Serious Illness Communication Practices in Glioblastoma: An Institutional Perspective.

Early, high-quality advance care planning discussions are essential for supporting goal-concordant care among glioblastoma (GBM) patients. Using mixed methods, we sought to characterize current serious illness (SI) communication practices at our institution. The electronic medical records of 240 deceased GBM patients cared for at the Abramson Cancer Center in Philadelphia, PA between 2017 and 2019 were systematically reviewed for documented SI conversations about four domains: prognosis, goals, end-of-life planning, and code status.

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation.

Background: Palliative care consultation to discuss goals-of-care ("PCC") may mitigate end-of-life care disparities.

Objective: To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs.

Methods: This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital.

Posttraumatic stress disorder symptoms in patients with acute myeloid leukemia.

Background: Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy face a life-threatening illness, isolating hospitalization, and substantial physical and psychological symptoms. However, data are limited regarding risk factors of posttraumatic stress disorder (PTSD) symptoms in this population.

Methods: The authors conducted a secondary analysis of data from 160 patients with high-risk AML who were enrolled in a supportive care trial.

Serious Illness Conversations With Outpatient Oncology Clinicians: Understanding the Patient Experience.

Purpose: Guidelines recommend earlier advance care planning discussions focused on goals and values (serious illness communication) among oncology patients. We conducted a prospective, cross-sectional quality improvement evaluation of patients who had a serious illness conversation (SIC) with an oncology clinician using the Serious Illness Conversation Guide to understand patient perceptions of conversations using a structured guide.

Methods: We contacted 66 oncology patients with an SIC documented in the electronic health record.

Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis.

Background: Early palliative care consultation ("PCC") to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed.

Objective: To identify risk factor patient profiles associated with PCC timing before death.

Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients.

Context: African Americans are less likely to receive hospice care and more likely to receive aggressive end-of-life care than whites. Little is known about how palliative care consultation (PCC) to discuss goals of care is associated with hospice enrollment by race.

Objectives: To compare enrollment in hospice at discharge between propensity-matched cohorts of African Americans with and without PCC and whites with and without PCC.

Goals-of-Care Consultations Are Associated with Lower Costs and Less Acute Care Use among Propensity-Matched Cohorts of African Americans and Whites with Serious Illness.

African Americans receive more aggressive end-of-life care than Whites. Little is known about how palliative care consultation to discuss goals-of-care ("PCC") is associated with acute care utilization and costs by race. To compare future acute care costs and utilization between propensity-matched cohorts of African Americans with and without PCC, and Whites with and without PCC.

Machine Learning Approaches to Predict 6-Month Mortality Among Patients With Cancer.

Importance: Machine learning algorithms could identify patients with cancer who are at risk of short-term mortality. However, it is unclear how different machine learning algorithms compare and whether they could prompt clinicians to have timely conversations about treatment and end-of-life preferences.

Objectives: To develop, validate, and compare machine learning algorithms that use structured electronic health record data before a clinic visit to predict mortality among patients with cancer.

Electronic Health Record Mortality Prediction Model for Targeted Palliative Care Among Hospitalized Medical Patients: a Pilot Quasi-experimental Study.

Background: Development of electronic health record (EHR) prediction models to improve palliative care delivery is on the rise, yet the clinical impact of such models has not been evaluated.

Objective: To assess the clinical impact of triggering palliative care using an EHR prediction model.

Design: Pilot prospective before-after study on the general medical wards at an urban academic medical center.

Perceptions of hospitalized patients and their surrogate decision makers on dialysis initiation: a pilot study.

Background: Dialysis is often initiated in the hospital during episodes of acute kidney injury and critical illness. Little is known about how patients or their surrogate decision makers feel about dialysis initiation in the inpatient setting.

Methods: We conducted a prospective cohort study at a large academic center in the United States.

Palliative Care Consultation for Goals of Care and Future Acute Care Costs: A Propensity-Matched Study.

Background: Hospitals are under increasing pressure to manage costs across multiple episodes of care. Most studies of the financial impact of palliative care have focused on costs during a single hospitalization.

Objective: To compare future acute health-care costs and utilization between patients who received inpatient palliative care consultation for goals of care (Palliative Care Service [PCS]) and a propensity-matched cohort of patients who did not receive palliative care consultation (non-PCS) in a single academic medical center.

Palliative Care Office Hours for Patients with Hematologic Malignancies: An Innovative Model for Symptom Management and Education.

Background: Palliative care programs are experiencing rapid growth, with demand for consults surpassing staffing. Innovative models are needed to equip nonpalliative care providers to manage basic palliative care issues.

Objectives: To develop a novel program of palliative care office hours for hematologic oncology advanced practice providers, and to evaluate its impact on palliative care consult volume and composition.

Electronic Goals of Care Alerts: An Innovative Strategy to Promote Primary Palliative Care.

Context: Given the shortage of palliative care specialists, strategies are needed to promote primary palliative care by nonpalliative care providers. Electronic reminders are frequently used in medicine to standardize practice, but their effectiveness in encouraging goals of care discussions is not well understood.

Objectives: To determine whether brief education and electronic alerts increase the frequency of goals of care discussions.

Emerging Collaboration Between Palliative Care Specialists and Mechanical Circulatory Support Teams: A Qualitative Study.

Context: Despite national requirements mandating collaboration between palliative care specialists and mechanical circulatory support (MCS) teams at institutions that place destination therapy ventricular assist devices, little is known about the nature of those collaborations or outcomes for patients and families.

Objectives: To assess how Centers for Medicare & Medicaid Services' regulations have changed collaboration between palliative care and MCS teams and how this collaboration is perceived by MCS team members.

Methods: After obtaining verbal consent, members of MCS teams were interviewed using semistructured telephone interviews.

Scripted Nurse Visits: A Resource-Efficient Palliative Care Model for Ventricular Assist Devices.

Background: The Center for Medicare Services (CMS) requires palliative care involvement for patients who receive a destination therapy ventricular assist device (VAD). Creative solutions are needed to meet this requirement in the context of limited palliative care resources.

Purpose: To evaluate a novel program in which a nurse conducts scripted pre-VAD visits to promote advance care planning and to triage the need for a full palliative care consult.

Toward Safer Transitions: A Curriculum to Teach and Assess Hospital-to-Hospice Handoffs.

Context: Patient handoffs are an increasingly emphasized skill in medical and nursing education, and handoff education is required by the Accreditation Council for Graduate Medical Education. Traditional handoff tools lack content that is unique to hospice and palliative medicine.

Objectives: The objective of the study was to develop a comprehensive curriculum to teach and assess patient handoffs in hospice and palliative medicine fellowships.

The Impact of Inpatient Palliative Care Consultations on 30-Day Hospital Readmissions.

Background: Inpatient palliative care consultations have been shown to reduce acute care utilization by reducing length of stay, but less is known about their impact on subsequent costs including hospital readmissions.

Objective: The study's objective was to examine the impact of inpatient palliative care consultations on 30-day hospital readmissions to a large urban academic medical center.

Methods: The hospital's electronic medical record system was used to identify all live discharges between August 2013 and November 2014.

Hospice admissions for cancer in the final days of life: independent predictors and implications for quality measures.

Purpose: To define patient characteristics associated with hospice enrollment in the last 3 days of life, and to describe adjusted proportions of patients with late referrals among patient subgroups that could be considered patient-mix adjustment variables for this quality measure.

Methods: Electronic health record-based retrospective cohort study of patients with cancer admitted to 12 hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network.

Results: Of 64,264 patients admitted to hospice with cancer, 10,460 (16.

Survival after dialysis discontinuation and hospice enrollment for ESRD.

Background And Objectives: Textbooks report that patients with ESRD survive for 7-10 days after discontinuation of dialysis. Studies describing actual survival are limited, however, and research has not defined patient characteristics that may be associated with longer or shorter survival times. The goals of this study were to determine the mean life expectancy of patients admitted to hospice after discontinuation of dialysis, and to identify independent predictors of survival time.

End-stage renal disease: symptom management and advance care planning.

The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. Pain is problematic in up to one-half of patients receiving dialysis and may result from renal and nonrenal etiologies. Opioids can be prescribed safely, but the patient's renal function must be considered when selecting a drug and when determining the dosage.