Palliative care and advance care planning for pancreas and other cancers

Agarwal, Rajiv; Epstein, Andrew S.

doi:10.21037/cco.2017.06.16

Cited by 11 publications

(12 citation statements)

References 96 publications

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“…The benefits of ACP have been identified from the perspective of patients (Brinkman‐Stoppelenburg et al, 2014) and professionals (Agarwal & Epstein, 2017). However, ACP is still a new concept in health care (Lakin et al, 2016; Rietjens et al, 2017) and lack of relevant research on the subject is prominent.…”

Section: Discussionmentioning

confidence: 99%

“…One part of palliative care should be advance care planning (ACP), which is a multifaceted, family‐centred and social process (Johnson et al, 2016) by which patients make decisions regarding their future medical care (Rietjens et al, 2017). The primary goal of ACP is to enable patients to consider their goals at the end of life (Agarwal & Epstein, 2017; Kok et al, 2018; Lamas et al, 2018; Rietjens et al, 2017; Sudore et al, 2017) so that they will receive the care they desire (Peppercorn et al, 2011). The aim is that their preferences can be taken into account even if they are unable to make their own decisions (Rietjens et al, 2017; Walbert, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…That is why they have not initiated end‐of‐life conversation with patients who are alone, look anxious and are having difficulties understanding information (Robinson et al, 2017). As for health professionals, ACP has helped them to obtain patients' end‐of‐life care wishes and prepare for their future medical and palliative needs (Agarwal & Epstein, 2017). However, in the opinion of the nurses, it has mainly been used in the form of documentation of treatment choices, for example advance directives (Johnson et al, 2016; Turley et al, 2016) and do‐not‐resuscitate (DNR) orders (Osinski, Vreugdenhil, de Koning, & van der Hoeven, 2017) rather than a communicative or supportive tool for the professional–patient relationship (Johnson et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Kuusisto

Santavirta

Saranto

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To describe advance care planning (ACP) for patients with cancer in palliative care from professionals' perspective. Background The number of patients with cancer is increasing. Palliative care should be based on timely ACP so that patients receive the care they prefer. Design A scoping review. Methods A systematic literature search was conducted in January 2019. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist was used. The methodological quality of the studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were analysed with content analysis. Results Of 739 studies identified, 12 were eligible for inclusion. The settings were inpatient and outpatient facilities in special and primary care including oncology, palliative and hospice care. ACP consisted of patient‐oriented issues, current and future treatment, and end‐of‐life matters. The participants were nursing, medical or social professionals. ACP conversations rarely occurred; if they did, they took place at the onset, throughout and late in the cancer. Conclusions Professionals could not separate day‐to‐day care planning and ACP. ACP documentation was scattered and difficult to find and use. Professionals were unfamiliar with ACP, and established practices were lacking. ACP conversations mostly occurred in late cancer. Further research clarifying concepts and exploring the significance of ACP for patients and relatives is recommended. Relevance to clinical practice Our results support the use of ACP by a multidisciplinary team from the early stages of cancer as a discussion forum around patients' wishes and choices. We showed the need to raise professionals' awareness of ACP. Education and appropriate data tools for ACP are important as they may reduce reluctance and promote ACP use. This paper contributes to the wider global clinical community by pointing out the importance of standardising ACP contents and practices.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Kuusisto

Santavirta

Saranto

et al. 2020

Journal of Clinical Nursing

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“…For PDAC, 75% of deaths occurred in hospital, higher than for oesophagogastric (71%) and colorectal (68%) cancers. Timeliness of contact with palliative care should be a focus for action that could reduce the proportion of PDAC patients dying in hospital . The American Society of Clinical Oncology have recently released an updated Clinical Practice Guideline for metastatic pancreas cancer specifying that palliative care should be timely and may require referral at diagnosis .…”

Section: Discussionmentioning

confidence: 99%

Population‐based analysis of treatment patterns and outcomes for pancreas cancer in Victoria

Pilgrim

Marvelde

Stuart

et al. 2020

ANZ Journal of Surgery

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Background The Victorian Pancreas Cancer summit 2017 analysed state‐wide data on management of Victorians with pancreas cancer between 2011 and 2015 to identify variations in care and outcomes. Pancreas cancer remains a formidable disease but systemic therapies are increasingly effective. Surgery remains essential but insufficient alone for cure. Understanding patterns of care and identifying variations in treatment is critical to improving outcomes. Methods This population‐based study analysed data collected prospectively by Department of Health and Human services (Victorian state government). Data were extracted from Victorian Cancer Registry (covering all Victorian cancer diagnoses), Victorian Admitted‐Episodes Dataset (all inpatient data), Victorian Radiotherapy Minimum Dataset and Victorian Death Index providing demographics, tumour and treatment characteristics, age‐standardized incidence, overall and median survival. Results Of 3962 Victorian patients with any form of pancreatic malignancy, 82% were ductal adenocarcinoma (PDAC), of whom 67% had metastases at diagnosis. One‐year overall survival for PDAC was 30% (60% non‐metastatic, 15% if metastatic). Median survival with metastases increased from 2.7 to 3.9 months, and from 13.3 to 15.9 months for non‐metastatic PDAC between 2011 and 2015. Thirty‐one percent of non‐metastatic patients underwent pancreatectomy. About 1.5% were treated with neoadjuvant chemotherapy/chemoradiation. Of patients undergoing intended curative resection, 77% proceeded to adjuvant therapy. Fifty‐one percent of metastatic PDAC patients never received anti‐tumour therapy. Conclusions Nearly one‐fourth of surgically treated patients never received systemic therapy. More than two‐thirds of non‐metastatic patients never proceeded to surgery. Further consideration of neoadjuvant therapy should be given to borderline resectable patients. Most patients with PDAC still die soon after diagnosis, but median survival is increasing.

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“…For this reason, they represent a population of oncology patients who would benefit from early end-of-life discussions. 32 We report a retrospective cohort analysis of patients with advanced pancreatic cancer in Northern Alberta, Canada, during a period when a system-wide, ACP quality improvement initiative was implemented.…”

Section: Introductionmentioning

confidence: 99%

Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study

Anaka

Lee

Lim

et al. 2022

JCO Oncology Practice

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PURPOSE: Goals of care (GoC) designations are an important part of advanced care planning (ACP) for patients with incurable cancers. Studies of outpatient oncology records show that most patients do not have GoC documented. We performed a retrospective analysis of changes in GoC designations in patients with advanced pancreatic cancer in Northern Alberta, Canada, during a system-wide ACP quality improvement initiative. METHODS: Four hundred seventy-one patients with newly diagnosis of advanced, non-neuroendocrine pancreatic cancer between 2010 and 2015 in Northern Alberta, Canada, were included. The ACP initiation launched April 2014, and included educational materials for patients and families, and a coded system of GoC designations describing care philosophies and preferences for resuscitation and medical interventions. Data sources included the Alberta Cancer Registry and oncology-specific electronic medical records. RESULTS: 25.5% of patients had a documented GoC, which increased over the study period (Mantel-Haenszel test-of-trend P < .001; increased from 7.8% in 2010 to 50.0% in 2015). GoC designations occurred later in patients who received palliative chemotherapy versus those who did not (median 130 days from diagnosis [95% CI, 76.019 to 183.981] v 36 days [95% CI, 28.107 to 43.893]; P < .001), and coincided with the end of treatment (median 4.5 days from last treatment). 64.8% of GoC designations were documented by palliative care physicians, but the proportion documented by medical oncologists increased with time (Mantel-Haenszel test-of-trend P = .020; increased from 0% in 2010 to 52.1% in 2015). CONCLUSION: GoC documentation increased in the outpatient records of patients with advanced pancreatic cancer during the system-wide, multifactorial ACP initiative. GoC documentation by medical oncologists also increased. These data provide real-world evidence supporting the impact of a specific ACP initiative to improve rates of GoC designation in patients with advanced cancer.

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Palliative care and advance care planning for pancreas and other cancers

Cited by 11 publications

References 96 publications

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Population‐based analysis of treatment patterns and outcomes for pancreas cancer in Victoria

Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study

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