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Missed Opportunities for Palliative Care Referrals of Patients Who Died of Advanced Cancer At a Comprehensive Cancer Center (788)
Vol. 43 No. 2 February 2012
Poster Abstracts
pain and suffering, further research is necessary to integrate PC into the ED.
Missed Opportunities for Palliative Care Referrals of Patients Who Died of Advanced Cancer At a Comprehensive Cancer Center (788) Sun Hyun Kim, MD, MD Anderson Cancer Center, Houston, TX. David Hui, MD, MD Anderson, Houston, TX. Linh Nguyen, MD, MD Anderson Cancer Center, Houston, TX. Edurardo Bruera, MD, UT MD Anderson Cancer Center, Houston, TX. Objectives 1. There are still many missed opportunities for receiving early and interdisciplinary Palliative care services in advanced cancer patients. We suggest that oncologists attempt to provide more opportunities for PC to advanced cancer patients by decreasing their own perception and attitudes about PC which may serve as barriers to PC referral. 2. After patients had a PC consultation, there are significant impact on interval between PC consultation and death and numbers of primary oncology encounters and cost. Palliative intervention can provide better quality of life and economically benefits to advanced cancer patients. Background. In recent years, although PC programs have been recognized as a major priority by the American Society of Clinical Oncology, 37 our results show that there are still many missed opportunities for early and integrated PC. Research Objectives. The purpose of this retrospective study is to determine the proportion of referrals to palliative care (PC) and compare the differences between patients who died with and without receiving PC services. Method. We reviewed the charts of 1995 consecutive cancer patients registered to MD Anderson Cancer Center who died between September 2009 and March 2010. We compared patients who received PC services with those who did not a PC services and before and after receiving PC services. Result. A total of 539 (38%) patients had a PC consultation. On multivariate logistic regression analysis, age (P < 0.001), race (P ¼ 0.005), marital status (P ¼ 0.001), education level
473
(P ¼ 0.030), and cancer type (P ¼ 0.001) were found to be significantly associated with the PC referral. The interval ACD-D and ACD-PC of hematologic patients were longest (741 days, 782 days), otherwise PC-D was shortest (18 days). Hematologic patients had the largest number of encounters of primary oncology team (Median, 45) before PC. After PC referral, median intervals (47 vs. 378 days; P < 0.001), median numbers of encounters of primary oncology team (3 vs. 18; P < 0.001), and median total charges (US$53,000 vs. US$200,500; P < 0.001) were significantly lower than before PC referral. Conclusion. We found many missed opportunities for early and multidisciplinary PC consultations. To decrease these missed opportunities, an early and integrated approach for PC services is still needed. Implications for Research, Policy, or Practice. In order to decrease these missed opportunities for early and interdisciplinary PC referral in patients with advanced cancers, more specific targeted educations and programs to vulnerable group such as hematology department about early integration of PC into active primary oncology care will be needed.
How Do We Talk To Our Children?: Using Child Life To Support the Children of Seriously Ill Adult Inpatients (789) Thomas Reid, MD MA, University of California, San Francisco, San Francisco, CA. Camilla Sutter, MA CCLS, UCSF Medical Center, Brookline, MA. Objectives 1. Understand the role of child life in supporting the children of seriously ill adult patients. 2. List resources available to support the children of seriously ill adult patients. 3. Understand how to integrate child life into an existing inpatient palliative care service. Background. Families with children struggle with how to talk about and cope with a parent’s life-threatening illness, yet open communication can reduce anxiety, depression, and other psychobehavioral problems in these children before and after their parent’s death. Clinicians of many disciplines who are trained in adult medicine may not be prepared to address these issues. Child life specialists traditionally fill this
Poster Abstracts
pain and suffering, further research is necessary to integrate PC into the ED.
Missed Opportunities for Palliative Care Referrals of Patients Who Died of Advanced Cancer At a Comprehensive Cancer Center (788) Sun Hyun Kim, MD, MD Anderson Cancer Center, Houston, TX. David Hui, MD, MD Anderson, Houston, TX. Linh Nguyen, MD, MD Anderson Cancer Center, Houston, TX. Edurardo Bruera, MD, UT MD Anderson Cancer Center, Houston, TX. Objectives 1. There are still many missed opportunities for receiving early and interdisciplinary Palliative care services in advanced cancer patients. We suggest that oncologists attempt to provide more opportunities for PC to advanced cancer patients by decreasing their own perception and attitudes about PC which may serve as barriers to PC referral. 2. After patients had a PC consultation, there are significant impact on interval between PC consultation and death and numbers of primary oncology encounters and cost. Palliative intervention can provide better quality of life and economically benefits to advanced cancer patients. Background. In recent years, although PC programs have been recognized as a major priority by the American Society of Clinical Oncology, 37 our results show that there are still many missed opportunities for early and integrated PC. Research Objectives. The purpose of this retrospective study is to determine the proportion of referrals to palliative care (PC) and compare the differences between patients who died with and without receiving PC services. Method. We reviewed the charts of 1995 consecutive cancer patients registered to MD Anderson Cancer Center who died between September 2009 and March 2010. We compared patients who received PC services with those who did not a PC services and before and after receiving PC services. Result. A total of 539 (38%) patients had a PC consultation. On multivariate logistic regression analysis, age (P < 0.001), race (P ¼ 0.005), marital status (P ¼ 0.001), education level
473
(P ¼ 0.030), and cancer type (P ¼ 0.001) were found to be significantly associated with the PC referral. The interval ACD-D and ACD-PC of hematologic patients were longest (741 days, 782 days), otherwise PC-D was shortest (18 days). Hematologic patients had the largest number of encounters of primary oncology team (Median, 45) before PC. After PC referral, median intervals (47 vs. 378 days; P < 0.001), median numbers of encounters of primary oncology team (3 vs. 18; P < 0.001), and median total charges (US$53,000 vs. US$200,500; P < 0.001) were significantly lower than before PC referral. Conclusion. We found many missed opportunities for early and multidisciplinary PC consultations. To decrease these missed opportunities, an early and integrated approach for PC services is still needed. Implications for Research, Policy, or Practice. In order to decrease these missed opportunities for early and interdisciplinary PC referral in patients with advanced cancers, more specific targeted educations and programs to vulnerable group such as hematology department about early integration of PC into active primary oncology care will be needed.
How Do We Talk To Our Children?: Using Child Life To Support the Children of Seriously Ill Adult Inpatients (789) Thomas Reid, MD MA, University of California, San Francisco, San Francisco, CA. Camilla Sutter, MA CCLS, UCSF Medical Center, Brookline, MA. Objectives 1. Understand the role of child life in supporting the children of seriously ill adult patients. 2. List resources available to support the children of seriously ill adult patients. 3. Understand how to integrate child life into an existing inpatient palliative care service. Background. Families with children struggle with how to talk about and cope with a parent’s life-threatening illness, yet open communication can reduce anxiety, depression, and other psychobehavioral problems in these children before and after their parent’s death. Clinicians of many disciplines who are trained in adult medicine may not be prepared to address these issues. Child life specialists traditionally fill this