Sociodemographic Characteristics and Lengths of Stay Associated With Acute Palliative Care: A 10-Year National Perspective

Mendieta, Maximiliano; Miller, Alysa

doi:10.1177/1049909118786409

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…On a sociodemographic level, the needs of the seriously ill person with MCC can be influenced by age, gender, socioeconomic status, race, ethnicity, level of income, and level of education. 32 Sociodemographic characteristics have been shown to impact health outcomes, as they can impact access to care or ability to pay for health care and result in disparities related to race, ethnicity, age, or gender. [32][33][34][35] The adapted model accounts for goals, values, or preferences of the individual.…”

Section: Factors Affecting Needs Of the Individualmentioning

confidence: 99%

“…32 Sociodemographic characteristics have been shown to impact health outcomes, as they can impact access to care or ability to pay for health care and result in disparities related to race, ethnicity, age, or gender. [32][33][34][35] The adapted model accounts for goals, values, or preferences of the individual. 10 Social, cultural, or religious beliefs that influence the needs of a seriously ill person with MCC are also relevant.…”

Section: Factors Affecting Needs Of the Individualmentioning

confidence: 99%

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An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions

Murali¹,

Merriman²,

Yu³

et al. 2020

Am J Hosp Palliat Care

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Objective: Seriously ill adults with multiple chronic conditions (MCC) who receive palliative care may benefit from improved symptom burden, health care utilization and cost, caregiver stress, and quality of life. To guide research involving serious illness and MCC, palliative care can be integrated into a conceptual model to develop future research studies to improve care strategies and outcomes in this population. Methods: The adapted conceptual model was developed based on a thorough review of the literature, in which current evidence and conceptual models related to serious illness, MCC, and palliative care were appraised. Factors contributing to patients’ needs, services received, and service-related variables were identified. Relevant patient outcomes and evidence gaps are also highlighted. Results: Fifty-eight articles were synthesized to inform the development of an adapted conceptual model including serious illness, MCC, and palliative care. Concepts were organized into 4 main conceptual groups, including Factors Affecting Needs (sociodemographic and social determinants of health), Factors Affecting Services Received (health system; research, evidence base, dissemination, and health policy; community resources), Service-Related Variables (patient visits, service mix, quality of care, patient information, experience), and Outcomes (symptom burden, quality of life, function, advance care planning, goal-concordant care, utilization, cost, death, site of death, satisfaction). Discussion: The adapted conceptual model integrates palliative care with serious illness and multiple chronic conditions. The model is intended to guide the development of research studies involving seriously ill adults with MCC and aid researchers in addressing relevant evidence gaps.

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Section: Factors Affecting Needs Of the Individualmentioning

confidence: 99%

Section: Factors Affecting Needs Of the Individualmentioning

confidence: 99%

An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions

Murali¹,

Merriman²,

Yu³

et al. 2020

Am J Hosp Palliat Care

View full text Add to dashboard Cite

show abstract

“…1 Prior research has identified sex-based disparities in both the intensity and the frequency of health care services, including hospital admission, access to home-based end-of-life care and use of lifesustaining interventions at the very end of life, accessed by male and female patients. [2][3][4][5] Palliative care improves quality of life, reduces symptom burden, and is associated with a reduction in use of health care services, an increase in quality-adjusted survival and an overall substantial cost-savings among patients with terminal lifelimiting conditions. [6][7][8][9][10][11][12] There remains considerable uncertainty about potential disparities in physician-delivered palliative care between male and female patients at the end of life.…”

mentioning

confidence: 99%

Association of patient sex with use of palliative care in Ontario, Canada: a population-based study

Gitau,

Huang,

Isenberg

et al. 2023

cmajo

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Background: It is unclear whether there are sex-based differences in use of palliative care near the end of life. The objective of this study was to measure the association between sex and palliative care use. Methods: We performed a population-based retrospective cohort study of all patients aged 18 years or older in the last year of life who died in Ontario, Canada, between 2010 and 2018. The primary exposure was patient biologic sex (male or female). The primary outcome was receipt of physician-delivered palliative care; secondary outcomes were approach to in-hospital palliative care and sex concordance of the patient and referring physician. We used multivariable modified Poisson regression to measure the association between patient sex and palliative care receipt, as well as patient–physician sex concordance. Results: There were 706 722 patients (354 657 females [50.2%], median age 80 yr [interquartile range 69–87 yr]) in the study cohort, 377 498 (53.4%) of whom received physician-delivered palliative care. After adjustment for age and selected comorbidities, female sex was associated with a 9% relative increase (adjusted relative risk [RR] 1.09, 95% CI 1.08–1.10) in receipt of physician-delivered palliative care. Female patients were 16% more likely than male patients (adjusted RR 1.14, 95% CI 1.14–1.18) to have had their first hospital admission in their final year of life categorized as having a likely palliative intent. Female patients were 18% more likely than male patients (RR 1.18, 95% CI 1.17–1.19) to have had a female referring physician, and male patients were 20% more likely than female patients (adjusted RR 1.20, CI 1.19–1.21) to have had a male referring physician. Interpretation: After adjustment for age and comorbidities, male patients were slightly less likely than female patients to have received physician-delivered palliative care, and female patients were more likely than male patients to have had their first hospital admission in their final year of life categorized as having a likely palliative care intent. These results may reflect a between-sex difference in overall end-of-life care preferences or sex differences in decision-making influenced by patient-specific factors; further studies exploring how these factors affect end-of-life decision-making are required.

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Duration of palliative care before death in international routine practice: a systematic review and meta-analysis

Jordan

Allsop

ElMokhallalati

et al. 2020

BMC Med

100

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Background Early provision of palliative care, at least 3–4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature. Methods We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker’s criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death). Results One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as ‘good’ quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries. Conclusions Duration of palliative care is much shorter than the 3–4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.

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Sociodemographic Characteristics and Lengths of Stay Associated With Acute Palliative Care: A 10-Year National Perspective

Cited by 3 publications

References 10 publications

An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions

An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions

Association of patient sex with use of palliative care in Ontario, Canada: a population-based study

Duration of palliative care before death in international routine practice: a systematic review and meta-analysis

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