TY - JOUR
T1 - Changes in the Care Setting of First Consults to Palliative and Supportive Care Over a Seven-Year Period
AU - Prado, Bernard L.
AU - Haider, Ali
AU - Naqvi, Syed
AU - Pestana, Roberto C.
AU - Williams, Janet L.
AU - Dibaj, Seyedeh
AU - Liu, Diane
AU - Allo, Julio
AU - De La Cruz, Vera
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© 2018
PY - 2019/1
Y1 - 2019/1
N2 - Context: Optimal benefits from palliative care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. Objectives: The objective of this study was to determine the proportion of PC1 over time in the outpatient, ICU, and inpatient non-ICU settings. We also examined patients’ baseline characteristics and the timing of PC access (from PC1 to death) by the setting of PC1. Methods: We retrospectively evaluated consecutive cancer patients’ records at our cancer center to ascertain the annual number of PC1 and its distribution across settings (2011–2017). ICU PC1 (n = 309) and a random sample of an equal number of outpatient and inpatient non-ICU PC1 were reviewed to retrieve patients’ characteristics and death date. Results: PC1 total annual number increased by 58% from 2011 (n = 2286) to 2017 (n = 3615). We found a significant decrease in the proportion of ICU PC1 (from 2.3% in 2011 to 1% in 2017, P < 0.001). There were no significant changes in the proportion of PC1 at outpatient versus inpatient settings (P = 0.2). Hematologic cancer patients were more likely to have an ICU PC1 (P < 0.001). Median survival (months) was 7.7 (6.3–9.7), 3.4 (2.4–4.5), and 0.1 (0.1–0.1) for outpatient, inpatient, and ICU, respectively (P < 0.01). Conclusion: PC1 total annual number has increased, and the proportion of PC1 at ICU, a very late clinical setting, is decreasing. Further efforts are needed to integrate PC in hematologic cancer care.
AB - Context: Optimal benefits from palliative care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. Objectives: The objective of this study was to determine the proportion of PC1 over time in the outpatient, ICU, and inpatient non-ICU settings. We also examined patients’ baseline characteristics and the timing of PC access (from PC1 to death) by the setting of PC1. Methods: We retrospectively evaluated consecutive cancer patients’ records at our cancer center to ascertain the annual number of PC1 and its distribution across settings (2011–2017). ICU PC1 (n = 309) and a random sample of an equal number of outpatient and inpatient non-ICU PC1 were reviewed to retrieve patients’ characteristics and death date. Results: PC1 total annual number increased by 58% from 2011 (n = 2286) to 2017 (n = 3615). We found a significant decrease in the proportion of ICU PC1 (from 2.3% in 2011 to 1% in 2017, P < 0.001). There were no significant changes in the proportion of PC1 at outpatient versus inpatient settings (P = 0.2). Hematologic cancer patients were more likely to have an ICU PC1 (P < 0.001). Median survival (months) was 7.7 (6.3–9.7), 3.4 (2.4–4.5), and 0.1 (0.1–0.1) for outpatient, inpatient, and ICU, respectively (P < 0.01). Conclusion: PC1 total annual number has increased, and the proportion of PC1 at ICU, a very late clinical setting, is decreasing. Further efforts are needed to integrate PC in hematologic cancer care.
KW - Palliative care integration
KW - cancer care
KW - hematological cancer
KW - intensive care unit
KW - supportive care
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U2 - 10.1016/j.jpainsymman.2018.10.269
DO - 10.1016/j.jpainsymman.2018.10.269
M3 - Article
C2 - 30315915
AN - SCOPUS:85057023067
SN - 0885-3924
VL - 57
SP - 86
EP - 92
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 1
ER -