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Background: Evidence from randomized controlled trials has demonstrated benefits in quality of life outcomes from early palliative care concurrent with standard oncology care in patients with advanced cancer. We hypothesized that there would be earlier referral to outpatient palliative care at a comprehensive cancer center following this evidence.
Materials And Methods: Administrative databases were reviewed for two cohorts of patients: the pre-evidence cohort was seen in outpatient palliative care between June and November 2006, and the post-evidence cohort was seen between June and November 2015. Timing of referral was categorized, according to time from referral to death, as early (>12 months), intermediate (>6 months to 12 months), and late (≤6 months from referral to death). Univariable and multivariable ordinal logistic regression analyses were used to determine demographic and medical factors associated with timing of referral.
Results: Late referrals decreased from 68.8% pre-evidence to 44.8% post-evidence; early referrals increased from 13.4% to 31.1% (p < .0001). The median time from palliative care referral to death increased from 3.5 to 7.0 months (p < .0001); time from diagnosis to referral was also reduced (p < .05). On multivariable regression analysis, earlier referral to palliative care was associated with post-evidence group (p < .0001), adjusting for shorter time since diagnosis (p < .0001), referral for pain and symptom management (p = .002), and patient sex (p = .04). Late referrals were reduced to <50% in the breast, gynecological, genitourinary, lung, and gastrointestinal tumor sites.
Conclusions: Following robust evidence from trials supporting early palliative care for patients with advanced cancer, patients were referred substantially earlier to outpatient palliative care.
Implications For Practice: Following published evidence demonstrating the benefit of early referral to palliative care for patients with advanced cancer, there was a substantial increase in early referrals to outpatient palliative care at a comprehensive cancer center. The increase in early referrals occurred mainly in tumor sites that have been included in trials of early palliative care. These results indicate that oncologists' referral practices can change if positive consequences of earlier referral are demonstrated. Future research should focus on demonstrating benefits of early palliative care for tumor sites that have tended to be omitted from early palliative care trials.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018311 | PMC |
http://dx.doi.org/10.1002/onco.13625 | DOI Listing |
J Palliat Med
December 2024
Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Many academic pediatric centers care for children with medical complexity (CMC) through established complex care and palliative care programs. There are little prior data investigating best practices for collaboration between these two subspecialties in caring for CMC. The aim of this study is to explore the distinct and overlapping roles and responsibilities of pediatric complex care and palliative care teams as identified by providers when caring for a shared population of CMC and their families.
View Article and Find Full Text PDFInt J Clin Pharm
December 2024
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Background: Potentially inappropriate prescribing (PIP) contributes significantly to treatment burden, specifically in older people. Detecting PIP and improving prescribing practices are therefore crucial for ensuring patient safety and positive outcomes.
Aim: This study aimed to assess physicians' and pharmacists' awareness and use of tools to identify PIP, as well as their confidence in recommending medication for older people.
Surgeon
December 2024
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, Khoo Teck Puat Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore.
Background: Fungating breast wounds cause significant complications and morbidity to patients. Wound care is of paramount importance in optimising care and alleviating suffering for patients with malignant breast wounds. Currently, routinely implemented objective assessment tools for fungating breast wound treatment outcomes are non-existent, and institutional practice varies.
View Article and Find Full Text PDFPalliat Med
December 2024
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
Background: Experience sampling methods typically involve multiple self-report assessments per day over consecutive days. Unlike traditional patient-reported outcome measures or interviews, such methods offer the possibility to capture the temporal fluctuations of experiences in daily environments, making them valuable for studying the daily lives of people with advanced illness. Yet, their use in palliative care research is limited.
View Article and Find Full Text PDFPalliat Med
December 2024
Palliative and Supportive Care, Mater Misericordiae Ltd., South Brisbane, QLD, Australia.
Background: Xerostomia is a common and difficult symptom experienced by patients with cancer. Pilocarpine is a cholinergic agent that stimulates salivation.
Aim: To assess the feasibility of conducting a N-of-1 trial to determine the efficacy of pilocarpine orally dissolving tablets in patients with xerostomia.
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