Journal of palliative medicine最新文献

Context: Specialty palliative care has been associated with cost savings at the end of life, while patient navigators have been independently associated with cost savings due to screening and treatment early in the course of disease. Evidence is limited regarding patient navigators and cost savings at the end of life. Objectives: To determine the cost-effectiveness of a lay patient navigator intervention in improving palliative care outcomes for Hispanic persons with serious noncancer illness. Methods: Total health care expenditures in the last 30, 90, and 180 days of life were compared for a randomized sample of 56 Hispanic persons. Expenditures included all inpatient, outpatient, and pharmaceutical claims. Results: Overall spending in the final 180, 90, and 30 days of life was $76,008, $34,731, and $16,613. Spending was lower (p = 0.05) in the last 30 days of life for individuals who died in hospice ($9,403) than those who did not ($19,032), and persons in the intervention had a significantly (p = 0.03) higher probability of dying in hospice (63%) versus those in the control group (37%). Conclusion: Study results support the use of a culturally tailored lay patient navigator intervention to improve palliative care outcomes. The results suggest a potential return on investment for culturally appropriate lay patient navigator interventions of 4:1.

Background: Inpatient palliative care (PC) consultations are increasingly used to address operational challenges. We aimed to understand how PC consultations in a southeastern program, affected by pandemic-related care delays, impacted common clinical performance metrics. Methods: This is a retrospective analysis of a tertiary system's adult patients who received PC consultations from December 2021 to August 2022. A Medicare Severity Diagnosis Related Groups (MS-DRG) code was identified for each PC encounter, and a comparison cohort was created from non-PC encounters. Outcomes: There were 1906 patients who received a PC consultation and 7730 patients in the matched cohort. Patients receiving a PC consultation were older (mean age 68.55 years) compared with the matched cohort (mean age 62.75 years). Despite a significantly longer length of stay (LOS) (12.46 days vs. 6.99 days, p < 0.001), the PC group experienced a lower readmission rate (adjusted odds ratio 0.54, 95% confidence interval 0.44-0.65, p < 0.001). Conclusions: Our cohort study using MS-DRG matching indicates that despite increased LOS, PC consultations were associated with significantly lower readmission rates. This suggests their potential to improve resource utilization, especially in regions affected by pandemic-deferred care.

Background: Cardiogenic shock (CS) is one of the leading causes of death in patients with myocardial infarction, myocarditis, and congestive heart failure. The utilization patterns of specialist palliative care (PC) consultation in these patients are currently unknown. Objectives: To determine the utilization of PC in patients with CS and the overall comorbidities of that population. Methods: Review of the 2020 National Inpatient Sample identified 6,471,165 hospitalizations of which 38,531 patients were hospitalized with CS via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) code R57.0. Demographics and details of hospitalization were compared for patients who received PC evaluation (N = 8457) and those who did not (N = 30,074) as identified via ICD-10 CM code Z51.5. Results: Patients who received PC evaluation were older (≥65 years: 69.01% vs. 55.04%, p < 0.001), had shorter hospital stays (<14 days: 78.92% vs. 70.35% patients, p < 0.001), and higher in-hospital mortality (65.80% vs. 24.23%, p < 0.001) with higher Charlson Comorbidity Index (≥4, 55.22% vs. 48.09%, p < 0.001). Furthermore, the patients who received PC had significantly higher odds of death than those who did not (adjusted odds ratio = 6, p < 0.0001). Conclusion: Despite high mortality rates, specialist PC is not routinely involved in the care of those who die with CS, although does appear to be utilized among those most likely to die. This suggests preferential utilization of specialist PC for terminal patients; however, further research will be helpful to better understand current consult practices and increase PC utilization for this highly morbid population.

Objectives: The field of pediatric palliative care (PPC) has grown in the last few years because of increased awareness of the unique requirements of children at the terminal stage. In this study, we aimed to analyze the willingness and confidence of adult palliative care physicians in Saudi Arabia who provide palliative care services to children in need. Methods: This study employed a cross-sectional design to collect data from a large sample of palliative care physicians in Saudi Arabia. This study included palliative care physicians with a Saudi license who worked in Saudi Arabia and cared for patients with palliative needs. Results: According to this study, palliative care physicians in Saudi Arabia felt unprepared to provide PPC while maintaining a good attitude toward the practice. Most palliative care physicians believed that their training was insufficient because they had little experience in this field. In addition, they are less comfortable managing pain and symptoms than interacting with families of palliative children. Conclusions: In Saudi Arabia, palliative care physicians are eager to offer PPC; however, they need requisite resources and training. In addition, we found that palliative care physicians and their patients would benefit from further support and assistance from a PPC team.

Background: Despite long-standing recognition that providers should discuss DNR (do-not-resuscitate) orders prior to surgery, there is evidence that perioperative code status discussions are frequently of limited quality. Limited attention has been paid to patient perspectives. Objective: Determine the scope of literature on management of perioperative DNR orders from the patient perspective. Design: Systematic search of Embase, OVID, MEDLINE, Web of Science, and CINAHL. Results: We identified over 2700 records, of which only three explored surgical patients' perspectives regarding code status discussions. We highlight themes, analyze limitations of existing evidence, and outline implications for future research. Conclusions: There has been relatively little attention to the patient's perspective, preferences, and expectations regarding perioperative code status decisions. Careful investigation is necessary to inform patient-centerted approaches to communication and decision making regarding perioperative use of life-sustaining therapies.

Background: Palliative care (PC) in rural aged care facilities faces significant challenges, including late referrals and insufficient staff training, leading to a risk of suboptimal end-of-life care. Objectives: The aim of the project was to develop and implement an evidence-based Palliative Care Assessment Toolkit (PCAT) to improve PC in rural aged care facilities and evaluate its impact on care delivery and staff practices. Design: The study employed a mixed-methods design across three phases: codesign of the toolkit, implementation, and evaluation (using pre- and post-data). Baseline data were collected through an audit of decedents records and interviews with clinical staff. The toolkit was developed based on these findings and included resources in four domains: anticipatory care; advanced care planning, end-of-life care management, and staff training. Post-implementation, the toolkit's impact was assessed through repeat audit of resident records. Results: The baseline audit revealed issues around advanced care directives, regular reviews, and end-of-life care management. Five to seven months post-implementation of the PCAT toolkit, there were improvements in key areas, the commencement of end-of-life care planning (54% vs. 88%, p = 0.03), availability of medications (55% vs. 100%, p = 0.0016), provision of psychological (59% vs. 82%, p = 0.17), and spiritual support (14% vs. 44%, p = 0.05). Staff feedback indicated increased confidence in delivering PC. Conclusions: The PCAT improved the delivery of PC in rural aged care settings, enhancing both resident outcomes and staff practices. Further research is recommended to validate these findings across various settings and to explore the long-term sustainability and cost-effectiveness of such interventions.

Background: Utility values of responders and nonresponders are essential inputs in cost-effectiveness studies of radiation therapy for painful bone metastases but, to our knowledge, they have not been reported separately. Objective: We sought to determine the utility values of responders and nonresponders using data from a prospective observational study on bone metastases. Methods: The original prospective observational study was conducted at 26 centers in Japan. Of 232 enrolled patients, 181 whose pain scores at baseline were ≥2 were analyzed. Health-related quality of life (QOL) was measured using the EuroQol 5-dimensions 5-levels (EQ-5D-5L) instrument at baseline and 2- and 6-month follow-up assessments. At follow-up assessments, patients were categorized as responders or nonresponders. Pain response was assessed using the International Consensus Pain Response Endpoints. Results: Of the 181 patients analyzed, 133 (73%) and 84 (46%) were evaluable at the 2- and 6-month follow-up assessment, respectively. The EQ-5D-5L index score (utility) increased from baseline to the 2- and 6-month follow-up assessments; regarding opioid analgesic use, no clear trend was observed during the same period. The mean utility was significantly higher in responders than in nonresponders at both follow-up times. The mean daily oral morphine equivalent dose was significantly lower in responders than in nonresponders at both follow-up times. Conclusion: We determined utility values for responders and nonresponders. Pain response was associated with better QOL and less opioid use. Our utility values according to response status can be used for model input in future cost-effectiveness studies on radiation therapy for bone metastases.