Palliative Care Patients Research Articles

Exploring the Utility of the Modified Hospitalized-Patient One-Year Mortality Risk Score to Trigger Referrals to Palliative Care for Inpatients With Cancer.

Estimating prognosis can be a barrier to timely palliative care involvement. The modified Hospitalized-patient One-year Mortality Risk (mHOMR) score uses hospital admission data to calculate the risk of death within 12 months and may be a useful tool to trigger a referral to palliative care. The mHOMR tool was retrospectively applied to consecutive acute admissions to a quaternary cancer center in Toronto, Canada from March 1 to May 31, 2018. The study aimed to investigate the association between dichotomized mHOMR scores (the cohort median score of 0.27 and the developer-recommended score of 0.21) and the risk of death, and whether these could be used to identify patients who may benefit from timely palliative care involvement. Of 269 inpatients, 87 were elective admissions and excluded from further analyses. At the median mHOMR score of 0.27, 91/182 patients (50%) were categorized as high-risk of death within 12 months (mHOMR+), 53 (58%) were referred to palliative care. At the lower cut-off of 0.21, 103 patients were mHOMR+, of whom 57 (55.3%) were referred to palliative care. The higher mHOMR was significantly associated with mortality (29.7% mHOMR- vs. 39.8% mHOMR+ at 12 months, log-rank p < 0.05). The association between the developer-recommended mHOMR cut-off (≥ 0.21) and mortality was not significant (p = 0.15). A higher mHOMR score was significantly associated with the risk of mortality in patients with advanced cancer. However, the developer-recommended mHOMR cut-off of 0.21 failed to identify a statistically significant difference between patients with advanced cancer at low versus high scores. While mHOMR may be a useful tool to augment clinical judgment and identify inpatients with advanced cancer at high risk of death, who in turn may benefit from referral to palliative care, the optimal mHOMR cutoff may warrant adjustment for this population.

Early palliative care and its impact on end of life care.

The impacts of early palliative care for patients with advanced cancer are well described. This has led to endorsement of early palliative care, alongside cancer treatment, by leading cancer organisations. The aim of this review is to consider how best to adopt and integrate the learning from studies of early palliative care into an effective, sustainable service that is offered as part of routine cancer care. 'Timely', 'targeted' and 'precision' approaches have been proposed to ensure that limited palliative care resources are available to those who are most likely to benefit. Triage and referral based on individual patients' needs has been shown to be both efficient and effective. Standardised referral criteria and the use of tools to assess complexity may support equitable service development. A specialist multidisciplinary approach is a common factor underpinning successful integration between palliative care and oncology but does not negate the importance patient-centred considerations such as advance care planning, which can be facilitated by non-specialist teams. The challenge is no longer whether early palliative care should be provided, but how. Evidence-based strategies about how best to implement early palliative care are needed to inform appropriate resourcing, funding, and delivery.

Impact of early palliative care referral in patients with locally advanced and metastatic GI/lung cancer.

201 Background: Early palliative care improves quality of life and survival in patients with metastatic NSCLC. As a result, ASCO recommends early palliative care integration in patients with metastatic cancer. However, generalizing the benefits outside of a clinical trial may be difficult due to selection bias of patients that opt into palliative care due to advanced symptom burden and real-world resource constraints. Therefore, the benefits of this in real-world practice may not be realized. We aimed to evaluate early vs late palliative care referral impact on unplanned hospital visits and survival among GI and lung cancer patients at a large health system cancer center. Methods: The study design was a retrospective, single health system, review of patients treated at Orlando Health from 2021-2022.156 patients of all stage GI and Lung cancers were included. For these patients, early referral was defined as receiving a palliative referral within 8 weeks of cancer diagnosis. Any referral later than this was considered late and it was possible for patients to opt out of referral. Our main outcomes were unplanned hospital visits and survival. To compare the rates of these between palliative care referral groups, a multivariable negative binomial regression model was fitted. To assess any differences in survival, a multivariable cox hazard regression model was fitted. These were adjusted for age, sex, diagnosis, stage, ECOG, race, and insurance. Results: Patients with any palliative care referral had increased unplanned hospital visits and shorter survival than patients who did not have referrals. Specifically, patients with no palliative care referrals had a 62% lower relative rate of unplanned hospital visits compared to patients with early referral (RR = 0.38 [0.22-0.66], p&lt;0.001). And patients with any time referral had approximately 8 months lower restricted mean survival times (RMST) when followed for 2 years for stage 1-3 cancers than patients receiving no palliative care (14 vs 22 month RMST; stage x palliative care interaction, p &lt;0.05). In contrast, stage 4 patients had similar survival of ~14-month RMST when followed for 2 years regardless of referral. Conclusions: In real world practice palliative care referral was associated with increased unplanned hospital visits. Additionally, in this retrospective review, palliative care referral was not found to confer a survival advantage in gastrointestinal and Lung cancer patients. We postulate that this is related to selection bias in the opt in approach to palliative care referral biasing towards a sicker population with higher symptom burden and comorbidities. Our future prospective study will build upon this work through expansion of palliative care services and to better evaluate patient co-morbidities. Our goal is to increase utilization of palliative care for patients with GI and lung malignancies as part of a multidisciplinary integrative approach.

Racial disparities in end-of-life care among patients with neuroendocrine tumors.

60 Background: Due to the rising incidence of neuroendocrine tumors (NETs), the prevalence of NETs now surpasses many other malignancies. Due to a slower course of disease and lack of awareness among care teams, end-of-life (EOL) care is typically underutilized in patients with NETs. Owing to a heavy symptom burden (related to disease burden and/or functionality), patients with NETs often struggle due to lack of palliative care and eventually EOL care support. Prior studies have revealed that Black patients with advanced cancer are more likely to receive aggressive care and suffer a significant decline in quality of life at EOL. However, similar data investigating racial differences in EOL among patients with NETs are lacking. Methods: The National Inpatient Sample (NIS) was queried between years 2016-2020 to identify all hospitalizations (regardless of site of origin) with NETs utilizing the appropriate ICD-10 codes (neuroendocrine carcinomas were excluded). Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using independent sample t-test, Chi-square test, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). NIS discharge weights were applied to calculate national estimates. Statistical analyses were performed with SPSS 28.0. A p-value of &lt;0.05 was considered statistically significant. Results: A total of 6,265 hospitalizations with NETs were included, of which 5,125 (81.8%) and 1,140 (18.2%) had White and Black patients respectively. Black patients were younger, more likely to be females, and less likely to have a do not resuscitate (DNR) code status. There was no significant difference in CCI between the groups. Palliative care consultation was less likely to be performed among Black patients (adjusted OR=0.70, p&lt;.001). Black patients also had longer mean length of stay in the hospital (10.25 vs 8.42 days, p&lt;.001). Black patients were also more likely to receive aggressive care in the form of mechanical ventilation at EOL (Table). Conclusions: This is the largest analysis demonstrating significant racial disparities in EOL care among patients with NETs. Black patients had longer inpatient stay, were less likely to receive inpatient palliative care consultation, have a DNR order and more likely to receive aggressive care at EOL. These findings may have implications for informing healthcare decision making for EOL care among Black patients with NETs. WhiteN=5125 BlackN=1140 aOR (95% CI) p-value Age (years) 67.67 ± 11.89 65.14 ± 11.29 - &lt;.001 Females 46.1% 50.9% - .004 CCI 11.0 ± 3.22 10.9 ± 3.42 - .538 Mean length of stay 8.42 ± 10.03 10.25 ± 15.75 - &lt;.001 Palliative 62.6% 54.5% 0.70 (.61-.80) &lt;.001 DNR 64.9% 60.1% 0.80 (.70-.92) .002 Blood transfusion 13.2% 15.4% 1.18 (.98-1.41) .052 Mechanical ventilation 28.8% 38.6% 1.55 (1.35-1.77) &lt;.001 Vasopressor 9% 9.6% 1.07 (.86-1.33) .47

Descriptive Analysis of Dexmedetomidine's Utility in a Palliative Care Unit at the End of Life.

Context: Pain and symptom management at the end of life (EoL) can pose unique challenges, particularly when symptoms are refractory to conventional methods. Dexmedetomidine, originally approved for sedation in ventilated patients, has been demonstrated to be beneficial in pain management and palliative care settings by functioning as an alpha-2 agonist. Methods: A retrospective review of inpatient palliative care unit (IPU) records from January 2020 to December 2023 was conducted. Twenty-five adult patients receiving continuous dexmedetomidine for refractory pain at the EoL were identified. These patients were further evaluated for concurrent opioid, benzodiazepine, and chlorpromazine usage. Results: Patients experienced predominantly cancer-related pain, and had a median infusion duration of 5 days. Dexmedetomidine's initial dosing differed between the intensive care unit (ICU) and IPU settings. There was a trend toward a decreased opioid requirement 24 hours after initiation. Patients transferred from the ICU showed a progressive increase in opioid use. Conclusion: This study contributes to understanding dexmedetomidine's role in managing refractory symptoms at the EoL in the palliative care setting.

Reconciliation in palliative care: A concept analysis.

The aim was to gain a deeper understanding of the meaning of reconciliation as a concept in palliative care. Terminal illnesses affect almost all aspects of life and being close to death may lead to a need for reconciliation. The end of life is stressful on an existential level for both patients and relatives. It can therefore be of relevance for palliative care nurses to understand the meaning of reconciliation. This study used a design for a literature study in accordance with a hybrid model. A deductive qualitative content analysis of autobiographies about being seriously ill and in a palliative stage in life was used to test the meaning of reconciliation. Ethical aspects concerning the use of autobiographies and the ethical principles of the Helsinki Declaration were considered. The theoretical perspective was the caritative theory of caring. The result showed that for patients in palliative care, reconciliation can be described as a strive for acceptance, to live in a truthful way, to forgive and be forgiven. People wish to create meaning in their existence and reconcile as a whole in body, spirit, and soul. By striving to unite suffering, life, and death as well as a peaceful relationship with relatives, people can achieve reconciliation at the end of life. Reconciliation is something ongoing and can be a force in what has been, what is, and what will be. We conclude that reconciliation is a concept of importance when caring for patients in end-of-life care. However, reconciliation can be expressed in different ways without necessarily using the concept itself. A broader and deeper understanding of the concept facilitates conversations about the meaning of reconciliation in palliative care and can enable patients who strive to achieve reconciliation to be more easily identified and supported.

Impact of moral resilience and interprofessional collaboration on nurses' ethical competence.

Home care nurses are central in providing holistic and compassionate care to patients in home-based palliative care. Ethical caring competency is essential for home care to sustain nurses' integrity in the face of moral adversity. Interprofessional collaboration is vital for ensuring ethical decision-making and providing patient-centered care in home-based palliative care settings. This study explored the predictive roles of interprofessional collaboration and moral resilience on ethical caring competency among home care nurses in home-based palliative care. A cross-sectional survey of 400 nurses was conducted from October to December 2023, utilizing standardized scales to measure interprofessional collaboration, moral resilience, and ethical caring competency. A convenience sample of 400 home care nurses was also included in this study. Correlation and linear regression analysis were used to clarify the associative and predictive findings. Ethical approval from the ethics committee, institutional permission, and informed consent from the participants were obtained for data collection. Correlation analysis showed significant positive correlations between the ethical caring competency, interprofessional collaboration, and moral resilience constructs, with coefficients ranging from 0.482 to 0.967. Linear regression revealed that management of collaborative systems and total moral resilience significantly predict ethical caring competency, explaining 14.6% and 36.6% of its variance, respectively. Other variables, such as the effects of collaboration and communication, did not significantly influence ethical caring competency. The study highlights the significant impact of interprofessional collaboration, particularly the management of collaborative systems and moral resilience, on enhancing ethical caring competency among nurses. Enhancing interprofessional collaboration and moral resilience through targeted strategies in nursing practice and education can significantly improve ethical caring competencies. These efforts are essential for delivering high-quality, patient-centered care and for fostering a healthcare environment that respects the ethical principles guiding nursing practice.

Medical and social aspects of euthanasia of palliative patients in the Netherlands, Belgium and Germany

In the palliative and hospice medicine of Ukraine, there are a number of unresolved legal and organizational problems that stand in the way of a dignified existence of hopelessly ill patients in the last days and months of their lives. First of all, these are unresolved issues with the coverage of treatment and care of a sufficient number of categories of patients: palliative care is provided mainly to patients with oncological, cardiovascular and neurological profiles of treatment. Secondly, it is the lack of adequate analgesia for a significant number of inpatients and the vast majority of patients receiving treatment at home. Availability of recently legalized medical cannabis remains low for palliative care patients, and palliative care euthanasia is not legalized. In our previous research, we found out that Ukrainian society is not ready for a dialogue about the need to legalize euthanasia, and that the best model of preparing society for euthanasia is the Canadian one, which is based on a comprehensive study of the opinions of the general public and direct participants of the Medical Assistance in Dying (MAiD), as well as on the implementation of decisions federal court. The article is devoted to legal procedures and socio-medical aspects of euthanasia and MAiD in the Netherlands, Belgium and Germany. Certain aspects of legalization, its context and circumstances, compared with the conditions of Ukraine. The article is an original theoretical study performed using the method of systematic analysis, comparative and bibliosemantic methods. Note that we are clarifying the terminology of the previous stages of the study: MAiD is performed by the patient himself, euthanasia is performed by the doctor. In our opinion, Ukraine needs the legalization of euthanasia and MAiD for all age categories, and with the implementation of special additional consent procedures for adult incapacitated patients. In the experience of the countries of the current comparison, we paid special attention to the prevention of abuses in the implementation of these procedures, in the conditions of frequent disregard for the norms of the law since the beginning of the war. Keywords: palliative and hospice care, suicides of palliative patients, Medical Assistance in Dying, right to life, right to die.

Occurrence of allergens in preparations dedicated for palliative care patients: product composition analysis

Occurrence of allergens in preparations dedicated for palliative care patients: product composition analysis

Effects of Dignity Therapy for Palliative Care Patients and Family Caregivers: A Systematic Review.

Dignity Therapy (DT) is a psychosocial intervention aimed at alleviating existential distress, enhancing meaning, and improving the overall well-being of palliative care patients and their family caregivers. While individual studies have demonstrated the benefits of DT, a comprehensive evaluation of its impact on key outcomes such as quality of life (QoL), depression, anxiety, and well-being is needed. This study aimed to systematically review the effects of DT on palliative care patients and their family caregivers, focusing on outcomes related to QoL, psychological distress (depression and anxiety), and overall well-being. A systematic review was conducted by searching multiple databases, including Cochrane Library, PubMed, ScienceDirect, Web of Science, and Scopus, for randomized controlled trials (RCTs) evaluating DT in palliative care. Inclusion criteria were RCTs reporting on QoL, depression, anxiety, well-being, and dignity-related distress. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Cochrane Risk of Bias tool. Eight RCTs met the inclusion criteria. DT demonstrated significant improvements in QoL and well-being among palliative care patients, with reductions in depression and anxiety. Improvements were observed in the physical, psychological, and social domains of QoL. Family caregivers also experienced enhanced spiritual well-being, hope, family cohesion, and adaptability. However, not all outcomes were consistently improved across all studies, indicating variability in DT effectiveness. DT is a promising intervention for enhancing QoL and reducing psychological distress among palliative care patients and their family caregivers. While evidence supports its beneficial impact, further high-quality research is required to confirm these findings and clarify the mechanisms through which DT works. Incorporating DT into palliative care practice is recommended to address the comprehensive needs of patients and their families.

Advance Care Planning Practices For Nursing Home Residents Referred To Specialist Palliative Care In An Acute Hospital Setting

Abstract Background Advance care planning (ACP) is a structured process of discussion between patients, their loved ones and health care professionals, which aims to establish and record an individual’s goals and preferences for future medical treatment and care. It is of significant relevance to nursing home residents, a comorbid and frail population at high risk of clinical deterioration. Methods This prospective, observational study included all nursing home residents referred to an inpatient specialist palliative care (SPC) service in a model four hospital over a six-month period (November 2023 to May 2024). Basic clinical and demographic information as well as data on functional status and advance care planning was anonymised and collated using Microsoft excel. Results 36 patients (mean age 79 years) were recruited. 36% (n=13) were referred within 48 hours of admission. The average Australia-modified Karnofsky Performance Scale score was 40 on admission. 94% (n=34) had a clinical frailty score of ≥7 on admission. 72% (n=26) had an advance care plan in the nursing home. However, 22% (n=8) had not recorded their wishes pertaining to hospital readmission and 3 patients were admitted despite documenting a preference to remain in the nursing home. 53% (n=19) had not documented their preferred place for end-of-life care. 69% (n=25) died in hospital. Conclusion Most nursing home residents referred to the inpatient SPC team had severe frailty and died in hospital, reflecting the prognostic implications of severe frailty. Crucial components of the advance care plan were omitted in a significant proportion of patients, which may have influenced their referral to hospital. Provision of increased support to staff caring for older, frail adults in the residential care setting should be considered to enhance ACP.

Complementary Musical Intervention for Patients in Palliative Care in Spain: A Randomized Controlled Trial.

Patients with advanced cancer often endure a heavy burden of symptoms, both in quantity and intensity. Complementary therapies offer potential relief in this challenging scenario. Increasing the number of randomized controlled trials provides a unique opportunity to generate rigorous data, which can be used to establish causal relationships and evaluate interventions; hence, nurses can strengthen evidence-based practices, leading to better patient outcomes and quality of care. Our study aimed to evaluate the impact of a 7-day pre-recorded music intervention on cancer symptoms and satisfaction in advanced-stage cancer patients receiving palliative care at home. This multicenter, double-blind, randomized, controlled clinical trial involved 80 Spanish cancer patients receiving palliative care at home, and was conducted from July 2020 to November 2021. The intervention group (n = 40) received self-selected pre-recorded music for 30 min daily over 7 days. The control group (n = 40) received pre-recorded basic health education sessions of equal duration and frequency. Symptoms and patient satisfaction were assessed before and after the intervention using the Edmonton Symptom Assessment System and the Client Satisfaction Questionnaire, respectively. Comparing the intervention with the control group, significant improvements were observed in various symptoms: total symptom burden (p < 0.001), pain (p = 0.001), fatigue (p = 0.007), depression (p = 0.001), anxiety (p = 0.005), drowsiness (p = 0.006), appetite (p = 0.047), well-being (p ≤ 0.001), and sleep (p < 0.001); additionally, patient satisfaction was higher in the intervention group (p < 0.001). The 7-day pre-recorded music intervention reduced both physical and psychological symptoms in advanced-stage cancer patients receiving home-based palliative care, demonstrating significant alleviation of overall symptom burden and increased satisfaction with healthcare.

Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients.

Background and Objectives: Anesthesiologists come into contact with patients under palliative care in different clinical settings. They also routinely encounter these patients in their primary field of work, the operating room. Patients receiving palliative care who are scheduled for surgery will pose unique challenges in perioperative management, often presenting with advanced disease and with different psychosocial and ethical issues. This study aims to evaluate whether anesthesiologists without specialty training in palliative medicine will spot perioperative challenges presented by patients under palliative care and address them adequately. Materials and Methods: In this study, we simulated a preoperative anesthesiological interview using standardized patients and anesthesiologists (specialists as well as trainees). The standardized patients were asked to represent a patient under palliative care in need of surgery because of a mechanical ileus. We conducted 32 interviews, dividing the anesthesiologists into two groups. In one group, the standardized patients were instructed to address four problems, i.e., use of a port catheter for anesthesia, nausea and vomiting, pain medication, and an advance directive including a limitation of treatment (DNR-order). In the other group, these problems were also present, but were not actively addressed by the standardized patients if not asked for. The interviews were recorded, transcribed, and then analyzed. Results: In most cases, the medical problems were spontaneously identified and discussed. In only a few cases, however, was a therapy recommendation made for improved symptom control. The advance directive was spontaneously discussed by only 3 of the 32 (9%) anesthesiologists. In another 16 cases, the advance directive was discussed at the request of the standardized patients. The limitation of treatment stayed in place in all cases, and the discussion of the advance directives remained short, with an average duration of just over 5 min. Conclusions: In this study, the complex problems of patients under palliative care are not sufficiently taken into account in a preoperative anesthesiological interview. To improve treatment of the medical problems, therapists who have palliative medicine expertise, should be involved in the perioperative medical care, ideally as a multi-professional team. The discussion about perioperative limitations of treatment should be held beforehand, for example, as part of a structured advanced care planning discussion.

Transformative Impact of Islamic Spiritual Care (ISC) Enriched with Murottal: Alleviating Anxiety and Depression among Coronary Heart Disease Patients through Pre- and Post-Intervention Analysis

Background:Spiritual care is a vital component of comprehensive nursing, especially for patients in palliative care, such as those with coronary heart disease. While pharmacological and medical interventions remain the primary approach for heart-related conditions, the substantial success rate observed with spiritual therapy incorporating Murottal recitations highlights its significant impact on improving patients' quality of life, particularly in managing anxiety and depression. Objective:This study aimed to assess the differences in anxiety and depression scores among cardiovascular patients diagnosed with coronary heart disease before and after the application of Islamic spiritual care interventions using Murottal, in both intervention and control groups. Method:Using a quasi-experimental pretest-posttest design with a control group, the study involved a population of 156 coronary heart disease patients undergoing treatment. Simple random sampling produced a sample size of 110 patients at Muhammadiyah Hospital in Palembang, South Sumatra, Indonesia. Respondents were divided into two groups of 55 participants each. The intervention group received spiritual care through Murottal, while the control group received standard hospital therapy. Levels of anxiety and depression were measured using the Depression Anxiety Stress Scale (DASS). Results:The Wilcoxon test results for anxiety and depression variables in the intervention group showed a p-value of &lt;0.005, indicating a significant difference in anxiety and depression scores before and after receiving the spiritual care intervention with Murottal. Conclusion:Islamic spiritual care (ISC) services incorporating Murottal recitations have the potential to reduce anxiety and depression among coronary heart disease patients at Muhammadiyah Hospital in Palembang, South Sumatra, Indonesia. Keywords: Anxiety, Coronary Heart Disease, Depression, Murottal, Spiritual Care, Patient.

Integration of Palliative Care in Neurosurgical Critical Care : Insights from a Single-Center Perspective.

Palliative care is a specialized approach designed to enhance the quality of life for both patients and their families, offering patient-centered care through comprehensive assessment and care planning. However, the integration of palliative care within neuro-critical care settings has been relatively understudied. This descriptive study aims to identify the characteristics, palliative care needs, and outcomes of patients referred to palliative care services during admission to the neurosurgical intensive care unit (NS-ICU). A retrospective analysis of adults admitted to the NS-ICU at a referral hospital between December 2019 and December 2021 was conducted. The study focused on those referred to the inpatient palliative care team with diagnoses of non-traumatic brain hemorrhage, traumatic brain injury, or brain neoplasm. Excluded were patients who died before palliative care consultation or lacked sufficient information. The investigation assessed demographic and clinical characteristics at consultation, along with post-consultation hospital outcomes derived from medical records and interview notes. In this study involving 38 enrolled patients, the median age was 65, with 42.1% females. The most prevalent diagnosis was non-traumatic brain hemorrhage (47.4%). Reasons for palliative care consultation included psychosocial support (95%), goal-of-care discussions (68%), decision-making support (50%), and communication facilitation (39%). The median time from NS-ICU admission to consultation was 3.5 days (range: 1-8 days), and all interviews involved family members. Key decision topics encompassed mechanical ventilation (23.7%) and tracheostomy (21.1%). Patient preferences for life-sustaining treatment could be estimated in only 47.4% of cases, often resulting in treatment disagreement. Among the 38 patients, 26 (68.4%) died during admission. Before the consultation, full code status, partial code status, and comfort care alone were reported as 32%, 66%, and 2%, respectively; post-consultation, these figures shifted to 11%, 42%, and 47%, respectively. Palliative care was predominantly sought for psychosocial support and discussions concerning goals of care. Despite challenges in ascertaining patient treatment preferences, palliative care consultations proved invaluable in aiding family members and facilitating treatment decision-making. Our study suggests the potential integration of palliative care within neuro-critical care, contributing to a heightened utilization of comfort care at the end-of-life.

Multicenter exploration of specialist palliative care in patients with left ventricular assist devices – a retrospective study

BackgroundThe number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients.MethodsWe conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included.ResultsIn 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3–50.3 months). Median duration between consultation and death was seven days (IQR 3–28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p < 0.001; DNR before: n = 20, after: n = 28, p < 0.001). Symptom burden as assessed at first specialist palliative care contact was higher compared to the consultation requests (request: median 3 symptoms (IQR 3–6); first contact: median 9 (IQR 6–10); p < 0.001) with a focus on weakness, anxiety, overburdening of next-of-kin and dyspnea. More than 70% of patients died during index hospitalization, one third of these in a palliative care unit.ConclusionsThis largest European multicenter investigation of LVAD-patients receiving specialist palliative care shows a late integration and high physical and psychosocial symptom burden. This study highlights the urgent need for earlier integration to identify and address poorly controlled symptoms. Further studies and educational efforts are needed to close the gap between guideline-recommendations and the current status quo.

Abstract B132: Access to palliative care for individuals with cancer experiencing homelessness

Abstract Introduction Persons experiencing homelessness (PEH) face significant disparities in health outcomes and access to healthcare, including cancer-related and end-of-life care. PEH are less likely to receive age-appropriate cancer screening, more likely to be diagnosed with cancer at later stages, and more likely to die secondary to cancer compared to the general population. Qualitative research has demonstrated that PEH and the providers who care for them perceive gaps in access to palliative care, largely due to a lack of palliative care programs that cater to the specific needs of PEH. However, less is known about how medical providers’ referral patterns affect access to care. Providers may be less likely to refer PEH to palliative care services because of these known gaps in access, exacerbating existing disparities. The purpose of this study was to quantify the rates of palliative care referrals and outpatient palliative care visits along with time to initial palliative care referral and ambulatory palliative care visit. We hypothesized that PEH would be referred to palliative care at lower rates and have longer intervals to palliative care follow-up as compared to their housed counterparts. Methods A retrospective analysis was performed on patients with cancer admitted to an academic center’s medical oncology service between July 2022 and June 2023. Patients were stratified into two groups based on their housing status: housed and PEH. A comparative quantitative analysis was conducted between these groups. Results 1166 patients with cancer were admitted to the medical oncology service during the one-year study period. The mean age of the cohort was 61.0 years and 46.7% were female. Seventeen (1.4%) PEH and 1149 (98.6%) patients who were housed were identified. Among PEH, five (29.4%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Among patients who were housed, 362 (31.5%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Two (11.8%) PEH attended an ambulatory palliative care appointment compared to 183 (15.9%) patients who were housed. The mean number of days to first palliative care or hospice referral/consult was 25.5 in PEH and 43.9 in patients who were housed. The mean number of days to first ambulatory palliative care visit was 131 in PEH and 83.7 in patients who were housed. Conclusion The frequency of inpatient and ambulatory palliative care referrals was comparable between the two groups, suggesting that PEH are appropriately referred to palliative care. However, PEH had longer intervals from cancer diagnosis to first outpatient palliative care visit, suggesting that additional supports may be needed to ensure PEH can access outpatient follow-up. While this quantitative study is underpowered to detect statistically significant differences, it highlights a potential area for further study to develop interventions to better support PEH to achieve timely follow-up with ambulatory palliative care and hospice services after referral. Citation Format: Brandon A. Bellen, Katarina Leyba, Amanda V. Johnson, Eric Grimm, Erin Bredenberg. Access to palliative care for individuals with cancer experiencing homelessness [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B132.

Electronic Patient Reported Outcomes Measures (e-PROMs) in Pediatric Palliative Oncology Care: A Scoping Review.

Objective: Research findings regarding child-centered care and electronic patient reported outcome measures (e-PROMs) within pediatric palliative oncology care reveal an intricate field of study. This study aimed to map innovations in e-PROMs for the pediatric cancer population in palliative care and their impact on symptom management, and communication with healthcare professionals. Methods: A scoping review was designed following the Arksey and O'Malley framework. Literature searches were conducted in CINAHL, Embase, MEDLINE, PsycINFO, SCOPUS, and Web of Science. Inclusion criteria targeted children aged 0-18 years with cancer, receiving palliative and/or end-of-life care, and using e-PROMs. Results: Twelve articles were included: 10 quantitative studies, one qualitative study, and one mixed-method study. A narrative synthesis approach was used to summarize the findings, categorized into three sections: (a) technological innovation of e-PROMs in pediatric palliative oncology care; (b) the impact of e-PROMs on symptom monitoring, management, and children's care; (c) the effects of e-PROMs on communication between children and healthcare professionals in pediatric palliative oncology care. Conclusion: e-PROMs have proven effective in empowering children to express their perspectives and actively engage in their end-of-life care. Due to flexible software and devices designed for various age groups, these tools fit seamlessly into children's daily routines and preferences, including the use of play-oriented applications. They facilitate a deeper understanding, and management of physical and emotional symptoms while ensuring care remains child-centered. This emphasizes the importance of preserving the essence of childhood and addressing the unique needs and experiences of young patients in pediatric palliative oncology care.

Comprehensive needs assessment tool for informal cancer caregivers (CNAT-ICs): Instrument development and cross-sectional validation study

BackgroundGrowing cancer incidence and its subsequent burden is a worldwide concern. Needs assessment for caregivers has recently received growing attention, as it identifies specific unmet needs. The remaining tools have been established within the healthcare context of Western countries and have been studied only in some Asian populations; it seems appropriate to develop needs assessment tools that apply to a wider ethnic and socio-cultural context. ObjectiveThis study planned to adapt and examine the psychometric properties of the CNAT-C for the Sri Lankan informal caregivers for wider applicability. DesignAn instrument development and cross-sectional validation study was conducted. SettingApeksha Hospital Maharagama, Sri Lanka (National Cancer Institute). ParticipantsA sample of 226 informal caregivers (ICs) providing palliative care for patients with advanced cancer was selected. MethodsA CNAT-C (41 items; seven factors) was incorporated and used after a cross-cultural adaptation following WHO guidelines after the permission and pilot test. ICs completed the socio-demographic and clinical details along with the validated Centre for Epidemiological Studies-Depression (CES-D), and the World Health Organization-Quality of Life-Brief (WHOQOL-BREF). Internal consistency and test-retest were used to check the reliability. Convergent and divergent validity of the Sinhala version of CNAT (S-CNAT) was confirmed using the CES-D scale and WHOQOL-BREF. Construct validity was evaluated using the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). ResultsMost of the participants were female (60 %) and married (72 %), and the mean age was 41.78 (SD+14.54). Face and content validity were established during the cross-cultural adaptation. Cronbach's alpha was 0.903 for the overall S-CNAT and the test-retest reliability was 0.965. The S-CNAT was associated positively with the CES-D while negatively with the WHOQOL-BREF. Both EFA and CFA discovered a structure contained seven factors (35 items); domain named as healthcare staff/nurses’ support and information, physical/practical needs, medical officers’ support, psychological needs, social/family support, spiritual/religious support, and hospital facilities/service. ConclusionsThe Sinhala version of CNAT is shown to have adequate validity and reliability in assessing the comprehensive and multidimensional/unmet needs of informal caregivers of patients with advanced cancer (S-CNAT-ICs). It would be a helpful tool to determine the unmet needs of ICs and guide future interventions to meet those needs and enhance or maintain the quality of life for patients and their informal caregivers.

Effect of applying digital health in palliative care for patients with advanced cancer: a meta-analysis and systematic review.

To assess the effectiveness of applying digital health palliative care to improve symptoms, mood, and quality of life in patients with advanced cancer. We searched PubMed, Embase, Web of Science, Cochrane Library (CENTRAL), and CINAHL databases on November 16, 2023, to identify randomized controlled trials of the impact of palliative care applying digital health on patients with advanced cancer. The Cochrane Risk of Bias Tool version 1.0 was used to evaluate the quality of randomized controlled trials. A total of 20 randomized controlled trials were included, of which 18 were meta-analyzed. Compared with usual care, palliative care applying digital health was effective in improving symptoms (SMD = -0.21, 95% CI: -0.37 to -0.06, P = 0.007) and reducing the intensity of pain (SMD = -0.49, 95% CI: -0.85 to -0.13, P = 0.008) in patients with advanced cancer, but no effective improvement in depressive symptoms, anxiety symptoms, or quality of life was found. Our systematic review provides evidence that palliative care applying digital health has great potential to improve symptoms in patients with advanced cancer, but more research is needed to explore its impact on mood and quality of life.