PURPOSE: Palliative care (PC) has been shown to improve the quality of care and resource utilization for inpatients. We examined the relationship between PC consultation before and during final admission and patterns of care for dying patients at our tertiary cancer center. METHODS: We retrospectively reviewed adult patients with solid tumor cancer with a length of stay ≥ 3 days who died in hospital between December 2012 and November 2014. We recorded services, including laboratory testing, imaging, blood products, medications, diet orders, do not resuscitate orders, and consultations, delivered within 3 days of death. We assessed the differences among services delivered to patients with outpatient PC, inpatient PC only, and no PC involvement. RESULTS: Of 695 patients, 21% received outpatient PC, 46% received inpatient PC only, and 33% received no PC. During their final admission, 11.2% of patients received radiation therapy, and 12.5% received tumor-directed therapy, with no differences on the basis PC involvement ( P = .09 to .17). In the last 3 days of life, imaging tests occurred in 50.1%; patients with outpatient or inpatient-only PC underwent fewer studies (43.5% and 47.3%) than did those with no PC involvement (58.1%; P = .048). Do not resuscitate orders were in place within the 6 months before final admission at a greater rate for patients with outpatient PC (22%) than for patients with inpatient-only PC (8%) or those with no PC involvement (12%; P = .002). CONCLUSION: In this retrospective cohort of patients with solid tumor dying in hospital, few patients received cancer-directed therapies at the end of life. Involvement of PC was associated with a decrease in diagnostic testing and other services not clearly promoting comfort as patients approached death.
PURPOSE: Palliative care (PC) has been shown to improve the quality of care and resource utilization for inpatients. We examined the relationship between PC consultation before and during final admission and patterns of care for dying patients at our tertiary cancer center. METHODS: We retrospectively reviewed adult patients with solid tumor cancer with a length of stay ≥ 3 days who died in hospital between December 2012 and November 2014. We recorded services, including laboratory testing, imaging, blood products, medications, diet orders, do not resuscitate orders, and consultations, delivered within 3 days of death. We assessed the differences among services delivered to patients with outpatient PC, inpatient PC only, and no PC involvement. RESULTS: Of 695 patients, 21% received outpatient PC, 46% received inpatient PC only, and 33% received no PC. During their final admission, 11.2% of patients received radiation therapy, and 12.5% received tumor-directed therapy, with no differences on the basis PC involvement ( P = .09 to .17). In the last 3 days of life, imaging tests occurred in 50.1%; patients with outpatient or inpatient-only PC underwent fewer studies (43.5% and 47.3%) than did those with no PC involvement (58.1%; P = .048). Do not resuscitate orders were in place within the 6 months before final admission at a greater rate for patients with outpatient PC (22%) than for patients with inpatient-only PC (8%) or those with no PC involvement (12%; P = .002). CONCLUSION: In this retrospective cohort of patients with solid tumor dying in hospital, few patients received cancer-directed therapies at the end of life. Involvement of PC was associated with a decrease in diagnostic testing and other services not clearly promoting comfort as patients approached death.
Authors: Andrea C Phelps; Katharine E Lauderdale; Sara Alcorn; Jennifer Dillinger; Michael T Balboni; Michael Van Wert; Tyler J Vanderweele; Tracy A Balboni Journal: J Clin Oncol Date: 2012-05-21 Impact factor: 44.544
Authors: Justin E Bekelman; Scott D Halpern; Carl Rudolf Blankart; Julie P Bynum; Joachim Cohen; Robert Fowler; Stein Kaasa; Lukas Kwietniewski; Hans Olav Melberg; Bregje Onwuteaka-Philipsen; Mariska Oosterveld-Vlug; Andrew Pring; Jonas Schreyögg; Connie M Ulrich; Julia Verne; Hannah Wunsch; Ezekiel J Emanuel Journal: JAMA Date: 2016-01-19 Impact factor: 56.272
Authors: Janis J Miller; Marlene H Frost; Teresa A Rummans; Mashele Huschka; Pamela Atherton; Paul Brown; Gail Gamble; Jarrett Richardson; Jean Hanson; Jeff A Sloan; Matthew M Clark Journal: J Psychosoc Oncol Date: 2007
Authors: Vicki A Jackson; Juliet Jacobsen; Joseph A Greer; William F Pirl; Jennifer S Temel; Anthony L Back Journal: J Palliat Med Date: 2013-06-20 Impact factor: 2.947
Authors: Soko Setoguchi; Craig C Earle; Robert Glynn; Margaret Stedman; Jennifer M Polinski; Colleen P Corcoran; Jennifer S Haas Journal: J Clin Oncol Date: 2008-11-10 Impact factor: 44.544