The impact of the palliative care mobile team on symptom assessment and medication profiles in patients admitted to a comprehensive cancer center

Yennurajalingam, Sriram; Zhang, Tao; Bruera, Éduardo

doi:10.1007/s00520-006-0172-0

Cited by 36 publications

(28 citation statements)

References 20 publications

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“…[34][35][36][37][38][39][40][41] According to two analyses of patients with terminal cancer in varied palliative care settings, fatigue was the most frequently reported symptom, and pain, depression, and anxiety were the most distressing symptoms. 2,42 In this study, the most frequently reported symptoms were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). The incidence of presented symptoms could be related to the cancer type and site of metastasis.…”

Section: Discussionmentioning

confidence: 56%

Impact of Combined Hospice Care on Terminal Cancer Patients

Loke

Rau

Huang

2011

Journal of Palliative Medicine

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Background: Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. Patients and Methods: From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. Results: A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% ( p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% ( p ¼ 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Conclusions: Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.

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Section: Discussionmentioning

confidence: 56%

Impact of Combined Hospice Care on Terminal Cancer Patients

Loke

Rau

Huang

2011

Journal of Palliative Medicine

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“…Both the outpatient center and the inpatient services are capable of rapidly improving physical and emotional distress. 17,18 In a recent study, we found a significant reduction of pain, fatigue, nausea, drowsiness, dyspnea, anorexia, sleep depression, and anxiety among 406 outpatients at their follow-up visit. 3.…”

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confidence: 88%

Conceptual Models for Integrating Palliative Care at Cancer Centers

Bruera

Hui

2012

Journal of Palliative Medicine

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119

104

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Palliative care programs are rapidly evolving in acute care facilities. Increased and earlier access has been advocated for patients with life-threatening illnesses. Existing programs would need major growth to accommodate the increased utilization. The objective of this review is to provide an update on the current structures, processes, and outcomes of the Supportive and Palliative Care Program at the University of Texas M.D. Anderson Cancer Center (UTMDACC), and to use the update as a platform to discuss the challenges and opportunities in integrating palliative and supportive services in a tertiary care cancer center. Our interprofessional program consists of a mobile consultation team, an acute palliative care unit, and an outpatient supportive care clinic. We will discuss various metrics including symptom outcomes, quality of end-of-life care, program growth, and financial issues. Despite the growing evidence to support early palliative care involvement, referral to palliative care remains heterogeneous and delayed. To address this issue, we will discuss various conceptual models and practical recommendations to optimize palliative care access.

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“…Only 22 patients (25%) were able to complete both the baseline and follow-up ESAS. For the patients who did complete the ESAS, significant improvements were documented in pain ( Delirium improved in 21 patients (30%) who were able to complete the MDAS from an initial median score of 13 (range, 8-21) to a median MDAS score of 11 (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Of these 21 patients, 20 (95%) were discharged alive (9 patients were discharged to home with hospice services, 5 patients were discharged to an inpatient hospice unit, 4 patients were discharged to home with outpatient follow-up, and 2 patients were discharged to a skilled nursing facility).…”

Section: (26)mentioning

confidence: 99%

“…The palliative care team (PCT) consists of a palliative care physician, palliative care and oncology fellows, advance practice nurses, a social worker, a case manager, a child-life specialist, and a psychiatric nurse counselor. The PCT consults with patients in all areas of the institution about symptom control and palliative care issues through a consult team, 13 an outpatient palliative care clinic, and a 12-bed inpatient palliative care unit (PCU). 14 The consult team provides services to patients who are treated by our medical and surgical oncology departments and is staffed by palliative care physicians certified by the American Board of Hospice and Palliative Medicine, 1 full-time palliative care advanced practice nurse, and 1 palliative medicine fellow in training.…”

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confidence: 99%

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

Delgado-Guay

Parsons

et al. 2009

Cancer

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111

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BACKGROUND:The symptom burden of intensive care unit (ICU) patients who are referred to a palliative care team (PCT) has not been characterized to the authors' knowledge, and the response of these symptoms to the palliative care intervention has not been reported.METHODS:The authors retrospectively reviewed PCT consults for ICU patients who were seen between July 2006 and October 2007. To characterize symptom distress and outcomes in ICU patients who were referred to PCT in a cancer center, information and descriptive statistics about patients' demographics, comorbidities, PCT findings, interventions, and outcomes were obtained. The chi‐square test was used to analyze ICU and PCT mortality, and the signed‐rank test was used to analyze PCT interventions.RESULTS:Of 1637 PCT consults, 88 consults (5%) were from the ICU. The median patient age was 60 years (range, 22‐87 years), and 41 patients (46%) were women. The types of cancers were hematologic (19 patients; 22%), gastrointestinal (19 patients; 22%), lung (18 patients; 20%), and others (24 patients; 26%). Nineteen patients were on mechanical ventilation (MV), and 24 patients were on bilevel positive airway pressure (BIPAP). The findings were delirium (71 patients; 81%), dyspnea (67 patients; 76%), pain (74patients; 84%), fatigue (84 patients; 95%), and anxiety (57 patients; 65%). The interventions used were opioid management (99%), steroids (70%), antipsychotics (76%), and counseling (100%), do not resuscitate conversion (62 of 88 patients; 70%), withdrawal of MV (15 of 19 patients; 79%), and withdrawal of BIPAP (26 of 26 patients; 100%). Improvement was reported in pain (67 patients; 90%), dyspnea (60 patients; 90%), anxiety (51 patients; 80%), and delirium (31 patients; 44%). Thirty‐five patients (40%) were transferred to the palliative care unit (PCU). Fifty‐one ICU/PCT patients (58%) died during admission versus 130 of 1549 (8%) non‐ICU PCT patients (P < .0001). Twenty‐three of 35 patients who were transferred to the PCU (66%) died there versus 212 of 629 patients (34%) who were admitted to the PCU from another service (P < .0001). Thirty‐seven of 88 ICU/PCT patients (42%) were discharged alive.CONCLUSIONS:ICU patients who are referred to the PCT have severe symptom distress. The PCT was able to identify multiple problems and make numerous pharmacologic and nonpharmacologic recommendations that improved these symptoms, including the participation in do not resuscitate conversion and withdrawal of MV and BIPAP. Although many patients in this population died, a significant subset, including those who were transferred to the PCU, survived to discharge. Cancer 2009. © 2009 American Cancer Society.

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The impact of the palliative care mobile team on symptom assessment and medication profiles in patients admitted to a comprehensive cancer center

Cited by 36 publications

References 20 publications

Impact of Combined Hospice Care on Terminal Cancer Patients

Impact of Combined Hospice Care on Terminal Cancer Patients

Conceptual Models for Integrating Palliative Care at Cancer Centers

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

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