TY - JOUR
T1 - Just-in-Time Decision Making
T2 - Preliminary Findings of a Goals of Care Rapid Response Team
AU - Zhukovsky, Donna S.
AU - Heung, Yvonne
AU - Enriquez, Parema
AU - Itzep, Nelda
AU - Lu, Zhanni
AU - Nortje, Nico
AU - Stanton, Penny
AU - Wong, Angelique
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© 2022 American Academy of Hospice and Palliative Medicine
PY - 2023/4
Y1 - 2023/4
N2 - Context: The COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOC RRT) to optimize resource utilization balanced with goal-concordant patient care. Objectives: Primary study objective was to evaluate feasibility of the GOC RRT by describing the frequency of consultations that occurred from those requested. Secondary objectives included adherence to consultation processes in terms of core team member participation and preliminary efficacy in limiting care escalation. Methods: We conducted a retrospective chart review of patients referred to GOC RRT (3/23/2020–9/30/2020). Analysis was descriptive. Categorical variables were compared with Fisher's exact or Chi-Square tests and continuous variables with Mann-Whitney U tests. Results: A total of 89 patients were referred. Eighty-five percent (76 of 89) underwent a total of 95 consultations. Median (range) patient age was 61 (49, 69) years, 54% (48 of 89) male, 19% (17 of 89) Hispanic, 48% (43/89) White, 73% (65 of 89) married/partnered and 66% (59 of 89) Christian. Hematologic malignancies and solid tumors were evenly balanced (53% [47/89] vs. 47% [42 of 89, P = 0.199]). Most patients (82%, 73 of 89) had metastatic disease or relapsed leukemia. Seven percent (6 of 89) had confirmed COVID-19. Sixty-nine percent (61 of 89) died during the index hospitalization. There was no statistically significant difference in demographic or clinical characteristics among groups (no consultation, 1 consultation, >1 consultation). Core team members were present at 64% (61 of 95) of consultations. Care limitation occurred in 74% (56 of 76) of patients. Conclusion: GOC RRT consultations were feasible and associated with care limitation. Adherence to core team participation was fair.
AB - Context: The COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOC RRT) to optimize resource utilization balanced with goal-concordant patient care. Objectives: Primary study objective was to evaluate feasibility of the GOC RRT by describing the frequency of consultations that occurred from those requested. Secondary objectives included adherence to consultation processes in terms of core team member participation and preliminary efficacy in limiting care escalation. Methods: We conducted a retrospective chart review of patients referred to GOC RRT (3/23/2020–9/30/2020). Analysis was descriptive. Categorical variables were compared with Fisher's exact or Chi-Square tests and continuous variables with Mann-Whitney U tests. Results: A total of 89 patients were referred. Eighty-five percent (76 of 89) underwent a total of 95 consultations. Median (range) patient age was 61 (49, 69) years, 54% (48 of 89) male, 19% (17 of 89) Hispanic, 48% (43/89) White, 73% (65 of 89) married/partnered and 66% (59 of 89) Christian. Hematologic malignancies and solid tumors were evenly balanced (53% [47/89] vs. 47% [42 of 89, P = 0.199]). Most patients (82%, 73 of 89) had metastatic disease or relapsed leukemia. Seven percent (6 of 89) had confirmed COVID-19. Sixty-nine percent (61 of 89) died during the index hospitalization. There was no statistically significant difference in demographic or clinical characteristics among groups (no consultation, 1 consultation, >1 consultation). Core team members were present at 64% (61 of 95) of consultations. Care limitation occurred in 74% (56 of 76) of patients. Conclusion: GOC RRT consultations were feasible and associated with care limitation. Adherence to core team participation was fair.
KW - advance care planning
KW - care limitation
KW - family meetings
KW - goal-concordant care
KW - Goals of care
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U2 - 10.1016/j.jpainsymman.2022.11.022
DO - 10.1016/j.jpainsymman.2022.11.022
M3 - Article
C2 - 36496112
AN - SCOPUS:85144802383
SN - 0885-3924
VL - 65
SP - e337-e343
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 4
ER -