How to better help cancer patients face their coming death?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21505-e21505 ◽  
Author(s):  
Francois-Xavier Goudot ◽  
Milena Maglio ◽  
Sandrine Bretonniere
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Disease Duration ◽  
Hospice Care ◽  
Good Practice ◽  
Terminal Phase ◽  
Palliative Care Teams ◽  
Short Disease Duration ◽  
Impending Death ◽  
The Mean

e21505 Background: According to literature and medical experience, the doctor-patient relationship becomes strained when oncologists tell their patients that they have no more curative treatments to offer them. Patients often resist when they are told that it is in their best interest to meet with the palliative teams. Little is known about how to meet patients’ expectations at this advanced stage. Methods: We conducted a multicenter qualitative research in an oncology department, a hospital at home service and in an inpatient hospice care center. We met 47 patients (M = 21, F = 27, mean age = 65 yrs, mean disease duration = 5 yrs) for in-depth face to face interviews performed by a multi-disciplinary ethics team. Interviews were carried out between 1 and 3 months before death. Results: Qualitative analysis revealed 4 main results. 1/ For respondents, palliative care introduction meant impending death. 2/ Palliative care introduction meant loss of hope. Without hope, the cancer trajectory is impossible to sustain, they said. 3/ Hope was intricately interwoven with the request for more chemotherapy, even if doctors had clearly refused to provide it. 4/ The oncologist remained the referent physician, even for patients in hospice care. Patients for which the mean duration between cancer diagnosis and interview was 5 years or more, were more willing to talk about death and better accepted palliative care than patients for which the mean duration of cancer was inferior to 3 yrs. For patients with fast progressing cancer (n = 11), 10 were not willing to talk about death and 7 strongly resisted palliative care introduction. There was no difference between patients according to age, sex, type of cancer or center of inclusion. Conclusions: In the terminal phase of cancer, patients are unwilling to talk about death and are reluctant to meet with palliative care teams. Short disease duration strongly reinforces this attitude. If patients resist discussions about their impending death, should physicians continue to consider it good practice to introduce such discussions? Is it beneficent for patients?

scholarly journals Hope of Recovery in Patients in the Terminal Phase of Cancer under Palliative and Hospice Care in Poland

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Bożena Baczewska ◽  
Bogusław Block ◽  
Beata Kropornicka ◽  
Antoni Niedzielski ◽  
Maria Malm ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Terminal Phase ◽  
Family Socioeconomic Status ◽  
Terminally Ill Cancer Patients ◽  
Patients With Cancer ◽  
Causal Treatment ◽  
Low Levels ◽  
The Individual ◽  
Oncologic Therapy

Introduction. The objective of the presented research is to characterize hope in the situational dimension, i.e., health, in the patients with cancer in the terminal phase of the disease, being treated in hospices and palliative care centers. Hope is very important for all the patients, especially for patients with cancer in various phases of the disease. Giving up on oncologic therapy and causal treatment is often associated with a transition into palliative care. When death and a loss of values become a threat, the individual has got hope to rely on. Material and Methods. The study relies on the Test to Measure Hope in the Health Context (NCN-36) by B.L. Block. 246 patients in the terminal phase of cancer participated in the study. Results. The internal structure of hope of recovery in the patients’ group was varied. The patients showed low levels of hope of recovery since they do not believe in the effectiveness of treatment. They were also not convinced of the effectiveness of modifications in dieting, lifestyle, or the use of nonconventional medicine. They trusted the doctor in charge and were moderately satisfied with the therapy in use. The intensity of hope of recovery was on the low level in the patients in the terminal phase of cancer. Age, sex, place of living, and marital status had a significant influence on the level of hope of recovery. Variables such as living on one’s own or living with one’s family, socioeconomic status, education, or profession did not affect the level of hope of recovery. Conclusions. The presented results allowed as to conclude that the assessment of hope in terminally ill cancer patients can be considered as one of the important tools enabling the personalization and the improvement of palliative care.

Impact of palliative care on end-of-life management of cancer patients dying in the hospital.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20613-e20613
Author(s):  
Syed Mustafa Karim ◽  
Jamal M Zekri ◽  
Ehab Mosaad Abdelghany ◽  
Azhar Rizvi ◽  
Aboelkhair Al-Gahmi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Healthcare Providers ◽  
Time Of Death ◽  
Chi Square ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Chi Square Test ◽  
Eol Care

e20613 Background: A substantial number of cancer patients receive inpatient care at the end-of-life (EoL). Involvement of palliative care teams during the course of cancer treatment has been shown to improve quality of life (QoL) in cancer patients. In this study, we compare the EoL care of cancer patients dying in the hospital under medical oncology (MO) and palliative care (PC) services. Methods: A retrospective review of medical records of adult cancer patients who received chemotherapy during their illness and died in our hospital between January 2010 and January 2012 was conducted. The quality metrics measured as endpoints were: chemotherapy given within 21 days of death, death in the ICU, CPR at time of death, and time from last chemotherapy to death (TLCD). These endpoints were compared between patients who died under the MO service (cohort A) and those dying under PC service (cohort B). Chi-square test and T-test were used to compare the endpoints between the two cohorts. Results: Of the 106 cancer patients who died in the hospital, 40 and 66 were in cohorts A and B respectively. 30% of all patients were 65 years of age or older, and were equally distributed between the two cohorts. Patients in cohort A were more likely to receive chemotherapy within last 3 weeks of life (27.5% versus 7.5%, p=0.012, 95% CI 4.16-37.15), to have CPR at time of death (15% versus 0%, p=0.005, 95% CI 4.2-29.8) and to die in the ICU (52.5% versus 1.5%, p=<0.001, 95% CI 33.3-67.1) as compared to patients in cohort B. The average time from last chemotherapy to death was significantly longer (221 days) for cohort B patients as compared to cohort A patients (96 days), p=0.01. Patients in cohort A who had PC consultation during their hospitalization had no differences in the measured endpoints when compared to patients in cohort B. Conclusions: Cancer patients who die in the hospital while under MO service without PC involvement tend to have more aggressive EoL care. This may impact negatively on some QoL features. Early referral to palliative care services may facilitate better understanding and fulfillment of the needs of cancer patients and their caregivers by the healthcare-providers.

Palliative referrals in advanced cancer patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12102-12102
Author(s):  
Abigail Sy Chan ◽  
Amit Rout ◽  
Irina Lev ◽  
Amy Yu ◽  
Chris D'Adamo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Hospice Care ◽  
Inpatient Setting ◽  
Care Needs ◽  
Clinical Indicators ◽  
Code Status ◽  
Palliative Care Needs

12102 Backgroun1d: Timely identification of palliative care needs have the ability to reduce hospitalizations and improve QOL. The Supportive & Palliative Care Indicators Tool (SPICT) is used to identify patients with advanced stage medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting and has been validated to assess 24-hour mortality risk. We used SPICT and RI in cancer patients admitted to the hospital and evaluated their roles in recognizing early palliative care needs and 6-month mortality. Methods: Advanced/metastatic cancer patients admitted to our institution from Jan 1, 2019 to June 30, 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), comorbidities, palliative/hospice care referrals, vital status, initial RI score, and computed SPICT scores were obtained. Worse clinical indicators were defined as SPICT positive if it met > 2 clinical indicators or RI < 60. Univariate and bivariate analyses were performed. Results: A total of 227 patients were included, mean age 68, 34% Caucasians, 63% Blacks, 59% female, median comorbidities of 3, with majority having lung and GI malignancies. A total of 137 (60%) were SPICT +, 47 (21%) had RI < 60, and 38 (17%) concurrent SPICT + and RI < 60. SPICT + patients were more likely to have longer hospital stay, change in code status, more palliative/hospice referrals, and increased mortality. Those with RI < 60 had similar results (Table). SPICT + patients are more likely to have RI < 60 (p = 0.0013). Conclusions: SPICT and RI are valuable tools in predicting 6-month mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer. [Table: see text]

Embedded model palliative care (PC) at a community oncology practice in central Nebraska.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 64-64
Author(s):  
Cindy Kathman ◽  
Mehmet Sitki Copur ◽  
Penny Price ◽  
Carrie Edwards ◽  
Pornchai Jonglertham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Symptom Management ◽  
Hospice Care ◽  
Prognostic Index ◽  
Cancer Center ◽  
Care Utilization ◽  
Community Oncology ◽  
Oncology Practice ◽  
Active Cancer

64 Background: PC combined with cancer care has been shown to improve patient outcomes and caregiver satisfaction while lessening unnecessary health care utilization. 85% of cancer patients receive their oncology care in the communities they live. Establishing a viable and sustainable outpatient PC service in the community oncology setting is challenging and rare nationwide. We present our 18-month PC services since its implementation at Morrison Cancer Center, a community oncology practice. Methods: Cancer patients were referred to PC by oncologists for symptom management, psychosocial support, and Advanced Care Planning (APC). PC visits were provided at the oncology clinic, home, nursing home, or hospital by our PC team (APRN, Social Workers, Chaplain and RN's). Palliative Care Prognostic Index (PPI), time to PC consultation, proportion of patients --on chemotherapy, switching to hospice care, receiving chemotherapy within the last 30 days of life, visiting ER and/or being admitted to hospital within the last 30 days of life-- were studied. Results: Over an 18-month period 72 patients were referred for a total of 470 visits. Lung, pancreas, gastroesophageal, and head and neck cancers were topmost sites. PC referrals per quarter increased from an initial 4 to an 18 at 18 months. Mean time from diagnosis to PC referral was 5.6 months (range: 1-36). Referral reasons included symptom management/support (58%), goals of care (50%), and/or predetermined triggers (15%). Mean PPI score was 50% (range 30-70). All patients had ACP. While 83% of patients were able to continue on active cancer treatment, only 5% received chemotherapy within the last 30 days of life, and 4 % had two or more ER visits with or without a hospital admission. Eventually, 17% of PC patients transitioned to hospice care. Conclusions: A PC program fostering expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care team, and patients, without prematurely stopping active cancer treatments, is feasible and can be incorporated into a community oncology practice as demonstrated by the growth and success of our program. Our model may set an example for similar practices in the community oncology setting.

Retrospective assessment of quality of cancer care in last 6 months of life.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 234-234
Author(s):  
Brian Cassel ◽  
Nevena Skoro ◽  
Kathleen Kerr ◽  
Lisa Shickle ◽  
Patrick J. Coyne ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Specialist Palliative Care ◽  
Retrospective Assessment ◽  
Palliative Care Teams ◽  
Social Security Death Index ◽  
National Quality ◽  
National Organizations

234 Background: National organizations such as the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum (NQF) have developed metrics that assess the quality of cancer care. These metrics include consensus standards by the NQF for management of symptoms and end-of-life-care. Cancer centers need feasible methods for self-evaluating their performance on such metrics. Methods: Claims for our cancer patients were matched to Social Security Death Index data to determine date of death.3,128 adult cancer patients died between January 2009 and July 2011 and had at least 1 contact with our center in their last six month of life. All inpatient and outpatient claims data generated in the last six months of life at our hospital were analyzed. Results: 32% of patients had an admission in their last 30 days of life, with 15% dying in the hospital. 19% had at least one 30-day readmission in their last six months of life. 6.7% had chemotherapy in the 2 weeks prior to death, and 11.4% in the last month. 27.5% had some contact with the specialist palliative care (SPC) team. Solid tumor patients with SPC earlier than 1 month until death had fewer in-hospital deaths (15.6%) versus those with later or no SPC (19.5%), p=.041. There was no SPC difference for 30-day mortality, or 14- or 30-day chemotherapy metrics. Conclusions: Hospitals can self-evaluate their own performance on NQF endorsed measures, and CMS outcome measures. These data provide additional impetus for earlier integration of specialist palliative care teams. SPC in the last 1-3 weeks of life did not improve most utilization metrics.[Table: see text]

Clinical interventions, economic impact, and palliative care

2015 ◽  
pp. 1048-1055
Author(s):  
Patrick J. Coyne ◽  
Thomas J. Smith ◽  
Laurel J. Lyckholm
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Management Strategies ◽  
Cost Savings ◽  
Palliative Care Teams ◽  
Futile Care ◽  
Seriously Ill Patients ◽  
Care Costs ◽  
Seriously Ill

Economic outcomes are increasingly important for all types of healthcare, including palliative care. There are substantial opportunities for improvement by using disease management strategies and care pathways. Directed, ethically motivated interventions about futile care appear to produce significant cost savings. The use of advance directives or hospice care may be good medical care, but have not been shown to produce major economic benefit. Integrated palliative care teams have been shown to reduce hospital and end-of-life care costs for seriously ill patients. For treatment to be justified, there must be some demonstrable improvement in disease-free or overall survival, toxicity, quality of life, or cost effectiveness.

scholarly journals Comparative analyses of responsiveness between the Rheumatoid Arthritis Impact of Disease score, other patient-reported outcomes and disease activity measures: secondary analyses from the ARCTIC study

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000754 ◽  
Author(s):  
Karen Holten ◽  
Joseph Sexton ◽  
Tore K Kvien ◽  
Anna-Birgitte Aga ◽  
Espen A Haavardsholm
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Inflammatory Markers ◽  
Disease Duration ◽  
Treat To Target ◽  
Patient Reported ◽  
Short Disease Duration ◽  
Activity Measures ◽  
The Mean ◽  
Disease Activity Measures

ObjectiveTo evaluate the responsiveness of the Rheumatoid Arthritis Impact of Disease (RAID) score compared with other patient-reported outcome measures (PROMs), inflammatory markers and clinical disease activity measures in patients with early rheumatoid arthritis (RA).MethodsDisease-modifying antirheumatic drug–naïve patients with RA with short disease duration were included in the treat-to-target ARCTIC trial and followed for 24 months. The responsiveness of the RAID score was evaluated using standardised response mean (SRM) and relative efficiency (RE) with respect to tender joints by Ritchie Articular Index (RAI). SRMs and REs were also calculated for other PROMs, inflammatory markers and clinical outcome measures. An SRM with value above 0.80 was considered high.Results230 patients with RA were included. The mean±SD symptom duration was 7.1±5.4 months and the baseline mean±SD  RAID score was 4.49±2.14. At 3 months of follow-up, the mean±SD change score for RAID was −2.25±1.98  and the SRM (95%  CI) −1.13 (−1.33 to −0.96). The RAID score showed high responsiveness both at 3 and 6 months (SRM≥0.80) and was more sensitive in detecting change than the reference, tender joints assessed by RAI.ConclusionsThe RAID score proved to be highly responsive to change in patients with RA with short disease duration who followed a treat-to-target strategy. The RAID score was more efficient in detecting change than the reference (RAI) as well as most other PROMs.

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