Development of a Standard for Hospital-Based Palliative Care Consultation Teams Using a Modified Delphi Method

Background: Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation. Aim: This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014. Methods: We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis. Results: We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC. Conclusion: There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.

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Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit

The Neurohospitalist ◽

10.1177/1941874419869714 ◽

2019 ◽

Vol 10 (3) ◽

pp. 163-167

Author(s):

Jon Rosenberg ◽

Allie Massaro ◽

James Siegler ◽

Stacey Sloate ◽

Matthew Mendlik ◽

...

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Palliative Care ◽

High Grade ◽

Neurological Intensive Care Unit ◽

Code Status ◽

Neurological Intensive Care ◽

Palliative Care Consultation ◽

Care Consultation

Background: Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods: We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results: Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion: In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.

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Identification of public health priorities, barriers, and solutions for Kuwait using the modified Delphi method for stakeholder consensus

The International Journal of Health Planning and Management ◽

10.1002/hpm.3270 ◽

2021 ◽

Author(s):

Janvier Gasana ◽

Harri Vainio ◽

Joseph Longenecker ◽

Tom Loney ◽

Balázs Ádám ◽

...

Keyword(s):

Public Health ◽

Delphi Method ◽

Health Priorities ◽

Modified Delphi Method ◽

Modified Delphi ◽

Stakeholder Consensus

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“I Don't Have Time to Sit and Talk with Them”: Hospitalists’ Perspectives on Palliative Care Consultation for Patients with Dementia

Journal of the American Geriatrics Society ◽

10.1111/jgs.16712 ◽

2020 ◽

Vol 68 (10) ◽

pp. 2365-2372

Author(s):

Katherine R. Courtright ◽

Trishya L. Srinivasan ◽

Vanessa L. Madden ◽

Jason Karlawish ◽

Stephanie Szymanski ◽

...

Keyword(s):

Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation

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Derivation of a procedural performance checklist for ultrasound-guided femoral arterial line placement using the modified Delphi method

The Journal of Vascular Access ◽

10.1177/1129729820904872 ◽

2020 ◽

Vol 21 (5) ◽

pp. 715-722

Author(s):

Jessica Baez ◽

Elizabeth Powell ◽

Megan Leo ◽

Uwe Stolz ◽

Lori Stolz

Keyword(s):

Delphi Method ◽

Competency Assessment ◽

Arterial Line ◽

Ultrasound Guided ◽

Arterial Access ◽

Modified Delphi Method ◽

Modified Delphi ◽

Item Checklist ◽

Standard Quality ◽

Femoral Arterial Access

Background: Many specialties utilize procedural performance checklists as an aid to teach residents and other learners. Procedural checklists ensure that the critical steps of the desired procedure are performed in a specified manner every time. Valid measures of competency are needed to evaluate learners and ensure a standard quality of care. The objective of this study was to employ the modified Delphi method to derive a procedural checklist for use during placement of ultrasound-guided femoral arterial access. Methods: A 27-item procedural checklist was provided to 14 experts from three acute care specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Results: Three rounds of the study were performed resulting in a final 23-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. Conclusion: A procedural performance checklist was created for ultrasound-guided femoral arterial access using the modified Delphi method. This is an objective tool to assist procedural training and competency assessment in a variety of clinical and educational settings.

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Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer

Current Oncology ◽

10.3747/co.26.4389 ◽

2019 ◽

Vol 26 (1) ◽

Cited By ~ 1

Author(s):

C. Lees ◽

S. Weerasinghe ◽

N. Lamond ◽

T. Younis ◽

Ravi Ramjeesingh

Keyword(s):

Pancreatic Cancer ◽

Palliative Care ◽

End Of Life ◽

Potential Effect ◽

Unresectable Pancreatic Cancer ◽

Palliative Care Consultation ◽

Integral Role ◽

Care Consultation ◽

Aggressive Care ◽

Key Indicators

Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.

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