David J Casarett1, Karen B Hirschman, John F Coffey, Lucy Pierre. 1. Philadelphia Veterans Affairs Medical Center and Department of Medicine, Institute on Aging, University of Pennsylvania, 19104, USA. casarett@mail.med.upenn.edu
Abstract
OBJECTIVE: To assess the efficacy of a palliative care clinic (PCC), which provided some of the interdisciplinary services and expertise of an inpatient consult service to outpatients, in traditional clinic sessions. DESIGN: Chart review. SETTING: A large urban Veterans Administration Medical Center. PATIENTS: One hundred patients referred to clinic. INTERVENTIONS: Palliative care clinic. OUTCOME MEASURES: Patients' reported needs, Global Distress Index (GDI) subscale, hospice eligibility, and time to death. RESULTS: The most common diagnosis was cancer (n = 85). Most patients (n = 89) had at least one need for services that the team provided (median, 2; range, 0-4), the most common of which was a desire for information about prognosis (n = 84). In a Cox proportional hazards model, predictors of enrollment in hospice included white ethnicity (hazard ratio, 3.42; p < 0.001), a need for help around the home (hazard ratio, 3.26; p = 0.002), and insufficient money left at the end of the month (hazard ratio, 2.39; p = 0.014). CONCLUSIONS: The experience of the PCC described here offers a unique approach to improving end-of-life care for those outpatients who may not be well served by existing structures of care such as palliative care consult services and who have not yet enrolled in hospice.
OBJECTIVE: To assess the efficacy of a palliative care clinic (PCC), which provided some of the interdisciplinary services and expertise of an inpatient consult service to outpatients, in traditional clinic sessions. DESIGN: Chart review. SETTING: A large urban Veterans Administration Medical Center. PATIENTS: One hundred patients referred to clinic. INTERVENTIONS: Palliative care clinic. OUTCOME MEASURES: Patients' reported needs, Global Distress Index (GDI) subscale, hospice eligibility, and time to death. RESULTS: The most common diagnosis was cancer (n = 85). Most patients (n = 89) had at least one need for services that the team provided (median, 2; range, 0-4), the most common of which was a desire for information about prognosis (n = 84). In a Cox proportional hazards model, predictors of enrollment in hospice included white ethnicity (hazard ratio, 3.42; p < 0.001), a need for help around the home (hazard ratio, 3.26; p = 0.002), and insufficient money left at the end of the month (hazard ratio, 2.39; p = 0.014). CONCLUSIONS: The experience of the PCC described here offers a unique approach to improving end-of-life care for those outpatients who may not be well served by existing structures of care such as palliative care consult services and who have not yet enrolled in hospice.
Authors: Lissi Hansen; Karen S Lyons; Nathan F Dieckmann; Michael F Chang; Shirin Hiatt; Emma Solanki; Christopher S Lee Journal: Res Nurs Health Date: 2017-06-30 Impact factor: 2.228