptoms, performance status and phase of illness in advanced cancer: multicentre cross-sectional study of palliative care unit admissions

Ohinata

Aoyama

Hiratsuka

et al. 2022

BMJ Support Palliat Care

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ObjectivesTo clarify the relationship between Phase of Illness at the time of admission to palliative care units and symptoms of patients with advanced cancer.MethodsThis study was a secondary analysis of the East Asian collaborative cross-cultural Study to Elucidate the Dying process. Palliative physicians recorded data, including Phase of Illness, physical function and the Integrated Palliative care Outcome Scale. We used multinomial logistic regression to analyse ORs for factors associated with Phase of Illness. Twenty-three palliative care units in Japan participated from January 2017 to September 2018.ResultsIn total, 1894 patients were analysed—50.9% were male, mean age was 72.4 (SD±12.3) years, and Phase of Illness at the time of admission to the palliative care unit comprised 177 (8.9%) stable, 579 (29.2%) unstable, 921 (46.4%) deteriorating and 217 (10.9%) terminal phases. Symptoms were most distressing in the terminal phase for all items, followed by deteriorating, unstable and stable (p<0.001). The stable phase had lower association with shortness of breath (OR 0.73, 95% CI 0.57 to 0.94) and felt at peace (OR 0.73, 95% CI 0.56 to 0.90) than the unstable phase. In the deteriorating phase, weakness or lack of energy (OR 1.20, 95% CI 1.02 to 1.40) were higher, while drowsiness (OR 0.82, 95% CI 0.71 to 0.97) and felt at peace (OR 0.81, 95% CI 0.71 to 0.94) were significantly lower.ConclusionOur study is reflective of the situation in palliative care units in Japan. Future studies should consider the differences in patients’ medical conditions and routinely investigate patients’ Phase of Illness and symptoms.Trial registrarion numberUMIN000025457

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Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland

Cited by 6 publications

References 26 publications

Palliative and End-of-Life Care Service Models: To What Extent Are Consumer Perspectives Considered?

Palliative and End-of-Life Care Service Models: To What Extent Are Consumer Perspectives Considered?

Specialist Palliative Care and Health Care Costs at the End of Life

Symptoms, performance status and phase of illness in advanced cancer: multicentre cross-sectional study of palliative care unit admissions

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