Palliative Research Articles

Recommendations for Specialty Palliative APRN Graduate Education

Background: Advanced practice registered nurses (APRNs) are essential to care for the growing number of individuals with advanced illness given the shortage of palliative care clinicians. Problem: Graduate education for specialty practice palliative APRNs lacks consistency in structure, content, and standardization of specialty palliative APRN education. Approach: A workgroup of expert palliative APRNs and graduate faculty conducted focused discussions and a literature review to develop consensus recommendations based on national palliative APRN competencies and aligned with the 8 core concepts of the AACN Essentials. Outcome: Recommendations include: (a) definition of core concepts; (b) associated skills; (c) andragogical approaches; (d) evaluation methods; and (e) references for curricular development. Conclusion: The Recommendations for Specialty Palliative APRN Education is a first step toward the standardization of quality advanced practice specialty palliative nursing education. These recommendations provide the foundation for a comprehensive curriculum for palliative APRNs.

Physicians' perspectives on cancer-related fatigue management and their suggestions for improvements in medical training: a cross-sectional survey study in Germany.

Contrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest. For an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians' knowledge, and Mann‒Whitney U tests were performed. Two-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Only 32% of the sample were aware of CRF-specific guidelines. Despite of this, participants rated the scientific evidence for recommending physical activity, exercise programs, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in medical studies and medical specialist training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR = 2.6, 95% CI [1.1-6.0], p < 0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops. Although awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower recommendation rates for others, including psychotherapy. Studies are required assessing for the reasons of this knowledge-to-practice gap. Moreover, training is needed among physicians in order to enhance knowledge of CRF guidelines. Clinicaltrials.gov , identifier: NCT04921644. Registered in June 2021.

Integrating Palliative Care Into Routine Head and Neck Cancer Care-Separate Is Inherently Unequal.

Integrating Palliative Care Into Routine Head and Neck Cancer Care-Separate Is Inherently Unequal.

Community Palliative Care: What are the Best Models?

Palliative care seeks to address the physical, psychosocial and spiritual concerns of patients with a life limiting illness and their caregivers. Early referral to palliative care improves symptoms and is the standard of care. This paper evaluates the evidence for different models of community palliative care and looks at the effects of homecare, hospice programs and residential aged care facility (RACF) interventions on symptom management, home death rate and acute health service utilization. It also examines the impact of COVID-19, telehealth, integration and staffing models on the efficacy of community palliative care. Evidence suggests that community palliative care increases the rate of death at home and may improve satisfaction with care, but effect on symptoms and acute health care utilization are less certain. Enrolment in a hospice program may decrease hospitalizations and improve satisfaction. RACF staff training interventions to improve the quality of palliative care provided to residents show mixed results across all indicators. COVID-19 saw a relative increase in the demand for community palliative care, as people opted out of the hospital system. Models of community palliative care that facilitate integration, support primary health providers, and promote technological innovation are worthy of further research.

The impact of an emercency form on the place of death of palliative care patients

Apilot study conducted by our research group in 2019 showed that adecision made in advance about the transfer of palliative care patients documented within the emergency information was associated with the actual place of death, thus realizing the patient's wishes regarding the place of death. There were also details on how the scope, duration, and frequency of home visits by mobile palliative care teams should be designed in order to fulfill patients' wishes regarding the place of death. Systematic reviews point to adiscrepancy between preferred and actual places of death and alack of prospective studies and data to support patients and their caregivers.The current observational study lasted one year, included all mobile palliative care teams for adults working in Styria and collected data from atotal of 1425 patients (52.6% men). The median age at the time of death was 78.1 years (IQR = 17.4). 76.9% of the sample were cancer patients. Other diseases included cardiovascular (6.3%), neurological (4.1%) and respiratory diseases (2.3%).The emergency information used in this study was an optimized version of the emergency information used in the 2019 pilot, based on input from all palliative care teams who participated in 2019.Atotal of 109 patients (7.6%) of the entire sample took part in the intervention (emergency information). Of these, 85individuals (78.9% of the intervention group) indicated apreference for on-side treatment, i.e., without transfer. Only 8patients (7.3%) indicated apreference for transfer and 16 (14.7%) did not indicate apreference. Of the 85patients who did not wish to be transferred, 75 (88.2%) died at home, i.e., in around 9out of 10cases the patient's wishes were complied with. In contrast, of the 8people who requested transfer, only 3 (37.5%) died at home, i.e., the majority (5or 62.5%) died in hospital or apalliative care unit, indicating that the patient's wishes were complied with in the majority of cases.The preference expressed in the emergency information for on-site treatment and against transfer was associated with amore than five times higher odds (p < 0.001) of actually dying at home. The preference expressed in the emergency information increased the probability of dying at home from 63% in the control group to 89% in the intervention group.There was also asignificant difference according to the number of medical contacts, i.e. patients who took part in the intervention and did not wish to be transferred had twice as many contacts with physicians (p = 0.031).The results of the logistic regression model also suggested an influence of age, disease and intensity of care by physicians on the odds of dying at home: Older people and the minority of palliative care patients who did not suffer from cancer had higher odds of dying at home than those with cancer. While there was no correlation between the duration of care and the total number of care contacts, the odds of dying at home increased with the number of medical contacts (+7% per contact).

Perceived effects of a home-based social care program on palliative care in Spain from the caregivers’ perspective

ABSTRACT This study explores the perceived effects of a home-based end-of-life social care program in palliative care in Spain, from the perspective of caregivers. A qualitative study using semi-structured interviews with 75 caregivers from the INTecum project. Non-probability purposive sampling was used to recruit the study participants. The analytical process followed a thematic analysis. Caregivers expressed several factors that were influential in reducing stress and anxiety. Knowing that they can count on a case manager in a situation of need was highlighted as very positive. Another important factor that helped to create a positive sense of security was the speed of the project in offering its services. One of the problems that arose was the lack of support in situations where a transition between home and hospital care was required. Aspects such as listening and kindness, and affection, are highlighted in a very positive way. In addition to the final desires, caregivers also recognized that it was important for professionals to take their relative’s wishes into account when making decisions. Incorporating a psychosocial component in palliative care for both patients and family caregivers is recognized and such actions are recommended, as well the strengthening of social and health care coordination.

Capacity Planning in Paediatric Palliative and Hospice Care: An Italian Case

Although the growing demand for healthcare services has enhanced the occurrence of inefficiencies in care provision, healthcare systems should ensure safe, timely and equitable access to care. In particular, the long waiting lists, the lack of beds, and the shortage of healthcare workforce have highlighted the necessity to effectively manage and strategically plan the available resources. Capacity Planning (CP) contributes to determine what, when, where and how much product or service to deliver, with the goal of analysing and optimizing the use and allocation of human and material resources (e.g., physical spaces, equipment, beds, workforce) based on the demand. CP demonstrates to be extremely relevant for hospital units to schedule appointments, diagnostics, surgeries and admissions. Complex contexts and broader healthcare networks could benefit even more from this approach, helping to coordinate multiple care providers and aligning the available resources with the demand pace. The current research presents the implementation of CP in the context of Paediatric Palliative and Hospice Care (PPHC), delivered in an Italian facility. PPHC provides long-term, interdisciplinary and coordinated care between territorial, ambulatory and hospice services. It encompasses follow-up activities, parental training, end-of-life and respite care. In the Italian case analysed, the shortage of beds affects the quality of care delivered to these patients, in terms of accessibility to the service, effectiveness and timeliness of care. Hence, a CP analysis has been performed to pursue a twofold objective: a) to understand if the current capacity of the facility meets the demand for care; b) to improve productivity through an optimized allocation of resources, particularly the available beds and the healthcare workforce. The expected results involve a more effective use of resources, an increased bed occupancy rate and a reduction in rescheduled admissions due to inadequate planning. Optimizing capacity in this specific setting can serve as a pilot project for other similar contexts, aiming to improve patients’ access to healthcare services, their quality of life and supporting the workforce involved in PPHC. This research offers new insights from both the academic and managerial point of view, providing evidence about the implementation of CP in complex healthcare settings.

OGC SO04 - Impact of COVID-19 on Decision-making and Survival in Esophago-Gastric Cancer Treatment: Insights from a Multidisciplinary Approach

Abstract Background The COVID-19 pandemic necessitated rapid adaptation in healthcare delivery, affecting cancer care pathways. This study assesses the impact of these changes on multidisciplinary team (MDT) decision-making and survival outcomes in esophago-gastric cancer patients across pre-pandemic, peak pandemic, and post-pandemic periods. Method A retrospective cohort study involving patients referred to a UK tertiary EG cancer center during distinct six-month intervals mirroring the pandemic's evolution. Analysis focused on MDT recommendations, treatment pathways, and two-year survival rates, comparing deviations from standard care across periods. Results The study revealed a significant reduction in patient referrals and expedited treatment decisions during the pandemic peak, with a shift towards palliative care in post-pandemic cases. Although no statistically significant difference in two-year survival rates was observed, the post-pandemic period showed an increase in tumor aggressiveness and positive resection margins, suggesting potential long-term impacts of delayed diagnosis and treatment. Conclusion COVID-19 has significantly influenced MDT decision-making and patient pathways in esophago-gastric cancer care, underlining the necessity of resilient healthcare systems. Despite maintaining survival rates, the observed increase in tumor aggressiveness post-pandemic highlights the critical need for uninterrupted cancer diagnosis and treatment services during global health emergencies.

Psychological assessment and the role of the psychologist in early palliative care

BackgroundEarly palliative care (EPC) is a recommended model for improving the quality of life for patients with advanced cancer and their caregivers. However, limited research has focused on the role of psychological evaluation within EPC. The Veneto Institute of Oncology (IOV), a Comprehensive Cancer Centre, employs an interdisciplinary team to assess patients with advanced-stage disease. This study aims to assess the psychological needs of these patients, investigate any correlations between psychological symptoms (PSs) and factors such as awareness of diagnosis and prognosis, symptoms detected using the Edmonton Symptom Assessment System (ESAS), as well as the patient’s gender, age, social issues, and survival and to clarify the psychologist’s role within the interdisciplinary team.MethodsData were retrieved from a prospectively maintained database. From 1st January 2018 to 31st December 2021, 819 consecutive patients were evaluated during EPC consultations, with 753 participants enrolled in the study. The ESAS was administered to each patient before the consultation.ResultsMore than half of the patients (385, 57.1%) reported at least one PS, with an ESAS score of ≥4. Specifically, 34.9% reported depression, 28.7% reported anxiety, and 43.2% indicated feeling “not well.” Referring oncologists tended to overestimate the presence of PSs compared to patient self-reports (51.8% versus 41.3%). According to the psychologists’ assessment, 29.2% of participants were found to have depression, and 10.8% of participants had anxiety. Additionally, 31 patients (10.8%) with psychological disorders were diagnosed with an adaptation disorder related to a physical condition. The psychology service engaged 47% of patients, while 18.5% declined psychological support. Patients exhibiting other ESAS symptoms with scores of ≥4 had an increased odds ratio for reporting PSs of ≥4. However, multivariable analysis revealed no significant relationship between PSs and awareness of diagnosis and prognosis.ConclusionThe systematic use of self-assessment in EPC is essential for understanding patient’s experience, determining whether PSs stem from physical disorders, and prioritizing interventions. Awareness of prognosis does not correlate with increased anxiety and depression in patients. Therefore, EPC is an ideal opportunity to discuss prognosis and facilitate patients’ end-of-life choices early in their care journey.

Abstract B026: Glioblastoma multiforme disseminates outside the central nervous system

Abstract Introduction: The liquid biopsy (LB) concept has gained significant attention in the last decade and has the potential to revolutionize cancer care. However, more validation in clinical trials is required on the value of LB in medical settings. Here, we focus on glioblastoma multiforme (GBM), a highly invasive and fatal subtype of the central nervous system malignant tumors. Circulating tumor cells (CTCs) are primary tumor cells released into the peripheral blood and migrating to distant organs. CTC presence is related to tumor spread and recurrence. In GBM, factors like short patient survival, the blood-brain barrier (BBB), and lack of lymphatic drainage in brain tissue make systemic dissemination rare but possible. Thus, noninvasive CTC detection can hold potential for diagnostic, predictive, and prognostic applications. Material and Methods: For cell stability preservation before sample processing, the peripheral blood samples from curatively resected GBM patients were collected preoperatively in Cell-Free DNA BCT® tubes (Streck, Inc.). CTCs were identified using CytoTrack CT11TM (2/C), a semi-automated immunofluorescence microscopy using glial fibrillary acidic protein, vimentin, and CD45 immunostaining, and DAPI counterstaining. The preliminary Kaplan-Maier survival analysis based on CTC positivity was performed in 39 patients with a follow-up longer than two years. Results: We analyzed the CTC presence in 100 GBM patient peripheral blood samples. The CTCs or cancer cell clusters were found in 35% of GBM patients. The Kaplan-Maier survival analysis did not show a correlation between CTC presence and survival. This phenomenon may be associated with the generally short survival of these patients, which is expected to increase with advances in oncology and palliative care and/or a possible suppression of tumor cell growth outside the CNS. Conclusions: We have observed the CTCs in the peripheral blood of GBM patients. The patient enrollment and clinical data recording are still ongoing. Citation Format: Pavel Stejskal, Josef Srovnal, Alona Rehulkova, Ondrej Kalita, Marek Slachta, Marian Hajduch. Glioblastoma multiforme disseminates outside the central nervous system [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B026.

Use of complementary and alternative medicine by cancer patients attending Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya

This study aimed to determine the prevalence and patterns of complementary and alternative medicine use among cancer patients at Jaramogi Oginga Odinga Teaching and Referral Hospital's Oncology and Palliative Care Unit. A cross-sectional study was carried out at the hospital. Seventy-one (71) participants were conveniently sampled. They were eligible to participate if they were at least 18 years old, had a cancer diagnosis, and could comprehend the questions. A questionnaire was used to collect data that was then analysed using STATA 13.0 at a 0.05 level of significance. Participants included 25(35.2%) males and 46(64.8%) females were recruited. About 67.6 per cent of the participants used complementary and alternative medicine. Majority used it for Tumour suppression (n = 25, 52.1%), and most sourced from CAM practitioners (n = 23, 47.9%). Overall, 60.4 per cent of complementary and alternative medicine users experienced side effects, with diarrhoea affecting the greatest percentage (62.1%). The highest level of education was found to be positively associated with the use of complementary and alternative medicine (aOR=3.337). In conclusion, complementary and alternative medicine is widely used by cancer patients attending Jaramogi Oginga Odinga Teaching and Referral Hospital Oncology and Palliative Care Unit. As a result, there is need identify specific herbs taken by cancer patients, evaluate their active constituents, and investigate their potential anticancer mechanisms, as well as assess their knowledge, attitude, and perspective.

Descriptive study on the overload of the main caregiver of cancer patients with tumour asthenia in Salamanca.

The incidence of oncology patients is increasing due to the ageing of the population and advances in research leading to early diagnoses. This has resulted in an increase in the care required for patients at all stages of their illness. To describe the current situation of the overload of informal caregivers of cancer patients with tumour asthenia belonging to the Medical Oncology Service of the University Health Care Complex of Salamanca and the Palliative Care Unit of the Hospital de los Montalvos, we employed the following. This is a cross-sectional descriptive observational study conducted at the Complejo Asistencial Universitario de Salamanca and the Palliative Care Unit of the Hospital de los Montalvos from February to May 2023. The study involved 75 informal caregivers of oncology patients with tumour asthenia. Data was collected through interviews, which included sociodemographic information and measurement scales. The study employed the Barthel Scale, PERFORM questionnaire, and Reduced Zarit Caregiver Overload Scale to assess the informal caregivers' ability to care for cancer patients with tumour asthenia. Of the caregivers, 58.7% were female, and the mean age was 60.0 years (± 14.10). Over half (50.7%) of the caregivers experienced high levels of overload, making it impossible to care for the patient. Among patients with tumour asthenia, 37.3% were totally dependent, and 8.0% were moderately dependent. Of these caregivers, 58.7% had no prior caregiving experience, 80.7% had no training, and 77.3% never received help in caring for the patient. In the Medical Oncology service of the Complejo Asistencial Universitario de Salamanca (CAUSA) and the Palliative Care Unit of the Hospital de los Montalvos, over one third of caregivers of oncology patients with tumour asthenia experienced caregiver overload. Variables such as the patient's age, the caregiver's age, the number of care hours, and the willingness to seek help can influence the perception of overload. This can worsen the effective care of the patient. It is important to consider these factors when providing care.

Advanced Care Plan Among Older Chinese in Residential Aged Care: A Retrospective Review.

Worldwide in the population of older people, ethnic diversity is prevalent and therefore warrants culturally sensitive advanced care planning. This study aimed to explore advanced care planning documentation related to the cultural needs of residents of Chinese ethnicity in Australian aged care facilities. A retrospective review of advanced care plan documentation was undertaken among 31 older Chinese residents with life-limiting illnesses across two residential aged care facilities in New South Wales, Australia. Data were analyzed using descriptive statistics. 90% of residents had advanced care planning documentation. The presence of the resident and their representative and medical care directives were well documented. Specific details on the provision of palliative care that considers the person's cultural needs and preferences were limited. Findings suggest the need for further research that explores an optimal way of embedding culture-specific information and the development of a culturally sensitive advanced care plan for people of Chinese ethnicity.

Dexmedotomidina

Procedural sedation is often required in paediatrics to execute diagnostic procedures. There are many sedative drugs that may be used, but all of them carry not negligible side effect risks and may not be easy to manage. The use of dexmedetomidine has increased in the last few years because of its sedation efficacy in painless procedures. Paediatricians should know the use of dexmedetomidine because of its sensational safety profile even in neonates, its administration route versatility, its neuroprotective properties and its in-home palliative care role in children with otherwise untreatable sleep disorders. This article summarizes the main characteristics of dexmedetomidine, its use, strengths and weaknesses.

Gender Disparities in Advanced Lung Diseases: do They Persist Towards the End of Life?

Advanced lung diseases are prevalent in women, yet are underrecognized and under-treated due to differing epidemiology and pathophysiology. To investigate any gender differences in access to palliative care and end-of-life management for patients with advanced lung diseases. A post-hoc analysis was conducted using three datasets that included information regarding the provision of palliative care to patients with advanced lung diseases - chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung diseases (f-ILD) or non-small cell lung cancer (NSCLC) in tertiary and regional hospitals in Victoria, Australia, from 2004 to 2019. 343 patients with advanced COPD, 67 with f-ILD and 1022 with NSCLC were included. Compared to men, women with COPD (n = 126, 36.7%) were less likely to have smoked (P = 0.024), had significantly worse lung function (P < 0.001), and were more likely to receive non-invasive ventilation at end of life (P = 0.021). Women with fibrotic ILDs (n = 30, 44.8%) had significantly worse lung function (P < 0.001) and were more likely to experience exacerbations during their last two years of life (P < 0.001). Women with NSCLC (n = 457, 44.7%) were significantly younger (P< 0.001), less likely to have smoked (P < 0.001) or had asbestos exposure (P < 0.001). There were no significant differences between men and women with advanced lung diseases regarding referral to palliative care services (P = 0.369), hospital place of death (P = 0.915), or end-of-life management. Despite differences in lung function, exacerbations and targeted therapies, men and women with advanced lung diseases received equal access to symptom palliation and palliative care services towards the end of life.

Knowledge and awareness of undergraduate medical students regarding palliative care in Pakistan: a cross-sectional study.

Our study assesses the current knowledge and prior awareness of undergraduate medical students in Pakistan regarding palliative care. This descriptive Cross-sectional online survey was distributed among undergraduate medical students across Pakistan, with a sample size of 246 participants. The questionnaire, adapted from the PaCKS questionnaire by Kozlov et al. (JAMA 15(5):524-34, 2017), was designed to assess the students' prior knowledge about palliative care. The mean PaCKS score was 9.7 out of 13, with a standard deviation of 2.76. Having heard of palliative care before participation in the study was significantly associated with higher PaCKS scores. Key factors associated with a higher incidence of prior awareness of palliative care included attending private institutions, being in a more advanced year of study, and having a higher mean monthly family income (P < 0.001 for each factor). This study explores medical students' understanding of palliative care in Pakistan, finding that while many have a basic grasp of the concept, there are notable misconceptions, particularly in differentiating palliative care from hospice care and understanding its broader role. Interestingly, students' knowledge did not significantly improve as they advanced through medical school, suggesting potential shortcomings in the curriculum. The findings highlight the need for more precise education and targeted training to better equip future healthcare providers for delivering patient-centered care.

Certified Child Life Specialists in Hospice and Palliative Care Organizations: A State of the Profession.

Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care. To conduct a needs assessment among CCLS and examine the role in hospice and palliative care. CCLSs were surveyed on their experience and needs in providing care in hospice and palliative care organizations. The online survey contained questions about demographics and work environment. The survey included multiple choice, yes/no, and open-ended questions. Descriptive statistics were generated from the survey items and comments/open-ended questions were coded and assessed for themes. Among the 191 respondents, most were females (96.3%), under 40 years of age (63.8%), Caucasian (87.4%), and non-Hispanic (95.3%) with under 12 years of full-time work experience (57.0%). CCLSs commonly worked in urban/suburban (67.5%) pediatric programs (62.3%) with clients ranging from perinatal (33.5%) to adult caregivers of children (60.2%). Themes from the open-ended questions were: (a) role clarification, (b) staffing, (c) funding, (d) training/education, (e) professionality, and (f) self-care. Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.

Abstract 4147609: Hypoalbuminemia as predictor of poor functional status in hospitalized patients with advanced heart failure

Introduction: Timely involvement of palliative care services for patients with advanced heart failure (HF) improves symptom burden, functional status, and resource utilization. The Karnofsky Performance Scale (KPS) is an objective tool used by palliative care specialists to assess physical ability and guide palliative interventions. Patients with lower KPS have poor outcomes, however evidence linking clinical parameters such as New York Heart Association (NYHA) class, ejection fraction (EF), and albumin with KPS remains limited. Goals: To identify clinical parameters associated with poor functional status in hospitalized patients with advanced HF Methods: Individuals with acute decompensated HF admitted between 2021-2023, ineligible for advanced cardiac therapies, and referred to palliative care were included. Data collected encompassed demographic variables, clinical parameters (NYHA classification, KPS, comorbidities, EF, Brain natriuretic peptide (BNP), albumin, creatinine), and palliative care interventions (family meetings, advanced care planning discussions). Bivariate and multivariate analyses, utilizing Kruskal-Wallis and chi-square tests along with adjusted regression models, were conducted using R to compare characteristics, with a low KPS (≤40) as the primary outcome. Results: A total of 97 individuals were included, with a mean age of 68 ± 17.7 years, 32 (33.0%) were female. Hypoalbuminemia was directly associated with KPS. Patients with albumin levels ≤3 g/dL were more likely to have KPS ≤40 (OR 2.6 [CI 1.03-6.7], p=0.04). NYHA class, EF, serum creatinine, and comorbid conditions (chronic kidney disease, stroke, chronic obstructive pulmonary disease, dementia) were not significantly associated with KPS. Those with lower KPS scores had higher utilization of palliative care services for family meetings, although did not differ significantly in advanced care planning status. Conclusions: In our analysis of hospitalized patients with advanced HF, hypoalbuminemia had the highest predictive value for low functional status. Low KPS score was associated with increased utilization of palliative care services and higher rates of inpatient mortality.

Abstract 4116558: Navigator-driven Recommendations for Palliative Care Consults for Patients with Heart Failure and High Predicted Mortality

Background: Palliative care (PC) engagement can improve quality of life, reduce hospital costs, and enhance symptom control for individuals with heart failure (HF). For certain HF patients, PC can address symptoms and improve quality of life. However, referrals to PC often occur late, delaying benefits. Hypothesis: We hypothesize that a standardized recommendation for inpatient PC consultation will increase PC consultation rates and improve 30-day readmission without an impact on 30-day mortality rates. Methods: This interrupted time series study focused on high-risk HF patients at Atrium Health Wake Forest Baptist. The cohort included patients in the Golden Hearts Program, which is a local program to identify HF patients at elevated risk for 30-day readmissions and to accelerate resources to support their transitions. Baseline data were from patients 5 months before September 1, 2023, and the intervention group were from patients 5 months afterward. A standardized message recommending inpatient PC consultation was sent to attending physicians for patients with ESCAPE scores ≥4. Recommendations were also discussed at multidisciplinary rounds with senior residents. The primary outcomes were inpatient palliative care consultation and discharge to Hospice. Secondary outcomes were 30-day readmissions and 30-day mortality. Outcome measures were assessed post-discharge using Chi-square and T-test analyses. Results: The baseline group had 203 patients; the intervention group had 213. Post-intervention, PC consultation rates decreased from 12.3% to 8% (p=0.19), Discharge to hospice decreased from 2% to 0.9% (p=0.05), 30-day mortality decreased (8.4% vs 7%, p=0.74), and 30-day readmission dropped from 23.6% to 15% (p=0.04). The average length of stay remained 5.7 days in both groups. Limitations included provider buy-in and a limited time period. Conclusion: Though the intervention aimed at targeted PC consult recommendations for advanced HF patients led to reduced 30-day readmissions, there was a not a statistically significant impact on palliative care consultation or mortality.

Abstract 4134569: Palliative care needs assessment by integrated palliative care outcome scale in hospitalized heart failure patients: an observational study

Background and purpose: Patients with heart failure (HF) have a high burden of palliative care needs (PCN) and a worse prognosis that is not lower than cancer. The Integrated Palliative Care Outcome Scale (IPOS) is a scale that evaluates PCN in illness patients, mostly in cancer. Purpose: To evaluate the PCN in hospitalized heart failure patients by IPOS and its relation with patients’ characteristics and mortality. Methodology: A cross-sectional study was conducted on 160 HF hospitalized patients in Vietnam, who were evaluated by IPOS, including questions using a 5-point Likert scale (0 [best]–4 [worst] points) about physical symptoms (10 items), emotional symptoms (4 items), and communication and practical issues (3 items). Patients were determined to have PCN if having ≥ two items with 4 points or ≥ 3 items with ≥ 3 points. Results and discussions: Mean age: 69,57 ± 11,95 years, male: 68.75%, mean LVEF: 44.19 ±16.11%, and NT-proBNP level: 9107.3 ± 30459.1ng/L, the percentage of patients with PCN was 59.38%. The majority of patients had moderate levels (2 points) of dyspnea (38.13%), weakness (35.0%), and low levels (0 or 1 point) of other physical symptoms. Moderate levels (2 points) were the most common in the patient’s anxiety (43.13%) and family anxiety (51.25%), feeling at peace (40.0%), sharing feelings (55.0%), enough information (45.0%), and practical issue (45.0%). Having PCN was significantly correlated to the duration of heart failure, eGFR, and usage of intravenous medication but not related to heart failure severity (NYHA class, LVEF, NT-ProBNP level) and other characteristics (age, gender, residency, educational levels, occupation). Having PCN was independently associated with higher all-cause mortality after discharge with follow-up for one year (P = 0.037). Conclusions: Hospitalized patients with HF had multi-dimensional symptom burdens in moderate levels. PCN was not related to HF severity but correlated to duration of heart failure, eGFR, and usage of intravenous medication. Having PCN was independently associated with mortality after discharge.