Lauren T Starr1,2, Connie M Ulrich1,3, Paul Junker4, Liming Huang5, Nina R O'Connor3, Salimah H Meghani1. 1. NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA. 2. Center for Bioethics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Program for Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, PA, USA. 5. BECCA Lab, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Abstract
BACKGROUND: Early palliative care consultation ("PCC") to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed. OBJECTIVE: To identify risk factor patient profiles associated with PCC timing before death. METHODS: Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables. RESULTS: Of 1141 patients, 54% had PCC "close to death" (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC >60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or "Other" race/ethnicity intensive care patients with extreme illness severity (85%), with age <46 or >75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity. CONCLUSIONS: A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed.
BACKGROUND: Early palliative care consultation ("PCC") to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed. OBJECTIVE: To identify risk factor patient profiles associated with PCC timing before death. METHODS: Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables. RESULTS: Of 1141 patients, 54% had PCC "close to death" (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC >60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or "Other" race/ethnicity intensive care patients with extreme illness severity (85%), with age <46 or >75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity. CONCLUSIONS: A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed.
Entities:
Keywords:
communication; end of life; goals of care; intensive care; palliative care; racial disparities; terminal care; timing before death
Authors: Lauren R Pollack; Nathan E Goldstein; Wendy C Gonzalez; Craig D Blinderman; Mathew S Maurer; David J Lederer; Matthew R Baldwin Journal: J Am Geriatr Soc Date: 2017-03-06 Impact factor: 5.562
Authors: Grace M Johnston; Lynn Lethbridge; Pam Talbot; Margaret Dunbar; Laura Jewell; David Henderson; Anne Frances D'Intino; Paul McIntyre Journal: Can J Diabetes Date: 2014-07-22 Impact factor: 4.190
Authors: Franchesca Hwang; Sri Ram Pentakota; Nina E Glass; Ana Berlin; David H Livingston; Anne C Mosenthal Journal: J Surg Res Date: 2019-10-10 Impact factor: 2.192