Impact Of Palliative Care Research Articles

Optimizing outcomes: Impact of palliative care consultation timing in the cardiovascular intensive care unit

BackgroundICU patients and their families experience significant stress due to illness severity and prognostic uncertainty, making palliative care (PC) integral for symptom management, family support, and end-of-life care goals. The impact of PC in the Cardiac Intensive Care Unit (CICU) remains unstudied. ObjectiveWe explore the impact of early palliative care consultation (PCC) on patient outcomes in the CICU, including mortality, length of stay, and family meeting frequency. MethodsThis retrospective study at MedStar Washington Hospital Center included 209 adult patients admitted to the CICU between December 2021 and June 2022 receiving PCC. We compared outcomes between those receiving early (<72 h) and late (>72 h) PCC, including mortality, length of stay, and family meeting frequency. Statistical analysis included Wilcoxon rank sum tests, Chi-squared tests, Fisher's exact test, and Poisson regression models. ResultsThe study included 209 patients admitted to the (M age = 68 years, SD = 14; 45 % female; 62 % Black, 30 % White) who received PCC, most (79 %) within 72 h. Early PCC was associated with shorter CICU stays (median, 3 vs. 5.5 days; p = 0.005). Early PCC patients had higher odds of family meetings (IRR=3.59; p < 0.001) and experienced a change in code status sooner (median 1 day vs. 3 days, p < 0.001). Late PCC patients were more likely to undergo tracheostomy (13.6% vs. 2.4 %; p = 0.007), cardioversion (9.1% vs. 1.8 %; p = 0.037), and have PEG tubes placed (13.6% vs. 2.4 %; p = 0.007). ConclusionsEarly PCC in the CICU is associated with shorter CICU stays, fewer procedures, and more frequent family meetings.

Impact of palliative care on hospital length of stay and charges in hospitalized patients with cancer at end of life.

Impact of palliative care on hospital length of stay and charges in hospitalized patients with cancer at end of life.

Real-world quality analysis of palliative care utilization in patients with brain metastases at three academic institutes.

12080 Background: Brain metastases (BMETs) are a devastating complication of cancer, occurring in up to 30-50% of patients with advanced solid tumors. Median survival after diagnosis of BMETs can be limited, with 3-6 months survival for patients with poorer performance status (Updated Recursive Partition analysis [U-RPA] classification class 2b and 3). Early integration of palliative care (PC) can improve a patient’s quality of life. Per guidelines, patients with advanced cancer should be referred to an interdisciplinary team, including PC, early in the disease. We aimed to assess the utilization and impact of PC in patients with BMETs at three academic centers. Methods: We obtained data from the electronic medical record (EMR) of all patients diagnosed with BMETS at the University of Virginia, the Medical College of Wisconsin, and the University of Vermont between 1 January 2017 and 31 December 2019. Inclusion criteria were age 18+ years, diagnosis of BMETs secondary to a solid tumor malignancy (excluding leptomeningeal metastases), and &gt;3 months of follow-up treatment. Patients were included if considered at high risk for mortality, which was defined as KPS &lt;70 (U-RPA Class 3) or KPS 70-80 and age &gt; 65 (U-RPA Class 2b). Chi-squared and Fisher’s exact tests compared survival, hospice referral, emergency visits, readmissions, and advance directives (AD) on the file between the PC and non-PC groups. Results: In total, of the 309 patients that were assessed, 220 patients were class 2b, and 89 were class 3 per U-RPA classification. The mean age was 66 in both groups, and 167 (54%) were seen by PC. The median survival for patients seen by PC was 7.8 months compared to 8.3 months (p 0.056). There was no statistically significant difference in survival between the two groups. 80% of patients in the group seen by PC enrolled with hospice care compared to 58% in the non-PC group (p 0.0002). 80% of patients had an AD on file in the group seen by PC compared to 56% in the non-PC group (p &lt;0.0001). In terms of ED visits or re-hospitalization, there was a trend for more ED visits/readmissions in the group seen by PC compared to the non-PC group (p 0.057). Conclusions: In this real-world quality analysis, we found that there is under-utilization of formal PC consultation in patients with BMETs. There was no difference in survival between groups, indicating PC is not synonymous with end-of-life or hospice care. PC was associated with more patients completing ADs and more patients using hospice. Health systems and policy initiatives promoting palliative care utilization earlier in the disease course may support patient values and preferences at the end of life. [Table: see text]

The impact of palliative care and parental involvement on the emotional health of children with cancer: an integrative review

The objective of this study was to carry out an integrative review to analyze the impact of palliative care and parental involvement on the emotional health of children with cancer. For the search, the PubMed database was considered, with the following descriptors: “Mental health; Palliative care; Health; Oncology". Articles using only the English language were included, with individuals aged between 0 and 18 years old, with publication data from 2019 to 2023. After the research carried out, 5 articles were selected, in which it was identified that children undergoing Palliative care presents increased fear, pain relief and fewer depressive symptoms. In addition, research shows that parents have an important role in alleviating the negative impacts of cancer treatment on children. Parents are adept at palliative care, due to some factors, such as: lack of recognition, accessibility and understanding of how palliative care works. Therefore, it is concluded that the impacts of exposure to palliative care and parental involvement are beneficial to the emotional health of the patient. oncological child.

Nurses' Experiences in Carrying Out Palliative Care in Independent Nursing Practice

Palliative care is total care that is carried out actively, especially for patients suffering from chronic diseases. The aim of this research is to obtain an overview of nurses' experiences in providing palliative care in independent nursing practice. The method used is qualitative with a descriptive phenomenological method design. The population is nurses who carry out palliative care in independent nursing practice with a sample of 5 nurses selected using the snowball sampling technique. Data collection techniques are interviews, observation and documentation. This research produced 6 themes related to nurses' experiences in carrying out palliative care in independent nursing, including: (1) Sufficient knowledge, (2) impact of palliative care, (3) Nursing Intervention, (4) Barriers, (5) Problem solving, and (6) Hope. In providing palliative nursing care, nurses must have sufficient knowledge regarding palliative care in order to provide maximum nursing care. While providing palliative care, nurses carry out nursing interventions to improve the patient's quality of life. Providing maximum nursing care is the main hope for every nurse in providing palliative care.

Impact of palliative care at end-of-life Covid-19 patients – a small-scale pioneering experience

BackgroundIn March 2020, the outbreak caused by the SARS-CoV-2 virus was declared a pandemic, resulting in numerous fatalities worldwide. To effectively combat the virus, it would be beneficial to involve professionals who specialize in symptom control for advanced illnesses, working closely with other specialties throughout the illness process. This approach can help manage a range of symptoms, from mild to severe and potentially life-threatening. No studies have been conducted in Portugal to analyse the intervention of Palliative Medicine at the end of life of Covid-19 patients and how it differs from other specialties. This knowledge could help determine the importance of including it in the care of people with advanced Covid-19.ObjectivesThe objective of this study is to examine potential differences in the care provided to patients with Covid-19 during their Last Hours and Days of Life (LHDOL) between those who received care from Palliative Medicine doctors and those who did not.MethodsThis is a retrospective cohort study spanning three months (Dec 2020 to Feb 2021), the duration of the Support Unit especially created to deal with Covid-19 patients. The database included clinical files from 181 patients admitted to the Support Unit, 27 of which died from Covid-19.ResultsStatistically significant differences were identified in the care provided. Specifically, fewer drugs were administered at the time of death, including drugs for dyspnoea, pain and agitation, suspension of futile devices and use of palliative sedation to control refractory symptoms.ConclusionsEnd-of-life care and symptomatic control differ when there’s regular follow-up by Palliative Medicine, which may translate less symptomatic suffering and promote a dignified and humane end of life.

Early palliative care referral may improve end-of-life care in end-stage liver disease patients: A retrospective analysis from a non-transplant center

BackgroundPatients with end-stage liver disease (ESLD) who are not transplant candidates often have a trajectory of rapid decline and death similar to patients with stage IV cancer. Palliative care (PC) services have been shown to be underutilized for such patients. Most studies examining the role of PC in ESLD have been done at transplant centers. Thus, determining the utilization and benefit of PC at a non-transplant tertiary center may help establish a standard of care in the management of patients with ESLD not eligible for transplant. MethodsWe conducted a retrospective analysis of adult (>18 years) patients with ESLD admitted to Rochester Regional Health (RRH) system hospitals from 2012 to 2021. Patients were divided into groups based on the presence or absence of PC involvement. Baseline characteristics were recorded. The impact of PC was assessed by comparing the number of hospitalizations before and after the involvement of PC, comparing code status changes, health care proxy (HCP) assignments, Aspira catheter placements, and frequency of repeated paracentesis. ResultsIn our analysis of 576 patients, 41.1% (237 patients) received a PC consult (PC group), while 58.9% (339 patients) did not (no-PC group). Baseline characteristics were comparable.However, their mean number of admissions significantly decreased (15.66 vs. 3.49, p < 0.001) after PC involvement. Full code status was more prevalent in the no-PC group (67.8% vs. 18.6%, p < 0.001), while comfort care code status was more common in the PC group (59.9% vs. 20.6%, p < 0.001). Changes in code status were significantly higher in the PC group (77.6% vs. 29.2%, p < 0.001). The PC group had a significantly higher mortality rate (83.1% vs. 46.4%, p < 0.01). Patients in the PC group had a higher likelihood of having an assigned HCP (63.7% vs. 37.5%, p < 0.001). PC referral was associated with more frequent use of an Aspira catheter (5.9% vs. 0.9%, p < 0.001) and more frequent paracentesis (30.8% vs. 16.8%, p < 0.001). ConclusionsIn conclusion, our study provides compelling evidence of the diverse advantages of palliative care for patients with end-stage liver disease, including reduced admissions, improved goals of care, code status modifications, enhanced healthcare proxy assignments, and targeted interventions. These findings highlight the potential significance of early integration of palliative care in the disease trajectory to provide comprehensive, patient-centered care that addresses the unique needs and preferences of individuals with advanced liver disease.

Impacts of an outpatient palliative care team on the end-of-life care at a cancer center in Brazil.

231 Background: It has been demonstrated. that early palliative care improves the quality of life of cancer patients by reducing overtreatment at the end-of-life (EoL) and improving symptomatic control. However, there is a lack of research on the impact of palliative care on the EoL outcomes in developing countries. EoL cancer care varies widely and very few centers evaluate it systematically. Studies suggest that people often prefer dying at home, however, data also shows that most deaths in Latin America occur at hospitals. Methods: This study aimed to analyze the impact of cancer patients’ follow-up by an outpatient palliative care team (OPCT) on the EoL outcomes at a private Multicentric Cancer Center in Brazil. Data were retrospectively retrieved from electronic medical records of patients who were treated at a Brazilian Cancer Center and who died between January 2022 and December 2022. Adults with any type of cancer were considered eligible. The participants were divided into two groups: the OPCT group was followed up by a palliative care multidisciplinary team who regularly evaluated cancer patients during their treatments in an outpatient setting and the No-OPCT group followed up by oncologists with multidisciplinary teams as demanded. Univariate comparisons and multivariate analysis adjusted to the multivariate logistic regression model were performed and p&lt;0.05 was deemed as statistically significant. Results: A total of 1980 patients were included in the study: OPCT (N=640) and No-OPCT (N=1340). Most of the patients in both groups were older than 65 years (61% vs 66%). The groups were well balanced concerning gender (women: 54% vs 46%), and TNM stage (stage IV: 87% vs 89%). Gastrointestinal and breast cancers were the most prevalent in both groups. The rate of home death was 20.2% in the OPCT group, compared to 10.6% in the No-OPCT group, meaning a 2 times greater chance of dying at home when the OPCT was provided (p&lt;0.001). In multivariate analysis, follow-up by the OPCT was the strongest independent predictor of home death. Age, gender, and TNM stage did not influence the place of death. Conclusions: The current study suggests that an active palliative care program in an outpatient care institution, through early conversations about goals of care, prognostic awareness, and EoL preferences may potentially improve the EoL outcomes for patients with cancer, while also reinforcing the need of early referral for a palliative care team. Future studies and ongoing prospective studies in Brazil are needed to validate these findings and also to evaluate the impact of other variables, such as health support systems for home deaths.

The Role of Palliative Care in Heart Failure, Part 4: A Framework for Collaboration in Advance Care Planning.

Background: Palliative care integration into cardiology is growing, allowing primary cardiology care teams increasing opportunities to utilize palliative care to support processes such as advance care planning (ACP). Objective: The aim of the study is to understand perspectives of cardiac care team members about the involvement and impact of palliative care on ACP in heart failure. Design: A qualitative study using a semistructured interview guide was performed. Settings/Subjects: Interviews were conducted with cardiac care team members, including cardiologists, cardiac surgeons, and nurse practitioners, at a large academic medical center in the United States with an integrated cardiac palliative care team. Measurements: Deductive and inductive thematic analysis of interview transcripts enabled characterization of themes around the role of palliative care in ACP. Results: Two themes were identified with regard to providers' perspectives about ACP: (1) different levels of comfort with initiating and conducting ACP conversations and (2) different opinions about the desired role of palliative care in the ACP process. In exploring these themes, we characterized four distinct approaches to ACP with palliative care as a novel framework for planning consultation. Conclusions: The different approaches to ACP and the implications for how cardiac providers interact with the palliative care team present an important opportunity to guide ACP consultation in practice. Adoption of this framework may help cardiac providers enhance the process of care delivery and ACP in important ways that improve care for their patients.

Palliative care at any stage of amyotrophic lateral sclerosis: a prospective feasibility study.

Many patients with amyotrophic lateral sclerosis (ALS) receive palliative care (PC) very late or not at all. The impact of PC on patients with ALS and caregivers has not been quantified. Study goals included (1) measuring the impact of early PC on quality of life and mood of patients/caregivers and (2) describing patient/caregiver satisfaction with PC. The study was a non-randomized, prospective feasibility study of patients with ALS being treated at The Ottawa Hospital ALS Clinic and their caregivers. Exclusion criteria were age < 18 years, inability to complete questionnaires, and prior receipt of PC. The ALS Specific Quality of Life-Revised (ALSSQOL-R) questionnaire (patients only) and Hospital Anxiety and Depression Scale (HADS) were completed at regular intervals for up to 2 years. Patients accepting a PC consultation completed a post-PC satisfaction survey. Primary outcome measures included ALSSQOL-R and HADS scores compared before and after PC consultation, and between groups receiving and not receiving a PC consultation. Secondary outcome measures included responses on the post-PC satisfaction survey (1 = strongly disagree, 5 = strongly agree). 39 patients with ALS (age 66 ± 10 years, median time from diagnosis = 6 months) and 22 caregivers were enrolled. 32 patients had a PC consultation (30 were virtual). Patients and caregivers agreed with statements that the PC consult was helpful (mean ± SD = 4.54 ± 0.60, range = 3-5) and they would recommend PC to others with ALS (4.59 ± 0.59, range = 3-5). Participants disagreed with statements that the consult would have been better later in disease course (1.87 ± 0.80, range = 1-4) and that it took too much time/energy (1.44 ± 0.85, range = 1-4). Average ALSSQOL-R scores worsened significantly over time. HADS and ALSSQOL-R scores did not significantly differ between groups receiving and not receiving PC. Patients with ALS and their caregivers found virtual PC consultations beneficial irrespective of disease duration or severity. Offering routine PC to all patients with ALS is feasible and should be considered as part of standard care. https://clinicaltrials.gov/ct2/show/NCT04257760, identifier NCT04257760.

Impact of Palliative care in the Management of pain and Suffering in urgent and Emergency Situations

Impact of Palliative care in the Management of pain and Suffering in urgent and Emergency Situations

D.1 Feasibility and impact of palliative care at any stage of amyotrophic lateral sclerosis

Background: Although palliative care (PC) is recommended for patients with amyotrophic lateral sclerosis (ALS), many patients receive PC very late or not at all. Our study goals included 1) determing the feasibility of early PC 2) describing patient/caregiver satisfaction with early PC and 3) measuring the impact of early PC on quality of life (QOL) and mood. Methods: Patients followed at the multidisciplinary ALS clinic in Ottawa, Canada and their caregivers were eligible for the study irrespective of duration or severity of disease. All participants completed questionnaires tracking QOL and mood and all were offered a palliative care consultation. Participants completed a satisfaction survey post-PC consultation. Results: 32 patients and 20 caregivers received a PC consultation, conducted virtually. All of them found the consult beneficial and none of the patients reported preferring the consultation later in their illness. The PC consultations were most highly rated by patients with high levels of anxiety and worse bulbar function, and by caregivers of patients with low function. There was no statistically significant change in mood or QOL compared to the 7 participants who declined PC consultation. Conclusions: PC consultations are feasible and beneficial at all stages of illness. Patients with anxiety and bulbar dysfunction may benefit most.

Deactivation of implantable defibrillators at the end of life - A register-based study of ICD-deactivation at home and the impact of palliative care

BackgroundThe Implantable Cardioverter-Defibrillator (ICD) is a well-established life-saving therapy for heart failure patients, but due to the risk for unnecessary shocks, deactivation of ICD:s is recommended at the end of life.We aimed to identify i) how many people with HF and an ICD who died in Sweden in 2018 received Specialized Palliative Care (SPC), ii) of those dying outside of hospital, the proportion with deactivated ICDs prior to death for the group as a whole and by SPC access. Methods and resultsWe analyzed data from i) the Swedish ICD and Pacemaker Registry to find all who died with an ICD in Sweden in 2018, ii) the Swedish Register of Palliative Care and, iii) the Swedish Causes of Death Certificate Register to find those who died outside of hospital. Clinical records were obtained to assess if ICDs were deactivated before death. Descriptive statistics, t-tests and chi-squared tests were applied.46/406 (11%) of those who died with an ICD in Sweden in 2018 had SPC access, of whom 50% also had cancer. 86/164 (52%) ICDs were deactivated prior to death in people dying outside of hospital; higher in those accessing SPC (36/46, (78%) SPC access versus 151/360, (42%) no SPC access; p < 0.05). ConclusionsHalf of those with HF and an ICD dying outside of hospital had ICD deactivation prior to death. Those accessing SPC were more likely to have their ICD deactivated but few received SPC, without a comorbid cancer diagnosis.

Palliative Care Impact on Symptomatology in Patients Undergoing CRS/HIPEC

Sneider, Abigail Pollock; Dhiman, Ankit MD; Morgan, Ryan MD; Tun, Sandy MD; Turaga, Kiran K MD, MPH, FACS; Eng, Oliver MD, FACS Author Information

Personalizing the Setting of Palliative Care Delivery for Patients with Advanced Cancer: "Care Anywhere, Anytime".

The specialty of palliative care has evolved over time to provide symptom management, psychosocial support, and care planning for patients with cancer throughout the disease continuum and in multiple care settings. This review examines the delivery and impact of palliative care in the outpatient, inpatient, and community-based settings. The article will discuss how these 3 palliative care settings can work together to optimize patient outcomes under a unifying model of palliative care "anywhere, anytime" and how to prioritize palliative care services when resources are limited. Many patients with advanced cancer receive care from each of the 3 branches of palliative care-outpatient, inpatient, and community-based settings-at some point along their disease trajectory. Early on, outpatient clinics provide longitudinal supportive care concurrent with active disease-modifying treatments. Telemedicine appointments can serve patients remotely to minimize their need to travel. When patients experience functional decline, community-based palliative care services can provide support and monitoring for patients at home. When patients develop acute symptomatic complications requiring admission, inpatient care consultation teams are essential for symptom management and goals-of-care discussions. For patients in severe distress, receiving care in a palliative care unit that provides intensive symptom control and facilitates complex discharge planning is ideal. Under a unifying model of palliative care designed to offer care "anywhere, anytime," the 3 branches of palliative care could work in unison to support each other, minimize gaps in care, and optimize patient outcomes.

S1172 Early Palliative Care Referral May Improve End of Life Care in End-Stage Liver Disease Patients. A Retrospective Analysis From a Non-Transplant Center

Introduction: Patients with End Stage Liver Disease (ESLD) who are not transplant candidates often have a trajectory of rapid decline and death similar to patients with stage IV cancer. Palliative care (PC) services have been shown to be underutilized for such patients. Most studies examining the role of PC in ESLD have been done at transplant centers. Thus, determining the utilization and benefit of PC at a non-transplant tertiary center may help establish a standard of care in the management of transplant-ineligible patients with ESLD. Methods: We conducted a retrospective analysis of adult patients with ESLD admitted to Rochester Regional Health (RRH) system hospitals from 2012 to 2021. Patients were divided into groups based on presence (Group 1) or absence (Group 2) of PC involvement. Baseline characteristics were recorded. Impact of PC was assessed by comparing number of hospitalizations before and after PC referral, comparing code status changes, health care proxy (HCP) assignments, and requirement of repeated paracentesis. Results: 576 patients were analyzed of which 237 received a PC consult (Group 1) and 339 did not (Group 2). Baseline characteristics were comparable in both groups (Table). Mortality rate was significantly higher in group 1 than group 2 (83.1 vs 46.4%, p < 0.01). Changes in code status were higher in group 1 than in group 2 (77.6% vs 29.2%, p < 0.001). 59.9% in group I had comfort care code status and 67.8% in group 2 had full code. Patients in group 1 were more likely to have an HCP assigned (63.7% vs 37.5%, p < 0.001). Aspira catheter use (5.9% vs 0.9%, p < 0.001) and hospitalizations for frequent paracentesis (30.8% vs 16.8%, p < 0.001) were both more frequent in group 1. Mean number of emergency room visits or hospitalizations before the first PC consult was 15.6 and mean number of admissions after PC consult was 3.4 (P< 0.001). Conclusion: Our study shows that PC referral in patients with ESLD is associated with a higher rate of code status changes, HCP assignments and reduced hospitalizations. Patients receiving a PC referral were more likely to have a comfort care status while patients without a PC referral were more likely to be full code. Mortality rates at our non-transplant center were higher in patients with palliative care referral than those without. It suggests that patients did not receive a PC referral unless their disease severity was significant, however all patients with ESLD may benefit from early PC referral. Table 1. - Baseline characteristics and outcomes Variable PC involved (237) PC not involved (339) P-value Age (years) 64.61 64.07 0.58 Sex (% male) 57.40% 55.20% 0.59 Hepatocellular carcinoma 11 (4.6%) 12/339 (3.5%) 0.38 Transplant referral done 41 (17.3%) 72/339 (21.2%) 0.29 Mortality 196 (83.1%) 157 (46.4%) < 0.0001 Aspira catheter 14 (5.9%) 3 (0.9%) < 0.001 Frequent paracentesis 73 (30.8%) 57 (16.8%) < 0.001 TIPS procedure 8 (3.4%) 24 (7.1%) 0.06 Code status changes 184 (77.6%) 99 (29.2%) < 0.001 Full code 44 (18.6%) 230 (67.8%) < 0.001 Comfort care 142 (59.9%) 70 (20.6%) < 0.001 HCP assignments 151 (63.7%) 127 (37.5%) < 0.001

Impact of palliative care on quality of life in advanced cancer: A meta-analysis of randomised controlled trials.

This study aimed to examine the impact of palliative care on the life quality of adults with advanced cancer. After a comprehensive and regular search using [MeSH] keywords in some important databases, 25 published randomised controlled trials (RCTs) involving 5160 adults with advanced cancer were selected and examined through meta-analysis. Analysis of 36 reports in 1-3 months follow-up, and 19 reports in 4-7 months follow-up, showed that compared to usual care (g = 0.25; 95%CI: 0.1 to 0.41), palliative care had a significant impact on quality of life (QOL) (g = 0.1; 95%CI: 0.019 to 0.18) of advanced cancer patients. Also, based on the analysis of 15 reports on outpatients (g = 0.27; 95%CI: 0.04 to 0.4), 10 reports of early (g = 0.27; 95%CI: 0.029 to 0.52), and 8 reports of end-of-life (g = 0.24; 95%CI: 0.06 to 0.47) palliative care in 4-7 months follow-up, a significant impact on life quality was shown. However, in four reports, the impact of palliative care on health related quality of life in ≥10 months follow-up (g = 0.19; 95%CI: -0.03 to 0.42) was not significant. Systematic QOL assessment with valid tool in palliative care setting would establish quality assurance and could further develop the application of this pretty new discipline in oncology care worldwide.

The Impact of Palliative Care and Nursing Intervention on the Psychology and Quality of Life of Elderly Patients with Colorectal Cancer.

Colorectal cancer patients face physical, psychological, and social difficulties. Psychosocial therapies appear to be successful in improving cancer patients' psychological and social results. Preoperative and postoperative psychological therapies for colorectal surgery patients have not been extensively studied. During their treatment, up to 35% of cancer patients experience clinically severe psychological discomfort. As a consequence, a greater knowledge of health-related quality of life and its causes can assist oncology nurses in developing effective treatments to improve the health-related quality of life. The palliative care model and the nursing intervention model are used in this study to assess the effectiveness of an individually customized nursing intervention for lowering chemotherapy-related symptom distress in adult patients with colorectal cancer. Initially, the dataset is collected and split into the control group and the experimental group. The patient conditions are evaluated using the novel accelerated gradient boosting regression tree (AGBRT) estimation model. For improving the evaluation process, we have proposed the enriched gravitational search optimization algorithm (EGSOA). The system's success is evaluated in terms of the patients' psychological well-being and quality of life.

Palliative care pilot initiative for transplant patients: The Westchester Medical Center experience.

e19050 Background: It is well known HCT recipients experience multiple symptoms affecting quality of life. Emerging data supports the role palliative care can play in mitigating these issues. Our cellular therapy team collaborated with the Palliative Care team on a pilot project incorporating their expertise into the management of our new allogeneic transplant patients. We chose this group of patients given their increased needs relative to other cellular therapy recipients (i.e. autologous, CTL) and our institution’s available resources. Methods: Patients admitted to the HCT unit for allogenic stem cell transplant underwent palliative care consult during their conditioning regimen. During the initial palliative care visit, performed by a specialist palliative care nurse practitioner, patients underwent comprehensive assessment of physical symptoms, psychosocial distress, and overall quality of life. Patients were then followed during hospitalization by members of the palliative care team including Nurse Practitioner, Social Worker and Chaplain, to address identified needs and support both the patient and their family. The palliative care team provided daily communication and recommendations to our inpatient HCT team. Results: Patient one was a 61-year-old man with intermediate risk MDS who underwent a reduced intensity conditioning regimen of busulfan, fludarabine, and alemtuzumab. His transplant was complicated by delirium and anorexia. Patient two was a 63-year-old man with AML who underwent a reduced conditioning regimen of the same combination. His transplant was complicated by bone pain and insomnia. Patient three was a 70-year-old woman with AML who also underwent a reduced conditioning regimen. Her transplant was complicated by severe mucositis and gastric reflux. Conclusions: Allogeneic stem cell transplant patients experience a multitude of symptoms and psychosocial distress. With the help of a dedicated palliative care assessment, we can improve patients’ quality of life during their admission for the transplant. Considering the positive feedback from patients, we plan to conduct a formal prospective study evaluating the impact of palliative care on adult stem cell transplant patients at our institution. By addressing the patient’s whole person rather than just their disease, we also hope to decrease number of admissions as well as length of stay. Ultimately, we look forward to expanding this to other malignancies as well.

Impact of Palliative Care on Interhospital Transfers to the Intensive Care Unit.

Community hospitals will often transfer their most complex, critically ill patients to intensive care units (ICUs) of tertiary care centers for specialized, comprehensive care. This population of patients has high rates of morbidity and mortality. Palliative care involvement in critically ill patients has been demonstrated to reduce over-utilization of resources and hospital length of stays. We hypothesized that transfers from community hospitals had low rates of palliative care involvement and high utilization of ICU resources. In this single-center retrospective cohort study, 848 patients transferred from local community hospitals to the medical ICU (MICU) and cardiac care unit (CCU) at a tertiary care center between 2016-2018 were analyzed for patient disposition, length of stay, hospitalization cost, and time to palliative care consultation. Of the 848 patients, 484 (57.1%) expired, with 117 (13.8%) having expired within 48 hours of transfer. Palliative care consult was placed for 201 (23.7%) patients. Patients with palliative care consult were statistically more likely to be referred to hospice (p<0.001). Over two-thirds of palliative care consults were placed later than 5 days after transfer. Time to palliative care consult was positively correlated with length of hospitalization among MICU patients (r=0.79) and CCU patients (r=0.90). Time to palliative consult was also positively correlated with hospitalization cost among MICU patients (r=0.75) and CCU patients (r=0.86). These results indicate early palliative care consultation in this population may result in timely goals of care discussions and optimization of resources.