Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

2020 ◽  
Vol 29 (13-14) ◽  
pp. 2069-2082
Author(s):  
Anne Kuusisto ◽  
Jenni Santavirta ◽  
Kaija Saranto ◽  
Päivi Korhonen ◽  
Elina Haavisto
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Scoping Review ◽  
Care Planning ◽  
Patients With Cancer ◽  
Professional Perspective ◽  
Advance Care

Characteristics of Advance Care Planning in Patients With Cancer Referred to Palliative Care

2021 ◽  
Vol 17 (2) ◽  
pp. e94-e100
Author(s):  
Callie M. Berkowitz ◽  
Steven P. Wolf ◽  
Jesse Troy ◽  
Arif H. Kamal
Keyword(s):  
Palliative Care ◽  
Data Collection ◽  
Advance Care Planning ◽  
Care Quality ◽  
Quality Data ◽  
Care Planning ◽  
Data Collection Tool ◽  
Serious Illness ◽  
Patients With Cancer ◽  
Advance Care

PURPOSE: Advance care planning (ACP) is a process in which patients share their values, goals, and preferences regarding future medical care. ACP can improve care quality, yet may be challenging to address for patients with cancer. We sought to characterize key components of ACP in patients with cancer as compared with patients with noncancer serious illness referred to palliative care (PC). METHODS: We performed a retrospective cross-sectional analysis of initial outpatient PC visits from the Quality Data Collection Tool for PC database from 2015 to 2019. Quality Data Collection Tool is a web-based point-of-care specialty PC registry to track quality metrics. RESULTS: We analyzed 1,604 patients with cancer and 1,094 patients without cancer: 44% of patients were female, 87% were White, and 98% were non-Hispanic. The average age was 72.2 years (standard deviation [SD] 15.4). Patients with cancer were on average younger than patients without cancer (66.5 [SD: 13.9] v 80.5 [SD: 13.8]) and had a higher Palliative Performance Scale (PPS) (59.5 [SD: 22.4] v 33.4 [SD: 25.1]). In our unadjusted comparison, patients with cancer were less likely to be DNR/DNI (37% v 53%; P < .0001) and less likely to have an advance directive (53% v 73%; < .0001); rates of healthcare proxy identification were similar (92.8% v 94.5%; P = .10). These differences did not persist when we accounted for age, race, sex, and PPS, with age being the primary explanatory factor. CONCLUSION: Despite having serious illness meriting PC referral, many patients with cancer in our study lacked advance directives. This highlights both the important role of oncologists in facilitating ACP and the utility of PC playing a complementary role.

Different Associations Between Inpatient or Outpatient Palliative Care and End-of-Life Outcomes for Hospitalized Patients With Cancer

2021 ◽  
Author(s):  
Jonathan C. Yeh ◽  
Arielle R. Urman ◽  
Robert J. Besaw ◽  
Laura E. Dodge ◽  
Kathleen A. Lee ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Care Planning ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Advance Care

PURPOSE Palliative care (PC) improves outcomes in advanced cancer, and guidelines recommend early outpatient referral. However, many PC teams see more inpatient than outpatient consults. We conducted a retrospective study of hospitalized patients with cancer to quantify exposure to inpatient and outpatient PC and describe associations between PC and end-of-life (EOL) quality measures. METHODS We identified all decedents admitted to an inpatient oncology unit in 1 year (October 1, 2017-September 30, 2018) and abstracted hospitalization statistics, inpatient and outpatient PC visits, and EOL outcomes. Descriptive statistics, univariate tests, and multivariate analysis evaluated associations between PC and patient outcomes. RESULTS In total, 522 decedents were identified. 50% saw PC; only 21% had an outpatient PC visit. Decedents seen by PC were more likely to enroll in hospice (78% v 44%; P < .001), have do-not-resuscitate status (87% v 55%; P < .001), have advance care planning documents (53% v 31%; P < .001), and die at home or inpatient hospice instead of in hospital (67% v 40%; P < .01). Decedents seen by PC had longer hospital length-of-stay (LOS; 8.4 v 7.0 days; P = .03), but this association reversed for decedents seen by outpatient PC (6.3 v 8.3 days; P < .001), who also had longer hospice LOS (46.5 v 27.1 days; P < .01) and less EOL intensive care (6% v 15%; P < .05). CONCLUSION PC was associated with significantly more hospice utilization and advance care planning. Patients seen specifically by outpatient PC had shorter hospital LOS and longer hospice LOS. These findings suggest different effects of inpatient and outpatient PC, underscoring the importance of robust outpatient PC.

Developing a new model of care for patients with cancer who present to the emergency department: The Mayo Clinic experience.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 61-61
Author(s):  
Debra A. Wong ◽  
Tom R. Fitch ◽  
Eric Prommer ◽  
Yu-Hui Chang ◽  
Christopher A. Lipinski
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Advance Care Planning ◽  
Emergency Department Visits ◽  
Cancer Type ◽  
Care Planning ◽  
Patients With Cancer ◽  
Advance Care

61 Background: Patients with cancer often have complex symptoms and morbidity that prompt frequent Emergency Department visits. The length of stay in the ED for cancer patients exceeds that of patients without cancer. Patients with cancer are also more likely to be admitted, but are often discharged within 72h. Protracted ED visits, extensive investigations, and the burdens of even a short admission may be distressing and may not be aligned with patients’ care goals and preferences. Furthermore, the healthcare resources dedicated to these patients is considerable and has economic implications. We recently established a Supportive Care Infusion Center (SCIC), an on-campus outpatient unit where patients can receive treatments for symptom relief and comfort; they are assured integrated palliative care with routine oncologic care. We believe there is a subset of cancer patients who can be safely transferred from the ED to the SCIC for appropriate care. Methods: We are retrospectively evaluating cancer patients admitted through the ED to validate clinical parameters likely to lead to admission, and also identify any differences between patients admitted for <72h vs >72h. Patients are analyzed based on symptoms, cancer type, prior cancer therapies, performance status, comorbidities, and presence/absence of advance care planning as well as previous contact with Palliative Care. Data are also being gathered on patient outcomes, including mortality within 60d of admission. Results: Previously established indicators predictive of admission included shortness of breath and SIRS criteria, which our current review validates. We also observe that patients admitted for >72h have greater symptom burden and comorbidities and have received multiple lines of therapy. They also less frequently have advance care planning in place. Data analysis is ongoing. Conclusions: There exists a difference between cancer patients admitted >72h and those discharged within 72h. Awareness of these characteristics may lead to improved workflow in the ED. Identifying patients who may be suitable for transfer to an outpatient supportive care unit rather than short-term admission will also facilitate cost-effectiveness. Future direction includes evaluation of outcomes such as mortality, quality of life, and patient-caregiver satisfaction.

Demenz aus palliativmedizinischer Perspektive: warum ein krankheitsspezifisches Advance Care Planning wichtig ist

2018 ◽  
Vol 75 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Ralf J. Jox ◽  
Francesca Bosisio ◽  
Eve Rubli Truchard
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care ◽  
Menschen Mit Demenz

Zusammenfassung. Die Palliative Care muss sich im Zuge des demographischen Wandels vieler Gesellschaften rund um den Globus tiefgreifend wandeln. Sie muss mehr und mehr mit der Geriatrie zusammenarbeiten und geriatrische Expertise integrieren. Eine der zentralen Herausforderungen Geriatrischer Palliative Care ist die ethisch angemessene Therapieentscheidung für Menschen, die nicht mehr urteilsfähig sind. Nachdem der bisherige Ansatz herkömmlicher Patientenverfügungen erwiesenermassen enttäuscht hat, wird aktuell, gerade auch in deutschsprachigen Ländern, das systemische Konzept des Advance Care Planning (ACP) verfolgt. In diesem Artikel wird zunächst ACP mit seinen Zielen, Elementen und Effekten vorgestellt. Sodann wird gezeigt, weshalb es für Menschen mit Demenz eines adaptierten ACP-Programms bedarf und was ein solches demenzspezifisches ACP beinhalten muss.

Communication around palliative care principles and advance care planning between oncologists, children with advancing cancer and families

2021 ◽  
Author(s):  
Erica C. Kaye ◽  
Cameka Woods ◽  
Kendall Kennedy ◽  
Srilakshmi Velrajan ◽  
Melanie Gattas ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

Welche Relevanz hat Advance Care Planning für die pädiatrische Intensivstation?

intensiv ◽  
2021 ◽  
Vol 29 (02) ◽  
pp. 99-106
Author(s):  
Simone Keller
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

Advance Care Planning hat in der Palliative Care einen hohen Stellenwert. Dabei werden Wünsche und Bedürfnisse von Patienten und deren Familien erfasst, Therapieziele und Maßnahmen für den Krankheitsverlauf und das Lebensende frühzeitig diskutiert und festgehalten. Bei der Betreuung von kritisch kranken Kindern auf der Intensivstation sind Kommunikation und Entscheidungsfindungsprozesse von großer Wichtigkeit, und sie stellen hohe Anforderungen an das Behandlungsteam. Der folgende Beitrag zeigt den Nutzen und die positiven Aspekte von Advance Care Planning, auch für das Setting der Intensivstation.

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