Outcomes of an Integrated Urology-Palliative Care Clinic for Patients With Advanced Urological Cancers: Maintenance of Quality of Life and Satisfaction and High Rate of Hospice Utilization Through End of Life

Abstract

Introduction: Systematic integration of palliative care in a surgical setting is important, but has yet to be achieved. Despite evidence of early palliative care improving patients’ quality of life, hospice utilization remains low. Through an integrated palliative care-urology clinic, we aim to assess the effect of early outpatient palliative care on hospice utilization, health-related quality of life (HRQOL) and satisfaction in patients with advanced urological cancers. Methods: Participants were recruited from 2012 through 2016 in the Greater Los Angeles Veterans Affairs Hospital. We partnered with palliative care clinicians to develop an integrated urology-palliative care clinic, where participants were seen by the palliative care team on the same day as their urological visit. The 12-item Short-Form Survey, Patient Satisfaction Questionnaire Short-Form, Patient Health Questionnaire, and Brief Pain Inventory were administered at initial and subsequent visits. Follow-up questionnaire results were compared between baseline and the 2 follow-up visits, and hospice utilization rates were assessed. Results: Fifty-three participants completed baseline questionnaires. Of those 22 (42%) patients completed at least one follow-up assessment. The median time for the first and second follow-up visits was 2.9 and 7.8 months, respectively. There were no significant differences in HRQOL and satisfaction between baseline and subsequent follow-up visits. A total of 36 (68%) of 53 participants who were enrolled at the start of the study were deceased. Of those, 29 (81%) expired within a home or inpatient hospice. Conclusions: Rates of hospice use were high in an integrated palliative care-urology model. Health-related quality of life and satisfaction did not worsen over time.

The Tandem VR™ protocol: Synchronized nature-based and other outdoor experiences in virtual reality for hospice patients and their caregivers

“…The average of all items will be used to create a single pain severity score. This measure shows strong reliability and validity in palliative care populations [ 28 ].…”

Incorporating palliative care principles to improve patient care and quality of life in urologic oncology

“…The investigators offered all patients with newly diagnosed metastatic bladder, metastatic kidney and bone-metastatic prostate cancer a palliative care referral at the point of care. Quality of life and satisfaction were assessed among the 53 patients recruited to the integrated clinic over a 3.5-year period 86 . Outcomes were reassessed during follow-up visits occurring within varying timeframes.…”

Unmet needs in palliative care for patients with common non-cancer diseases: a cross-sectional study

“…To our knowledge, studies on palliative care satisfaction in non-cancer patients have been difficult to find. In a study targeting patients with cancer, satisfaction was high before and after provision of palliative care [ 17 ]. Since this evaluated palliative care satisfaction related to communication with medical staff and system functions of healthcare services, there was a limitation in that it was difficult to understand in detail which part of the care was satisfied or dissatisfied.…”