Palliative care in BMT

Chung, Harold M.; Lyckholm, Laurie; Smith, Thomas J.

doi:10.1038/bmt.2008.436

Cited by 45 publications

(36 citation statements)

References 73 publications

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“…Integration of a palliative care approach with hematopoietic stem cell or solid organ transplantation has been recently proposed. [40][41][42] Song et al have found that barriers to integrating palliative care with lung transplantation include providers' misconceptions that palliative care is equivalent to EOL care, difficulty in discussing palliative care with families, and uncertainty about prognosis. 43 Pediatricians and nurses report similar barriers to the provision of pediatric palliative care in ICU and non-ICU settings, including prognostic uncertainty.…”

Section: Discussionmentioning

confidence: 99%

End-of-life experience of children undergoing stem cell transplantation for malignancy: parent and provider perspectives and patterns of care

Ullrich

Dussel

Hilden

et al. 2010

Blood

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The end-of-life (EOL) experience of children who undergo stem cell transplantation (SCT) may differ from that of other children with cancer. To evaluate perspectives and patterns of EOL care after SCT, we surveyed 141 parents of children who died of cancer (response rate, 64%) and their physicians. Chart review provided additional information. Children for whom SCT was the last cancer therapy (n ‫؍‬ 31) were compared with those for whom it was not (n ‫؍‬ 110). SCT parents and physicians recognized no realistic chance for cure later than non-SCT peers (both P < .001) and were more likely to have a primary goal of cure at death (parents, P < .001; physicians, P ‫؍‬ .02). SCT children were more likely to suffer highly from their last cancer therapy and die in the intensive care unit (both P < .001), with less opportunity for EOL preparation. SCT parents who recognized no realistic chance for cure more than 7 days before death along with the physician were more likely to prepare for EOL, and if their primary goal was to reduce suffering, to achieve this (P < .001). SCT is associated with significant suffering and less opportunity to prepare for EOL. Children and families undergoing SCT may benefit from ongoing discussions regarding prognosis, goals, and opportunities to maximize quality of life. (Blood.

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Section: Discussionmentioning

confidence: 99%

End-of-life experience of children undergoing stem cell transplantation for malignancy: parent and provider perspectives and patterns of care

Ullrich

Dussel

Hilden

et al. 2010

Blood

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“…“As stated by the National Consensus Project, palliative care is ‘The goal is to prevent and relieve suffering and to support the best quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies.’ Also described by the Center to Advance Palliative Care as, ‘Interdisciplinary care that aims to relieve suffering and improve quality of life for patients with advanced illness and their families.’”(52)…”

Section: Tablementioning

confidence: 99%

The Lack of Standard Definitions in the Supportive and Palliative Oncology Literature

Hui

Mori

Parsons

et al. 2012

Journal of Pain and Symptom Management

130

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Context Multiple organizations have raised concerns about the lack of standard definitions for terminology in the supportive and palliative oncology literature. Objectives We aimed to determine: 1) the frequency of 10 commonly used terms in the supportive and palliative oncology literature; 2) the proportion of articles that provided definitions for each term; and 3) how each term was defined. Methods We systematically searched MEDLINE, PubMed, PsycINFO, the Cochrane Library, Embase, ISI Web of Science, and CINAHL for original studies, review articles and systematic reviews related to palliative care and cancer in the first six months of 2004 and 2009. We counted the number of occurrences for “palliative care,” “supportive care,” “best supportive care,” “hospice care,” “terminal care,” “end-of-life,” “terminally ill,” “goals of care,” “actively dying,” and “transition of care” in each article, reviewed them for the presence of definitions, and documented the journal characteristics. Results Among the 1213 articles found, 678 (56%) were from 2009. “Palliative care” and “end-of-life” were the most frequently used terms. “Palliative care,” “end-of-life” and “terminally ill” appeared more frequently in palliative care journals, while “supportive care” and “best supportive care” were used more often in oncology journals (P<0.001). Among 35 of 601 (6%) articles with a definition for “palliative care,” there were 16 different variations (21 of 35 articles used the World Health Organization definition). “Hospice care” had 13 definitions among 13 of 151 (9%) articles. “Supportive care” and other terms were rarely defined (less than 5% of articles that used the term). Conclusion Our findings highlight the lack of definitional clarity for many important terms in the supportive and palliative oncology literature. Standard definitions are needed to improve administrative, clinical and research operations.

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“…We also know that the presence of an advance directive is associated with a twofold higher survival rate during stem cell transplant, not the opposite, so people should not be afraid that having a conversation about the possibility of death will make it more immediately likely [8]. We just do not do it.…”

Section: Unrealistic or Uninformed Demands For Benefit From Palliativmentioning

confidence: 99%

Concrete Options and Ideas for Increasing Value in Oncology Care: The View from One Trench

Smith

Hillner

2010

The Oncologist

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In the U.S., medical oncology as a profession is wrestling with conflicting and often unrealistic clinical and financial expectations. Office-based practitioners face an environment of low reimbursement for cognitive care, high but declining reimbursement for chemotherapy and supportive care, and high income expectations of oncology professionals. As a field, there has been little incentive to assess or improve the quality of cancer care. Current incentives are often misaligned to reward doing the most aggressive and expensive actions, as long as patients are satisfied, because this leads to the highest return to the practice. Some consequences include U.S. cancer treatment costs that are twice that of any other nation with no or minimal differences in survival, late referrals (if at all) to hospice, and 14%-20% of patients receiving chemotherapy within 14 days of their death when it is highly likely to harm and cause complications. This pattern of care may lead to a significant risk for stress and burnout, as well as being economically unsustainable.Systematic change to reward value requires realignment of incentives to provide episode-based care free from incentives to give expensive chemotherapy or supportive care drugs without good evidence, and an external board to determine appropriate patterns of care. The only ways to reduce the cost of care are to reduce either the amount of care or the cost of care, and either has dramatic consequences in a field that has been built on high expectations. These actions will likely control costs, but in the short term will cause significant distress among patients, families, and health care practitioners. The Oncologist 2010;15(suppl 1):65-72

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Palliative care in BMT

Cited by 45 publications

References 73 publications

End-of-life experience of children undergoing stem cell transplantation for malignancy: parent and provider perspectives and patterns of care

End-of-life experience of children undergoing stem cell transplantation for malignancy: parent and provider perspectives and patterns of care

The Lack of Standard Definitions in the Supportive and Palliative Oncology Literature

Concrete Options and Ideas for Increasing Value in Oncology Care: The View from One Trench

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