Doran Bostwick1, Steven Wolf2, Greg Samsa2, Janet Bull3, Donald H Taylor4, Kimberly S Johnson1, Arif H Kamal5. 1. Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. 2. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA. 3. Four Seasons, Hendersonville, North Carolina, USA. 4. Sanford School of Public Policy, Durham, North Carolina, USA. 5. Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA. Electronic address: arif.kamal@duke.edu.
Abstract
BACKGROUND: Historically, palliative care has been focused on those with cancer. Although these ties persist, palliative care is rapidly integrating into the care of patients with common, non-cancer serious illnesses. Despite this, the bulk of literature informing palliative care practices stems from the care of cancer patients. OBJECTIVES: We compared functionality, advanced care planning, hospital admissions, prognosis, quality of life, pain, dyspnea, fatigue, and depression between patients with cancer and three non-cancer diagnoses-end-stage renal disease (ESRD), heart failure (HF), and chronic obstructive pulmonary disease (COPD). METHODS: We conducted a cross-sectional, retrospective analysis of the characteristics and symptoms of patient's with ESRD, HF, COPD, and cancer at time of first specialty palliative care referral. Using a web-based point of care quality assessment and reporting tool, Quality Data and Collection Tool-Palliative care, this analysis evaluated all eligible patients who received a palliative care consultation between October 1, 2012 and November 25, 2014. Data were obtained from 13 participating sites. The primary outcome for the study was functionality using the palliative performance scale. Hospital admission in the last 30 days, prognosis, patient's understanding of prognosis, advanced care planning including code status and appointed decision maker, pain, fatigue, depression, and dyspnea were also evaluated as secondary outcomes. We tested for an association between our outcomes with disease type (cancer vs. non-cancer) fitting multivariable logistic regression models. RESULTS: We found that the patients with primary diagnoses other than cancer were less functional at time of referral (odds ratio: 1.6; 95% CI: 1.1, 2.3; P < 0.05). CONCLUSION: Patients with COPD, ESRD, and HF were less functional and more likely to be hospitalized at time of referral to palliative care than cancer patients. These findings may be reflective of the slower and more varied trajectory of non-cancer serious illness. One aim of palliative care for those with non-cancer severe illness should be directed toward improving and assisting with functionality and decreasing frequency of hospital admissions. These interventions could take place in the palliative care office, but could also be integrated into hospital discharge plans.
BACKGROUND: Historically, palliative care has been focused on those with cancer. Although these ties persist, palliative care is rapidly integrating into the care of patients with common, non-cancer serious illnesses. Despite this, the bulk of literature informing palliative care practices stems from the care of cancerpatients. OBJECTIVES: We compared functionality, advanced care planning, hospital admissions, prognosis, quality of life, pain, dyspnea, fatigue, and depression between patients with cancer and three non-cancer diagnoses-end-stage renal disease (ESRD), heart failure (HF), and chronic obstructive pulmonary disease (COPD). METHODS: We conducted a cross-sectional, retrospective analysis of the characteristics and symptoms of patient's with ESRD, HF, COPD, and cancer at time of first specialty palliative care referral. Using a web-based point of care quality assessment and reporting tool, Quality Data and Collection Tool-Palliative care, this analysis evaluated all eligible patients who received a palliative care consultation between October 1, 2012 and November 25, 2014. Data were obtained from 13 participating sites. The primary outcome for the study was functionality using the palliative performance scale. Hospital admission in the last 30 days, prognosis, patient's understanding of prognosis, advanced care planning including code status and appointed decision maker, pain, fatigue, depression, and dyspnea were also evaluated as secondary outcomes. We tested for an association between our outcomes with disease type (cancer vs. non-cancer) fitting multivariable logistic regression models. RESULTS: We found that the patients with primary diagnoses other than cancer were less functional at time of referral (odds ratio: 1.6; 95% CI: 1.1, 2.3; P < 0.05). CONCLUSION:Patients with COPD, ESRD, and HF were less functional and more likely to be hospitalized at time of referral to palliative care than cancerpatients. These findings may be reflective of the slower and more varied trajectory of non-cancer serious illness. One aim of palliative care for those with non-cancer severe illness should be directed toward improving and assisting with functionality and decreasing frequency of hospital admissions. These interventions could take place in the palliative care office, but could also be integrated into hospital discharge plans.
Authors: Gwen M Bernacki; Cara L McDermott; Daniel D Matlock; Ann M O'Hare; Lyndia Brumback; Nisha Bansal; James N Kirkpatrick; Ruth A Engelberg; Jared Randall Curtis Journal: J Pain Symptom Manage Date: 2021-08-04 Impact factor: 3.612
Authors: Birgit Basedow-Rajwich; Thomas Montag; Andreas Duckert; Christian Schulz; Gennadij Rajwich; Ingo Kleiter; Jürgen Koehler; Gabriele Lindena Journal: Palliat Care Date: 2018-07-18