H D Rockwell1, S A Beeson1, E J Keller2, S M Harman3, I G Newton4, N Kothary5. 1. School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA. 2. Division of Interventional Radiology, Stanford Hospitals & Clinics, 300 Pasteur Drive, H3630, Stanford, CA 94305, USA. Electronic address: ejkeller607@gmail.com. 3. Division of Primary Care and Population Health, Stanford Hospitals & Clinics, 1265 Welch Road, Stanford, CA 94305, USA. 4. School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Division of Interventional Radiology, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA. 5. Division of Interventional Radiology, Stanford Hospitals & Clinics, 300 Pasteur Drive, H3630, Stanford, CA 94305, USA.
Abstract
AIM: To characterise image-guided procedures performed near the end of life and the use of goals of care discussions (GOC) and palliative care consultation (PCC) prior to these procedures. MATERIALS AND METHODS: Retrospective chart review of 3,714 consecutive inpatient procedures performed for 2,351 patients and 8,206 outpatient procedures performed for 5,225 patients within a suburban medical system. Data were collected on demographics, procedures performed, mortality, and use of GOC or PCC prior to the procedures. Procedures near the end of life were classified as emergent, elective, or palliative. Logistic regression was used to assess for demographic disparities in care. RESULTS: Nine percent of inpatients died within 30 days of their procedure, 57% of which were within the same hospitalisation. Of these patients, 59% had a documented GOC and 35% had a PCC. Similarly, 7% of outpatients died within 6 months of their procedure. A minority of these patients had a documented GOC (37%) or PCC (13%). There were few statistically significant demographic disparities in this care and the associated odds ratios were small. CONCLUSION: A wide array of image-guided procedures is performed near the end of life. GOC and PCC are underutilised prior to these procedures. Few demographic disparities exist in this care.
AIM: To characterise image-guided procedures performed near the end of life and the use of goals of care discussions (GOC) and palliative care consultation (PCC) prior to these procedures. MATERIALS AND METHODS: Retrospective chart review of 3,714 consecutive inpatient procedures performed for 2,351 patients and 8,206 outpatient procedures performed for 5,225 patients within a suburban medical system. Data were collected on demographics, procedures performed, mortality, and use of GOC or PCC prior to the procedures. Procedures near the end of life were classified as emergent, elective, or palliative. Logistic regression was used to assess for demographic disparities in care. RESULTS: Nine percent of inpatients died within 30 days of their procedure, 57% of which were within the same hospitalisation. Of these patients, 59% had a documented GOC and 35% had a PCC. Similarly, 7% of outpatients died within 6 months of their procedure. A minority of these patients had a documented GOC (37%) or PCC (13%). There were few statistically significant demographic disparities in this care and the associated odds ratios were small. CONCLUSION: A wide array of image-guided procedures is performed near the end of life. GOC and PCC are underutilised prior to these procedures. Few demographic disparities exist in this care.