Nneka N Ufere1, David L O'Riordan2, Kara E Bischoff2, Angela K Marks2, Nwamaka Eneanya3, Raymond T Chung4, Vicki Jackson5, Steven Z Pantilat2, Areej El-Jawahri6. 1. Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: nneka.ufere@mgh.harvard.edu. 2. Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, California, USA. 3. Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 5. Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 6. Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
CONTEXT: Although palliative care (PC) has been shown to improve symptoms and end-of-life (EOL) care for patients with cancer, data are lacking on the patterns of use and outcomes of PC consultations for hospitalized patients with liver disease. OBJECTIVES: We sought to characterize the patterns of use and outcomes of PC consultations for hospitalized patients with liver disease compared with patients with cancer. METHODS: We conducted an observational study using data from the Palliative Care Quality Network (PCQN). The PCQN contains prospectively collected data on 135,197 hospitalized patients receiving PC consultations at 88 PCQN sites between January 2013 and December 2017. The PCQN data set includes patient demographics, processes of care, and patient-level clinical outcomes. RESULTS: The cohort included 44,933 patients, of whom 4402 (9.8%) had liver disease and 40,531 (90.2%) had cancer. Patients with liver disease were younger (58.9 years vs. 65.2 years, P < 0.0001) and had higher in-hospital mortality (28% vs. 16.8%, P < 0.0001). Patients with liver disease were more likely to receive PC consultations to address goals of care (81.7% vs. 67.9%, P < 0.0001) as opposed to pain management (10.9% vs. 34.9%, P < 0.0001). Both groups had similar rates of symptom improvement and change in resuscitation preferences after PC consultation. CONCLUSION: Hospitalized patients with liver disease were more likely to have a PC referral to address goals of care compared with those with cancer and were more likely to die in the hospital. Despite late PC consultations, patients with liver disease experienced improvement in symptoms and clarification of their goals of care, similar to those with cancer.
CONTEXT: Although palliative care (PC) has been shown to improve symptoms and end-of-life (EOL) care for patients with cancer, data are lacking on the patterns of use and outcomes of PC consultations for hospitalized patients with liver disease. OBJECTIVES: We sought to characterize the patterns of use and outcomes of PC consultations for hospitalized patients with liver disease compared with patients with cancer. METHODS: We conducted an observational study using data from the Palliative Care Quality Network (PCQN). The PCQN contains prospectively collected data on 135,197 hospitalized patients receiving PC consultations at 88 PCQN sites between January 2013 and December 2017. The PCQN data set includes patient demographics, processes of care, and patient-level clinical outcomes. RESULTS: The cohort included 44,933 patients, of whom 4402 (9.8%) had liver disease and 40,531 (90.2%) had cancer. Patients with liver disease were younger (58.9 years vs. 65.2 years, P < 0.0001) and had higher in-hospital mortality (28% vs. 16.8%, P < 0.0001). Patients with liver disease were more likely to receive PC consultations to address goals of care (81.7% vs. 67.9%, P < 0.0001) as opposed to pain management (10.9% vs. 34.9%, P < 0.0001). Both groups had similar rates of symptom improvement and change in resuscitation preferences after PC consultation. CONCLUSION: Hospitalized patients with liver disease were more likely to have a PC referral to address goals of care compared with those with cancer and were more likely to die in the hospital. Despite late PC consultations, patients with liver disease experienced improvement in symptoms and clarification of their goals of care, similar to those with cancer.
Authors: Nneka N Ufere; John Donlan; Lauren Waldman; Jules L Dienstag; Lawrence S Friedman; Kathleen E Corey; Nikroo Hashemi; Peter Carolan; Alan C Mullen; Michael Thiim; Irun Bhan; Ryan Nipp; Joseph A Greer; Jennifer S Temel; Raymond T Chung; Areej El-Jawahri Journal: Clin Gastroenterol Hepatol Date: 2019-03-15 Impact factor: 11.382
Authors: J S Bajaj; L R Thacker; J B Wade; A J Sanyal; D M Heuman; R K Sterling; D P Gibson; R T Stravitz; P Puri; M Fuchs; V Luketic; N Noble; M White; D Bell; D A Revicki Journal: Aliment Pharmacol Ther Date: 2011-09-19 Impact factor: 8.171
Authors: Steven Z Pantilat; Angela K Marks; Kara E Bischoff; Ashley R Bragg; David L O'Riordan Journal: J Palliat Med Date: 2017-04-06 Impact factor: 2.947
Authors: Jody C Olson; Julia A Wendon; David J Kramer; Vicente Arroyo; Rajiv Jalan; Guadalupe Garcia-Tsao; Patrick S Kamath Journal: Hepatology Date: 2011-11 Impact factor: 17.425
Authors: Fasiha Kanwal; Ian M Gralnek; Ron D Hays; Angelique Zeringue; Francisco Durazo; Steven B Han; Sammy Saab; Roger Bolus; Brennan M R Spiegel Journal: Clin Gastroenterol Hepatol Date: 2009-03-21 Impact factor: 11.382
Authors: Arpan A Patel; Anne M Walling; Joni Ricks-Oddie; Folasade P May; Sammy Saab; Neil Wenger Journal: Clin Gastroenterol Hepatol Date: 2017-02-04 Impact factor: 13.576
Authors: Corita R Grudzen; Lynne D Richardson; Pauline N Johnson; Ming Hu; Binhuan Wang; Joanna M Ortiz; Emmett A Kistler; Angela Chen; R Sean Morrison Journal: JAMA Oncol Date: 2016-05-01 Impact factor: 33.006