Leah M Haverhals1,2, Chelsea E Manheim3, Vincent Mor4,5, Mary Ersek6,7,8, Bruce Kinosian6,9, Karl A Lorenz10,11, Katherine E Faricy-Anderson4,12, Risha A Gidwani-Marszowski10,11,13, Cari Levy3,14. 1. Rocky Mountain Regional Veterans Affairs Medical Center, Denver-Seattle Center of Innovation, Aurora, CO, USA. leah.haverhals@va.gov. 2. Department of Health & Behavioral Sciences, University of Colorado Downtown Campus, Denver, CO, USA. leah.haverhals@va.gov. 3. Rocky Mountain Regional Veterans Affairs Medical Center, Denver-Seattle Center of Innovation, Aurora, CO, USA. 4. Center of Innovation, Providence Veterans Health Administration (VA) Medical Center, Providence, RI, USA. 5. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA. 6. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA. 7. National Performance Reporting and Outcomes Measurement to Improve the Standard of Care at End-of-Life (PROMISE) Center, US Department of Veterans Affairs, Washington, DC, USA. 8. College of Nursing, University of Pennsylvania, Philadelphia, PA, USA. 9. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. 10. Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA. 11. School of Medicine, Stanford University, Stanford, CA, USA. 12. Warren Alpert Medical School of Brown University, Providence, RI, USA. 13. VA Health Economics Resource Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA. 14. School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Abstract
PURPOSE: Veterans with advanced cancer can receive hospice care concurrently with treatments such as radiation and chemotherapy. However, variations exist in concurrent care use across Veterans Affairs (VA) medical centers (VAMCs), and overall, concurrent care use is relatively rare. In this qualitative study, we aimed to identify, describe, and explain factors that influence the provision of concurrent cancer care (defined as chemotherapy or radiation treatments provided with hospice) for veterans with terminal cancer. METHODS: From August 2015 to April 2016, we conducted six site visits and interviewed 76 clinicians and staff at six VA sites and their contracted community hospices, including community hospices (n = 16); VA oncology (n = 25); VA palliative care (n = 17); and VA inpatient hospice and palliative care units (n = 18). RESULTS: Thematic qualitative content analysis found three themes that influenced the provision of concurrent care: (1) clinicians and staff at community hospices and at VAs viewed concurrent care as a viable care option, as it preserved hope and relationships while patient goals are clarified during transitions to hospice; and (2) the presence of dedicated liaisons facilitated care coordination and education about concurrent care; however, (3) clinicians and staff concerns about Medicare guideline compliance hindered use of concurrent care. CONCLUSIONS: While concurrent care is used by a small number of veterans with advanced cancer, VA staff valued having the option available and as a bridge to hospice. Hospice staff felt concurrent care improved care coordination with VAMCs, but use may be tempered due to concerns related to Medicare compliance.
PURPOSE: Veterans with advanced cancer can receive hospice care concurrently with treatments such as radiation and chemotherapy. However, variations exist in concurrent care use across Veterans Affairs (VA) medical centers (VAMCs), and overall, concurrent care use is relatively rare. In this qualitative study, we aimed to identify, describe, and explain factors that influence the provision of concurrent cancer care (defined as chemotherapy or radiation treatments provided with hospice) for veterans with terminal cancer. METHODS: From August 2015 to April 2016, we conducted six site visits and interviewed 76 clinicians and staff at six VA sites and their contracted community hospices, including community hospices (n = 16); VA oncology (n = 25); VA palliative care (n = 17); and VA inpatient hospice and palliative care units (n = 18). RESULTS: Thematic qualitative content analysis found three themes that influenced the provision of concurrent care: (1) clinicians and staff at community hospices and at VAs viewed concurrent care as a viable care option, as it preserved hope and relationships while patient goals are clarified during transitions to hospice; and (2) the presence of dedicated liaisons facilitated care coordination and education about concurrent care; however, (3) clinicians and staff concerns about Medicare guideline compliance hindered use of concurrent care. CONCLUSIONS: While concurrent care is used by a small number of veterans with advanced cancer, VA staff valued having the option available and as a bridge to hospice. Hospice staff felt concurrent care improved care coordination with VAMCs, but use may be tempered due to concerns related to Medicare compliance.
Authors: Ann M O'Hare; Catherine R Butler; Janelle S Taylor; Susan P Y Wong; Elizabeth K Vig; Ryan S Laundry; Melissa W Wachterman; Paul L Hebert; Chuan-Fen Liu; Nilka Rios-Burrows; Claire A Richards Journal: J Am Soc Nephrol Date: 2020-08-06 Impact factor: 10.121
Authors: Carolyn J Presley; Ling Han; John R O'Leary; Weiwei Zhu; Emily Corneau; Herta Chao; Tracy Shamas; Michal Rose; Karl Lorenz; Cari R Levy; Vincent Mor; Cary P Gross Journal: J Palliat Med Date: 2020-03-02 Impact factor: 2.947
Authors: Lisa C Lindley; Jessica Keim-Malpass; Radion Svynarenko; Melanie J Cozad; Jennifer W Mack; Pamela S Hinds Journal: J Hosp Palliat Nurs Date: 2020-06 Impact factor: 2.131