Gulcan Bagcivan1,2, J Nicholas Dionne-Odom1, Jennifer Frost1, Margaret Plunkett3, Lisa A Stephens4, Peggy Bishop4, Richard A Taylor1, Zhongze Li5, Rodney Tucker6, Marie Bakitas1,6. 1. 1 UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA. 2. 2 Gulhane Training and Research Hospital, Ankara, Turkey. 3. 3 The Center for Nursing Excellence, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 4. 4 Palliative Care, Sentara Martha Jefferson Hospital, Charlottesville, VA, USA. 5. 5 Norris Cotton Cancer Center, Lebanon, NH, USA. 6. 6 UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA.
Abstract
BACKGROUND:Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters. AIM: Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations. DESIGN: Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated. SETTING/PARTICIPANTS: Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US. RESULTS: In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants. CONCLUSION: Outpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom indicators versus reliance on oncologist referral.
RCT Entities:
BACKGROUND: Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters. AIM: Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations. DESIGN:Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated. SETTING/PARTICIPANTS: Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US. RESULTS: In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants. CONCLUSION:Outpatient palliative care consultations for newly diagnosed advanced cancerpatients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom indicators versus reliance on oncologist referral.
Authors: Marie Bakitas; Kristen Allen Watts; Emily Malone; J Nicholas Dionne-Odom; Susan McCammon; Richard Taylor; Rodney Tucker; Ronit Elk Journal: J Clin Oncol Date: 2020-02-05 Impact factor: 44.544
Authors: Meghan Price; Elizabeth P Howell; Tara Dalton; Luis Ramirez; Claire Howell; Theresa Williamson; Peter E Fecci; Carey K Anders; Devon K Check; Arif H Kamal; C Rory Goodwin Journal: Neurooncol Pract Date: 2021-02-24