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A Retrospective Analysis of Pain Burden in Hospitalized Young Adult Cancer Patients Compared to Their Older Adult Counterpart (S772)
Vol. 53 No. 2 February 2017
Scientific Poster Abstracts
the number of consults over time. Discharge disposition included 30.2% dying in hospital, 17.3% to home hospice, 12.0% to hospice, and the remainder to home or rehab. 46.3% of the patients who died in hospital had a PC consult within a day of death. Conclusion. Since the initiation of a Palliative Care consult service at our hospital there has been an increase in the utilization of their services by surgical services. The main reason for consultation has been for goals of care and EOL care with an increase in consultation for assistance with symptom management. There continues to remain a significant portion of patients who died in the hospital with a significant portion of the consults placed late in the hospital course, specifically within a day of death.
Implications for research, policy or practice. Within surgical training additional training in the principles of palliative care principles may improve the EOL care for surgical patients and should be incorporated into standardized curriculum.
Association Between Mental Health Diagnoses and Process of Care at the End Of Life: Findings from the BEACON Trial (S771) Chao-Hui Sylvia Huang, PhD, University of Alabama at Birmingham, Birmingham, AL. Elizabeth Kvale, MD, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL. F. Amos Bailey, MD FACP FAAHPM, University of Colorado Anschutz Medical Campus, Aurora, CO. Patricia Goode, MSN MD, University of Alabama at Birmingham, Birmingham, AL. Kathryn Burgio, PhD, Birmingham VA Medical Center, Birmingham, AL. Objectives Gain knowledge on mental health disparities in end of life care. Identify at least three quality indicators of end-oflife care processes that are associated with mental health diagnoses. Original Research Background. Mental health disparities have garnered increasing interest in the last two decades. Patients diagnosed with mental disorders are less likely to receive optimal care in various health care settings; however, little is known about the relationship between mental health diagnoses and processes of care at the end of life. Research Objectives. Our study aimed to determine whether the presence of mental health diagnoses was correlated with specific processes of care in the last 7 days of life. Methods. Data were drawn from the Best Practices for End-of-Life Care for Our Nation’s Veterans (BEACON) trial conducted between 2005 and 2011. Five processes of care were identified as primary end points
449
as indicators of quality end-of-life (EOL) care, including opioid order, do not resuscitate order (DNR), intravenous line infusing at time of death, nasogastric tube, and physical restraints. Generalized estimating equation (GEE) modeling was conducted to examine the association between mental health diagnoses and each process of care. Results. Among the 5476 inpatient decedents (mean [SD] age, 70.1 [22.5]), 98.2% were male, 65.2 were white, and 34.4% were black. Over a half had a terminal diagnosis of cancer (30.1%) or heart disease (20.1%). After controlling for covariates, patients with any mental health diagnosis were less likely to have IV infusion at time of death (OR¼0.80, p¼.001) but more likely to have DNR (OR¼1.23, P¼.002) and physical restraints (OR¼1.23, P¼.004) compared to those without. No differences were observed in other processes. Conclusion. Significant differences were observed for several EOL processes of care between veterans with mental disorders and those without. Patients with comorbid mental conditions were more likely to receive care that was directed at controlling symptoms or supporting DNR.
Implications for research, policy or practice. More research is needed to explore whether differences exist in other quality indicators of EOL care processes and develop care guidelines for those with mental health needs.
A Retrospective Analysis of Pain Burden in Hospitalized Young Adult Cancer Patients Compared to Their Older Adult Counterpart (S772) Shannon Devlin, MD, University of California San Diego, San Diego, CA. James Murphy, MD MS, University of California San Diego, San Diego, CA. Heidi Yeung, MD, University of California San Diego, San Diego, CA. Objectives Review current evidence for symptom burden in young adults with cancer. Identify differences in clinical characteristics and related outcomes between young adult and older adult cancer patients admitted for cancer-related pain. Describe future research areas that will help to refine pain management strategies in young adults with cancer-related pain. Original Research Background. Literature shows an increased symptom burden in young adult (YA) cancer patients compared to their older adult counterpart. Research focused on defining this difference is limited.
450
Scientific Poster Abstracts
Vol. 53 No. 2 February 2017
Research Objectives. The purpose of this study is to
Original Research Background. The ability of many
identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pain. Methods. We retrospectively identified 100 patients using a single electronic medical record admitted with diagnoses of cancer and pain to a single academic center from July 2013 to July 2014. Patients were grouped into either ‘‘young adult’’, defined in the literature as ages 18-39 years (N¼26), or ‘‘older adult’’ cohorts (N¼74). Basic demographic data, type of cancer, readmissions within 30 days for pain, and information regarding pain regimens were collected. Fisher’s exact tests, and Wilcoxon rank-sum tests were used to identify differences between young and older adults. Results. The majority of patients in both groups were admitted for abdominal pain but the cancer type varied. Gastrointestinal (not colorectal) cancer was most common in older adults compared to hematologic malignancy or sarcoma in YAs. The median length of hospitalization was 5.0 days for both YAs and older adults. Younger adults received a median daily oral morphine equivalent (OME) of 290 mg compared to 72 mg for older adults (p¼0.034). Younger adults were more likely to use a PCA compared to older adults (54% vs. 28%; p¼0.030). Palliative care consultation rates were similar between YAs and older adults (54% vs. 50%; p¼0.82), as were readmissions for pain (3% vs. 11%; p¼0.44). Conclusion. This study found that in YAs admitted with cancer-related pain, there is a higher median OME per 24-hour requirement, along with increased PCA use.
hospital-based palliative care programs to provide highquality care in a sustainable fashion is now paradoxically threatened by their own success. Approximately 10% of such programs have responded by instituting caps on consults, but the effects are unknown. Methods. We identified all palliative care inpatient consults requested from July 1, 2014 to April 30, 2016 at a large academic hospital. We describe the implementation of a hospital-wide daily cap on new consults on May 1, 2015, and compare the volume, characteristics, and timing of consults in the year before and year after the cap.
Implications for research, policy or practice. Future research is needed to identify tailored treatment regimens for YAs with cancer-related pain.
Results. The hospital-wide cap on new palliative care consults was typically set at 8 per day and varied based on available staffing and census. Consults requested after the cap were prioritized the following day. Mean monthly consult requests increased from 157.7 (range 126-196) in the year before to 173.7 (range 155-209) in the year after the cap (p<0.001), while the proportion actually seen decreased from 96.4% to 88.6% (p<0.001). There was no difference in mean pre-consult length of stay (8.4 days [SD 14.8] vs. 8.6 days [SD 14.3], p¼0.75), the proportion of patients transitioned from aggressive to comfort care (38% vs. 35%, p¼0.08), or the number of patients discharged to hospice (287 (25.4%) vs. 263 (24.4%), p¼0.59). Following the cap, reduced proportions of consults originated from the Oncology and ICU services, and an increased proportion from General Medicine, but not all changes were statistically significant. Conclusion. Implementation of a daily cap on new palliative care consults did not reduce consultative demand, increase the time to consultation, or change the rates of hospice referrals or transitions in goals of care.
Implications for research, policy or practice.
Impact of a Consult Cap for a Busy Inpatient Palliative Care Program (S773) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Mary Moyer, BSN RN, Hospital of the University of Pennsylvania, Glenside, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Scott Halpern, MD PhD, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania, Philadelphia, PA Objectives Describe implementation of an inpatient consult cap at a large academic hospital. Examine the impact of implementing a daily consult cap on a palliative care program.
Future research is needed to examine the impact of capping consults on patient- and family-centered outcomes, including among those whose consults were deferred.
Excess Consult Volume for Hospital-Based Palliative Care Teams in the U.S. (S774) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Jacqueline McMahon, MSW, University of Pennsylvania, Philadelphia, PA. Kuldeep Yadav, BA, FIELDS Program, University of Pennsylvania, Philadelphia, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Elizabeth Cooney, MPH, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania,
Scientific Poster Abstracts
the number of consults over time. Discharge disposition included 30.2% dying in hospital, 17.3% to home hospice, 12.0% to hospice, and the remainder to home or rehab. 46.3% of the patients who died in hospital had a PC consult within a day of death. Conclusion. Since the initiation of a Palliative Care consult service at our hospital there has been an increase in the utilization of their services by surgical services. The main reason for consultation has been for goals of care and EOL care with an increase in consultation for assistance with symptom management. There continues to remain a significant portion of patients who died in the hospital with a significant portion of the consults placed late in the hospital course, specifically within a day of death.
Implications for research, policy or practice. Within surgical training additional training in the principles of palliative care principles may improve the EOL care for surgical patients and should be incorporated into standardized curriculum.
Association Between Mental Health Diagnoses and Process of Care at the End Of Life: Findings from the BEACON Trial (S771) Chao-Hui Sylvia Huang, PhD, University of Alabama at Birmingham, Birmingham, AL. Elizabeth Kvale, MD, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL. F. Amos Bailey, MD FACP FAAHPM, University of Colorado Anschutz Medical Campus, Aurora, CO. Patricia Goode, MSN MD, University of Alabama at Birmingham, Birmingham, AL. Kathryn Burgio, PhD, Birmingham VA Medical Center, Birmingham, AL. Objectives Gain knowledge on mental health disparities in end of life care. Identify at least three quality indicators of end-oflife care processes that are associated with mental health diagnoses. Original Research Background. Mental health disparities have garnered increasing interest in the last two decades. Patients diagnosed with mental disorders are less likely to receive optimal care in various health care settings; however, little is known about the relationship between mental health diagnoses and processes of care at the end of life. Research Objectives. Our study aimed to determine whether the presence of mental health diagnoses was correlated with specific processes of care in the last 7 days of life. Methods. Data were drawn from the Best Practices for End-of-Life Care for Our Nation’s Veterans (BEACON) trial conducted between 2005 and 2011. Five processes of care were identified as primary end points
449
as indicators of quality end-of-life (EOL) care, including opioid order, do not resuscitate order (DNR), intravenous line infusing at time of death, nasogastric tube, and physical restraints. Generalized estimating equation (GEE) modeling was conducted to examine the association between mental health diagnoses and each process of care. Results. Among the 5476 inpatient decedents (mean [SD] age, 70.1 [22.5]), 98.2% were male, 65.2 were white, and 34.4% were black. Over a half had a terminal diagnosis of cancer (30.1%) or heart disease (20.1%). After controlling for covariates, patients with any mental health diagnosis were less likely to have IV infusion at time of death (OR¼0.80, p¼.001) but more likely to have DNR (OR¼1.23, P¼.002) and physical restraints (OR¼1.23, P¼.004) compared to those without. No differences were observed in other processes. Conclusion. Significant differences were observed for several EOL processes of care between veterans with mental disorders and those without. Patients with comorbid mental conditions were more likely to receive care that was directed at controlling symptoms or supporting DNR.
Implications for research, policy or practice. More research is needed to explore whether differences exist in other quality indicators of EOL care processes and develop care guidelines for those with mental health needs.
A Retrospective Analysis of Pain Burden in Hospitalized Young Adult Cancer Patients Compared to Their Older Adult Counterpart (S772) Shannon Devlin, MD, University of California San Diego, San Diego, CA. James Murphy, MD MS, University of California San Diego, San Diego, CA. Heidi Yeung, MD, University of California San Diego, San Diego, CA. Objectives Review current evidence for symptom burden in young adults with cancer. Identify differences in clinical characteristics and related outcomes between young adult and older adult cancer patients admitted for cancer-related pain. Describe future research areas that will help to refine pain management strategies in young adults with cancer-related pain. Original Research Background. Literature shows an increased symptom burden in young adult (YA) cancer patients compared to their older adult counterpart. Research focused on defining this difference is limited.
450
Scientific Poster Abstracts
Vol. 53 No. 2 February 2017
Research Objectives. The purpose of this study is to
Original Research Background. The ability of many
identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pain. Methods. We retrospectively identified 100 patients using a single electronic medical record admitted with diagnoses of cancer and pain to a single academic center from July 2013 to July 2014. Patients were grouped into either ‘‘young adult’’, defined in the literature as ages 18-39 years (N¼26), or ‘‘older adult’’ cohorts (N¼74). Basic demographic data, type of cancer, readmissions within 30 days for pain, and information regarding pain regimens were collected. Fisher’s exact tests, and Wilcoxon rank-sum tests were used to identify differences between young and older adults. Results. The majority of patients in both groups were admitted for abdominal pain but the cancer type varied. Gastrointestinal (not colorectal) cancer was most common in older adults compared to hematologic malignancy or sarcoma in YAs. The median length of hospitalization was 5.0 days for both YAs and older adults. Younger adults received a median daily oral morphine equivalent (OME) of 290 mg compared to 72 mg for older adults (p¼0.034). Younger adults were more likely to use a PCA compared to older adults (54% vs. 28%; p¼0.030). Palliative care consultation rates were similar between YAs and older adults (54% vs. 50%; p¼0.82), as were readmissions for pain (3% vs. 11%; p¼0.44). Conclusion. This study found that in YAs admitted with cancer-related pain, there is a higher median OME per 24-hour requirement, along with increased PCA use.
hospital-based palliative care programs to provide highquality care in a sustainable fashion is now paradoxically threatened by their own success. Approximately 10% of such programs have responded by instituting caps on consults, but the effects are unknown. Methods. We identified all palliative care inpatient consults requested from July 1, 2014 to April 30, 2016 at a large academic hospital. We describe the implementation of a hospital-wide daily cap on new consults on May 1, 2015, and compare the volume, characteristics, and timing of consults in the year before and year after the cap.
Implications for research, policy or practice. Future research is needed to identify tailored treatment regimens for YAs with cancer-related pain.
Results. The hospital-wide cap on new palliative care consults was typically set at 8 per day and varied based on available staffing and census. Consults requested after the cap were prioritized the following day. Mean monthly consult requests increased from 157.7 (range 126-196) in the year before to 173.7 (range 155-209) in the year after the cap (p<0.001), while the proportion actually seen decreased from 96.4% to 88.6% (p<0.001). There was no difference in mean pre-consult length of stay (8.4 days [SD 14.8] vs. 8.6 days [SD 14.3], p¼0.75), the proportion of patients transitioned from aggressive to comfort care (38% vs. 35%, p¼0.08), or the number of patients discharged to hospice (287 (25.4%) vs. 263 (24.4%), p¼0.59). Following the cap, reduced proportions of consults originated from the Oncology and ICU services, and an increased proportion from General Medicine, but not all changes were statistically significant. Conclusion. Implementation of a daily cap on new palliative care consults did not reduce consultative demand, increase the time to consultation, or change the rates of hospice referrals or transitions in goals of care.
Implications for research, policy or practice.
Impact of a Consult Cap for a Busy Inpatient Palliative Care Program (S773) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Mary Moyer, BSN RN, Hospital of the University of Pennsylvania, Glenside, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Scott Halpern, MD PhD, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania, Philadelphia, PA Objectives Describe implementation of an inpatient consult cap at a large academic hospital. Examine the impact of implementing a daily consult cap on a palliative care program.
Future research is needed to examine the impact of capping consults on patient- and family-centered outcomes, including among those whose consults were deferred.
Excess Consult Volume for Hospital-Based Palliative Care Teams in the U.S. (S774) Kate Courtright, MD MS, University of Pennsylvania, Philadelphia, PA. Jacqueline McMahon, MSW, University of Pennsylvania, Philadelphia, PA. Kuldeep Yadav, BA, FIELDS Program, University of Pennsylvania, Philadelphia, PA. Nicole Gabler, PhD, University of Pennsylvania, Philadelphia, PA. Elizabeth Cooney, MPH, University of Pennsylvania, Philadelphia, PA. Nina O’Connor, MD, University of Pennsylvania,