Annemieke van der Padt-Pruijsten1, Maria B L Leys2, Esther Oomen-de Hoop3, Agnes van der Heide4, Carin C D van der Rijt3. 1. Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands; Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: PruijstenA@maasstadziekenhuis.nl. 2. Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands. 3. Department Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 4. Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Abstract
CONTEXT: Early integration of oncology and palliative care has been recommended to improve patient outcomes at the end of life. A standardized Palliative Care Pathway, consisting of a structured electronic medical checklist, may support such integration. OBJECTIVES: We studied the effect of implementation of a Palliative Care Pathway on patients' place of death and advance care planning. METHODS: We conducted a prospective pre- and postimplementation study of adult patients with cancer from a single hospital who died between February 2014 and February 2015 (pre-implementation period) or between November 2015 and November 2016 (post-implementation period). RESULTS: We included 424 patients in the pre- and 426 in the post-implementation period. The pathway was started for 236 patients (55%) in the post-implementation period, on average 33 days (IQR 12-73 days) before death. 74% and 77% of the patients died outside hospital in the pre- and post-implementation period, respectively (P = 0.360). When the PCP was initiated, 83% died outside hospital. Bad-news conversations (75% and 62%, P < 0.001) and preferred place of death (47% and 32%, P < 0.001) were more often documented in the pre-implementation period, whereas a DNR-code was more often documented during the post-implementation period (79% and 89%, P < 0.001). CONCLUSIONS: Implementation of a Palliative Care Pathway had no overall positive effect on place of death and several aspects of advance care planning. Start of a Palliative Care Pathway in the last months of life may be too late to improve end-of-life care. Future research should focus on strategies enabling earlier start of palliative care interventions.
CONTEXT: Early integration of oncology and palliative care has been recommended to improve patient outcomes at the end of life. A standardized Palliative Care Pathway, consisting of a structured electronic medical checklist, may support such integration. OBJECTIVES: We studied the effect of implementation of a Palliative Care Pathway on patients' place of death and advance care planning. METHODS: We conducted a prospective pre- and postimplementation study of adult patients with cancer from a single hospital who died between February 2014 and February 2015 (pre-implementation period) or between November 2015 and November 2016 (post-implementation period). RESULTS: We included 424 patients in the pre- and 426 in the post-implementation period. The pathway was started for 236 patients (55%) in the post-implementation period, on average 33 days (IQR 12-73 days) before death. 74% and 77% of the patients died outside hospital in the pre- and post-implementation period, respectively (P = 0.360). When the PCP was initiated, 83% died outside hospital. Bad-news conversations (75% and 62%, P < 0.001) and preferred place of death (47% and 32%, P < 0.001) were more often documented in the pre-implementation period, whereas a DNR-code was more often documented during the post-implementation period (79% and 89%, P < 0.001). CONCLUSIONS: Implementation of a Palliative Care Pathway had no overall positive effect on place of death and several aspects of advance care planning. Start of a Palliative Care Pathway in the last months of life may be too late to improve end-of-life care. Future research should focus on strategies enabling earlier start of palliative care interventions.
Authors: Annemieke van der Padt-Pruijsten; Maria B L Leys; Esther Oomen-de Hoop; Agnes van der Heide; Carin C D van der Rijt Journal: Support Care Cancer Date: 2022-09-07 Impact factor: 3.359