Receipt Of Palliative Care Research Articles

Cancer Caregiver Anxiety Over Time: The Influence of Palliative Care.

Objectives: To explore anxiety experienced by caregivers providing home-based, end-of-life care to patients with cancer. We examined the relationship between caregiver anxiety and receipt of palliative care by the patient. Methods: A case series of terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 12 months or until patient death. Data collected included qualitative, quantitative, and observational data; this analysis utilizes the quantitative data. Longitudinal Latent Growth Models were used to characterize the heterogeneity of primary caregiver anxiety over time. The influence of palliative care on caregiver anxiety over time was assessed. Characteristics associated with membership in the trajectory groups rendered from those models are presented. Results: The majority of caregivers were female (73.9%), white (54.9%), and patient spouses (45.3%). Three classes of caregivers were identified based on their anxiety scores over time (low, elevated, and high). The 2 groups who had elevated and high anxiety had significant increases in anxiety over time. Controlling for patient receipt of palliative care attenuated those increases. Caregivers with the lowest level of anxiety were more likely to be Black, report fewer symptoms of depression or caregiver burden and higher self-rated physical health. Caregivers who were younger reported higher anxiety. Conclusions: Our analysis detected 3 distinct cancer caregiver groups reporting low, elevated, and very high levels of anxiety. Caregivers with elevated or high anxiety also demonstrated increasing anxiety overtime; however increases were attenuated with patient receipt of palliative care. For cancer caregivers with elevated and high levels of anxiety, palliative care buffers further deterioration of their mental health.

Impact of nurse-led palliative care on symptom management and life quality outcomes in elderly cancer patients: A retrospective study.

The objective was to explore impacts of nurse-led palliative care interventions on elderly cancer patients in terms of symptom management and life quality outcomes. This retrospective study examined 150 cancer patients from January 2021 to September 2023, divided into 2 groups based on nurse-led palliative care receipt. The observation group (n = 90) received nurse-led palliative care while the control group (n = 60) received routine nursing frequency was 3 times per week for 6 months. The treatment-related symptoms (therapy-related symptoms checklist, TRSC) was used to evaluate the symptom improvement rate of patients, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used to evaluate the improvement of patients' quality of life, and Chinese version of the Brief Pain Inventory (BPI-C) and Chinese version of the Brief Fatigue Inventory (BFI-C) were used to access the improvement of pain and fatigue respectively. Following the intervention, symptom improvement rate in the observation group exhibited markedly superior compared to the control group (100% vs 91.67%, P < .05) and a significant improvement in the patient's health-related quality of life was observed in the observation group at 1, 3, and 5 months postintervention (P < .05). In additional, the observation group displayed notably lower scores on both BPI-C and the BFI-C in contrast to the control group (P < .05). Nurse-led palliative care interventions can effectively improve symptom management and quality of life in elderly cancer patients compared to routine nursing care.

Moderating effects of organizational minority representation on racial and ethnic differences in early palliative care receipt among patients diagnosed with advanced cancers in 2010-2019 in the US.

52 Background: Early palliative care (PC) is recommended for advanced cancers, but differential use has been documented by race and ethnicity. We examined whether racial and ethnic differences in early PC use were moderated by organization-level proportions of minority patients served. Methods: We identified patients aged ≥65.5 years diagnosed with advanced-stage breast, colorectal, non-small cell lung (NSCL), small cell lung (SCL), pancreas, and prostate cancers in 2010-2019 with ≥6 months survival and continuous fee-for-service coverage from the SEER-Medicare data. Early PC was identified by PC encounter diagnosis codes or hospice and palliative medicine (HPM) specialty codes within 90 days post-diagnosis or up to first hospice admission date. Treating physicians and organizations were assigned based on the plurality of visits within 180 days surrounding diagnosis. Using patient race and ethnicity information, organizations were classified based on the percent of racial and ethnic minorities patients (Low&lt;10%, Medium 10-19%, and High Minority-Serving ≥20%). Multivariable logistic models assessed interacting effects of organizations’ minority representation and individual race and ethnicity on early PC receipt, adjusting for patient characteristics. Results: Among 102,060 patients treated at 8,039 organizations, the percent receiving early PC increased from 1.44% in 2010 to 10.30% in 2019. High Minority-Serving organizations were larger size and more likely to employ a HPM specialist and to treat a higher proportion of patients in metropolitan but lower socioeconomic areas, and were dually Medicare-Medicaid eligible. After adjusting for patient characteristics, Hispanic patients were 1.6 percentage points (ppts, 95%CI=-3.1, -0.1) less likely to receive early PC than Non-Hispanic (NH) White patients in Low Minority-Serving organizations. In High Minority-Serving organizations, Hispanic and NH Black patients were 0.8 ppts (95%CI=0.1, 1.6) and 1.6 ppts (95%CI=1.0, 2.3) more likely to receive early PC than NH White patients. (Table). Conclusions: Racial and ethnic minorities were more likely to receive early PC than NH White at High Minority-Serving organizations but not Medium/Low Minority-Serving organizations. System-level factors may be modified to narrow racial and ethnic differences in early PC use. Adjusted difference in early palliative care by race and ethnicity. Organization Minority Representation Individual Adjusted Probability Difference (95% CI) Low NH White Ref Hispanic -1.6 (-3.1, -0.1) NH Black 0.01 (-1.7, 1.7) Other/Unknown 1.1 (-1.2, 3.4) Medium NH White Ref Hispanic -0.6 (-1.7, 0.5) NH Black -0.8 (-1.7, 0.2) Other/Unknown 0.4 (-0.9, 1.7) High Non-Hispanic White Ref Hispanic 0.8 (0.1, 1.6) NH Black 1.6 (1.0, 2.3) Other/Unknown -0.3 (-1.1, 0.4)

Prostate cancer: unmet supportive and palliative care needs: national survey of patients and family carers

ObjectivesMen living with prostate cancer have supportive and palliative needs. However, few studies detail unmet needs (vs quality of life measurement) or include data from those with advanced disease. We...

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. We performed multivariable logistic regressions were performed in this retrospective cohort analysis, using deidentified data from the National Cancer Database (NCDB) of patients diagnosed with AJCC analytic group stage IV breast, lung, or prostate cancer (2004-2018) who were White or of Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. We conducted multivariable logistic regression analyses in a retrospective cohort study using deidentified data from the National Cancer Database (NCDB). The study included patients diagnosed with AJCC analytic group Stage IV breast, lung, or prostate cancer between 2004 and 2018, who were White or identified as Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. Adjusted odds ratios and 95% confidence intervals of receiving palliative care were measured when comparing White vs. AA&NHPI patients as one cohort and White vs. disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. Among 775,289 individuals diagnosed with cancer (median age: 68years), no significant differences in palliative care receipt were observed between White patients and aggregated AA&NHPI patients among patients with prostate, breast, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for breast cancer patients of Asian Indian/Pakistani descent (AOR 0.75, 95% CI, 0.60-0.94, P = 0.011) and for lung cancer patients of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR 0.88, [0.81-0.94], P = 0.001; Vietnamese AOR 0.89, [0.80 to 0.99], P = 0.032; Thai AOR 0.64, [0.44-0.92], P = 0.016; Asian Indian/Pakistani AOR 0.83, [0.74-0.93], P = 0.001). Palliative care was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR 1.92, [1.32-2.75], P = 0.001; Hawaiian AOR 2.09, [1.20-3.66], P = 0.009), breast cancer (Japanese AOR 1.72, [1.21-2.43], P = 0.001; Hawaiian AOR 1.70, [1.08-2.67], P = 0.021), and lung cancer (Japanese AOR 1.92, [1.70-2.17], P < 0.001; Hawaiian AOR 2.95, [2.5-3.5], P < 0.001), as well as patients of Other Pacific Islander descent with lung cancer (AOR 1.62, [1.34-1.96], P < 0.001). Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.

Does a palliative medicine service reduce hospital length of stay and costs in adults with a life-limiting illness?-a difference-in-differences evaluation of service expansion in Ireland.

People approaching end of life account disproportionately for health care costs, and the majority of these costs accrue in hospitals. The economic evidence base to improve value of care to this population is thin. Natural experiment methods may be helpful in bridging evidence gaps with credible causal estimates from routine data, but these methods have seldom been applied in this field. This study aimed to evaluate the association between timely palliative care consultation and length of stay for adults with serious illness admitted to acute hospital in Ireland. In primary analysis we evaluated if timely palliative care receipt following emergency hospital inpatient admission impacted length of stay (LOS); in secondary analysis we verified if palliative medicine service (PMS) implementation co-occurred with any changes in in-hospital mortality, and we estimated cost differences associated with any change in LOS. This was a secondary analysis on routinely collected data for acute admissions to public hospitals in Ireland. We used difference-in-differences analysis to exploit the staggered implementation of PMS teams at acute public hospitals in Ireland between 2010 and 2015. We identified palliative care receipt following PMS implementation using ICD-10 codes, and we matched admissions involving a palliative care interaction to admissions in years prior to PMS implementation using propensity score weights. Our primary analytic sample included 4,314 observations, of whom 608 (14%) received timely palliative care. We estimated that the intervention reduced LOS by nearly two days, with an estimated associated saving per admission of €1,820. These analyses were robust to multiple sensitivity analyses on regression specification, weighting strategy and site selection. Proportion of admissions ending in death did not change following PMS implementation. Prompt interaction between suitable patients and palliative care can improve the quality and efficiency of care to this population. Many patients receive palliative care later in the hospital stay, which does not yield cost-savings. Future studies can extend and strengthen our approach with better data, as well as using different methods to understand how to trigger palliative care early in a hospital admission and realise available gains.

Factors associated with the receipt of palliative care in Native American patients with hepatocellular carcinoma: A retrospective analysis.

e16202 Background: Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related deaths in the United States. This primary liver malignancy often has a poor prognosis and commonly metastasizes to the lungs, lymph nodes, bones, and adrenal glands. HCC has a high burden of disease with many patients suffering from discomfort and pain related to the disease and its treatment. Palliative care is a unique form of specialized care that provides relief, increasing comfort, and quality of life to patients suffering from illness. Many studies note its effectiveness in helping patients at any point in their illness. Furthermore, recent studies have shown that Native Americans face barriers to receiving palliative and end of life care. Thus, this study aims to examine the factors associated with receipt of palliative care within Native American HCC patients. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with Hepatocellular Carcinoma from 2004 to 2019 using the histology code 8170 and race code 03 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 28 and statistical significance was set at α = 0.05. Results: Out of 1536 Native American patients with HCC, 92 (5.9%) received palliative care. Patients who received palliative care experienced shorter mean survival than those who did not receive palliative care (15 vs 42 months; p &lt; 0.001). After controlling for age, year of diagnosis, surgical status and adjuvant therapies, not receiving palliative care was associated with an independent decrease in hazard (HR = 0.625, p &lt; 0.05). Palliative care patients were more likely to present with stage III and IV HCC, experience a longer delay in receiving treatment (69 vs 48 days) and have bone and lung metastasis when compared to those who did not receive palliative care (p &lt; 0.05). Patients who did not receive palliative care were more likely to have Medicare or Medicaid for insurance (p &lt; 0.05). There were no significant differences in the age, income bracket, facility type, tumor size or time to surgery between the patients who received palliative care and those who did not. Conclusions: This study found that patients with HCC are more likely to utilize palliative care if they have severe disease that metastasized to other organ systems. There is a higher mortality among patients who receive palliative care most likely because they had more severe disease. This research demonstrates the common trend of HCC patients underutilizing palliative care in the early stages of disease. Exploring the impacts early palliative care can have on HCC patients’ survival and quality of life would be valuable future areas of research.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Patterns of Palliative Care Consultation in Neurosurgical Patients.

Numerous neurosurgical (NSG) conditions entail high morbidity, mortality, and prolonged ICU stays. Palliative care (PC) serves to alleviate suffering, align treatment with patient preferences, and is linked to enhanced patient and family outcomes as well as reduced care costs. Notably, no studies have addressed demographic and clinical factors associated with PC receipt in NSG patients. Our aim is to identify characteristics and outcomes, particularly end of life outcomes, of hospitalized NSG patients associated with a PC consult compared with usual NSG care. A retrospective chart review was performed of patients admitted to the NSG service from January 1, 2017 to December 31, 2018 at the University of Iowa Hospitals & Clinics. Data regarding demographics, clinical outcomes, and GOC and ACP documentation were collected. The most common reasons for a PC consult were goals of care, end of life issues, and comfort care. Of 121 total decedent patients, 97 (80.2%) had PC referrals. Patients with a PC referral had longer hospital stays (10.3days vs 4days) and had the majority of care in the ICU (90.7% vs 83.3%). However, fewer PC patients died in the ICU (42.3% vs 75%) and more had PCA/NCA use (51.5% vs 8.3%), code status changes to DNR (90.7% vs 62.5%), GOC documented (78.4% vs 0%) and ACP documentation (35.1% vs 16.7%). In conclusion, in NSG patients, the integration of PC may contribute to improved end-of-life care.

Facilitators and Barriers of Palliative Care Receipt from the Perspective of People with Advanced Liver Cancer

Facilitators and Barriers of Palliative Care Receipt from the Perspective of People with Advanced Liver Cancer

Facilitators and Barriers of Palliative Care Receipt from the Perspective of People with Advanced Liver Cancer (GP125)

Facilitators and Barriers of Palliative Care Receipt from the Perspective of People with Advanced Liver Cancer (GP125)

Palliative Care Among Lung Cancer Patients With and Without COPD: A Population-Based Cohort Study.

Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden. We sought to compare the provision of timely palliative care and symptom burden by COPD status. We performed a retrospective, population-based cohort study of individuals diagnosed with lung cancer in Ontario, Canada (2009-2019) using health administrative databases and cancer registries. The impact of COPD on the probability of receiving palliative care was determined accounting for dying as a competing event, overall and stratified by stage. The provision of palliative care for patients with severe symptoms (Edmonton Symptom Assessment Scale score ≥ 7), location of the first palliative care visit and symptom severity were compared by COPD status. A total of 74,993 patients were included in the study (48% of patients had available symptom data). At the time of lung cancer diagnosis, 50% of patients had COPD. Stage I-III patients with COPD were more likely to receive palliative care (adjusted Hazard Ratio (HR)s: 1.05-1.31) with no difference for stage IV (1.02, 95% CI: 1.00-1.04). Despite having severe symptoms, very few patients with early-stage disease received palliative care (Stage I: COPD-23% vs. no COPD-18%, SMD=0.12). Most patients (84%) reported severe symptoms and COPD worsened symptom burden, especially among early-stage patients. COPD impacts the receipt of palliative care and symptom burden for patients with early-stage lung cancer. Many patients with severe symptoms did not receive palliative care, suggesting unmet needs among this vulnerable population.

Geographic accessibility to palliative care physicians and early receipt of palliative care among individuals diagnosed with stage IV cancer in the US.

89 Background: Guidelines recommend early specialty palliative care for patients with advanced cancer, but receipt is low in the US, potentially reflecting inadequate access. This study examines the association of geographic accessibility to palliative care physicians and receipt of palliative care as part of initial treatment among individuals with stage IV cancer in the U.S. Methods: Adults aged ≥18 years newly diagnosed with stage IV cancer between 2018-2019 in the contiguous US were identified from the National Cancer Database (NCDB). Medicare physicians who specialize in Hospice and Palliative Care were identified from the 2018-2019 CMS Medicare Physician and Other Practitioners dataset. We calculated a geographic accessibility score using the two-step floating catchment area (2SFCA) method, based on patients’ residence zip codes and physicians’ zip codes and road network, accounting for physician supply and patient demand. Multivariable logistic regression models examined associations of the geographic accessibility score quartiles and receipt of palliative care (abstracted from patients’ medical records including pain management, surgery, radiation, systemic or other therapy administered to alleviate symptoms). Supplemental analyses were conducted among patients who died within 180 days from diagnosis. Results: We identified and geocoded 333,127 patients with stage IV cancer and 1,063 palliative care physicians. Patients living in nonmetropolitan, socioeconomically deprived areas, living in the Southern US, or being treated at community facilities had lower accessibility to palliative care physicians. In adjusted analysis, patients with higher geographic accessibility to palliative care physicians were more likely to receive palliative care compared with those with lower geographic accessibility, among all and patients died within 180 days from diagnosis (Table). Conclusions: Higher geographic accessibility to palliative care physicians was associated with a greater likelihood of palliative care receipt among patients diagnosed with advanced cancer. Findings support the need for strategies to increase number of palliative care physicians, especially in rural and socioeconomically deprived areas, to enhance the accessibility of guideline-recommended palliative care.[Table: see text]

Association of patient sex with use of palliative care in Ontario, Canada: a population-based study.

It is unclear whether there are sex-based differences in use of palliative care near the end of life. The objective of this study was to measure the association between sex and palliative care use. We performed a population-based retrospective cohort study of all patients aged 18 years or older in the last year of life who died in Ontario, Canada, between 2010 and 2018. The primary exposure was patient biologic sex (male or female). The primary outcome was receipt of physician-delivered palliative care; secondary outcomes were approach to in-hospital palliative care and sex concordance of the patient and referring physician. We used multivariable modified Poisson regression to measure the association between patient sex and palliative care receipt, as well as patient-physician sex concordance. There were 706 722 patients (354 657 females [50.2%], median age 80 yr [interquartile range 69-87 yr]) in the study cohort, 377 498 (53.4%) of whom received physician-delivered palliative care. After adjustment for age and selected comorbidities, female sex was associated with a 9% relative increase (adjusted relative risk [RR] 1.09, 95% CI 1.08-1.10) in receipt of physician-delivered palliative care. Female patients were 16% more likely than male patients (adjusted RR 1.14, 95% CI 1.14-1.18) to have had their first hospital admission in their final year of life categorized as having a likely palliative intent. Female patients were 18% more likely than male patients (RR 1.18, 95% CI 1.17-1.19) to have had a female referring physician, and male patients were 20% more likely than female patients (adjusted RR 1.20, CI 1.19-1.21) to have had a male referring physician. After adjustment for age and comorbidities, male patients were slightly less likely than female patients to have received physician-delivered palliative care, and female patients were more likely than male patients to have had their first hospital admission in their final year of life categorized as having a likely palliative care intent. These results may reflect a between-sex difference in overall end-of-life care preferences or sex differences in decision-making influenced by patient-specific factors; further studies exploring how these factors affect end-of-life decision-making are required.

Timing of receipt of palliative care among participants in early-phase cancer clinical trials.

260 Background: Early phase clinical trials (EP-CTs) investigate novel therapeutics for patients with cancer. EP-CT participants often have advanced stages of disease, have received multiple lines of prior therapies, and remain sufficiently functional to enroll on EP-CTs. Limited research exists to describe the use and timing of palliative care (PC) in EP-CTs. Methods: We conducted a prospective study of patients with cancer enrolled on EP-CTs at Massachusetts General Hospital from April 2021- January 2023. We extracted demographic and clinical characteristics from the electronic health record as well as timing of receipt of PC (before/during EP-CT vs after EP-CT/never) and reason for PC referral documented in the referral. We used patient-reported surveys at time of treatment initiation to assess symptom burden (Edmonton Symptom Assessment System [ESAS]), financial toxicity (Comprehensive Score for Financial Toxicity [COST], lower scores indicate greater toxicity), quality of life (QOL; Functional Assessment of Cancer Therapy-General [FACT-G]), and hope (Herth Hope Index [HHI], higher scores indicate greater hope). We used descriptive statistics to explore associations of timing of receipt of PC with patient characteristics, symptom burden, financial wellbeing, QOL, and hope. Results: Of 221 eligible patients, we enrolled 204 (enrollment rate 92.3%, median age=63.4 years [range 54.8-70.2]; 57.0% female, 94.1% metastatic cancer). Less than one third of patients received PC before/during EP-CT (31.8% before/during, 68.2% post/never). Reasons for referral include: symptom management (84.4%), coping (12.5%), advance care planning (7.8%), illness understanding (1.6%), and treatment decision-making (1.6%). Patients age &lt;65 were more likely than those 65+ to receive PC before/during EP-CT (39.1% vs 22.1%, p=0.01). Patients with ECOG=1 were more likely than those with ECOG=0 to receive PC before/during EP-CT enrollment than post enrollment/never (37.9% vs 22.9%, p=0.01). Patients who received PC before/during EP-CT had a higher symptom burden (ESAS: 20.7 vs 15.5, p=0.01), lower QOL (70.9 vs 77.0, p=0.003), and worse financial toxicity (25.2 vs 29.4, p=0.003). We found no significant differences in hope scores based on timing of receipt of PC (27.6 vs 27.1, p=0.53). Conclusions: In this prospective cohort of EP-CT participants with cancer,less than one third received PC before/during EP-CT enrollment. Symptom management was the most common reason for referral to PC, which aligns with our patient-reported survey data. Characteristics associated with receiving PC before/during trial participation include age, decreased performance status, higher symptom burden, lower QOL, and increased financial toxicity. These findings suggest that earlier PC was appropriately delivered to those most in need yet highlight the importance of efforts to ensure earlier integration of PC in this population.

Palliative Care as a Component of High Value and Cost-Saving Care During Hospitalization for Metastatic Cancer

Randomized controlled trials have demonstrated that palliative care can improve both quality of life and survival for outpatients with advanced cancer, but there is limited population-based data on the value of inpatient palliative care. We assessed palliative care as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer. We further identified care, patient, and hospital characteristics significantly associated with high costs. This study analyzed hospitalizations of patients ≥18 years with a primary diagnosis of metastatic cancer from the National Inpatient Sample (covering 97% of the U.S. population) from 2010-2019. We utilized multivariable mixed-effects logistic regression to assess medical services (receipt of palliative care, invasive medical ventilation [IMV], systemic therapy), patient demographics, and hospital characteristics that were associated with high charges billed to insurance and hospital costs. We utilized generalized linear mixed-effects models to determine cost savings associated with provision of palliative care. Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in 2010 to $56,098 in 2019, while the median cost remained stable at $14,300. Receipt of inpatient palliative care was associated with significantly lower charges (Odds Ratio [OR], 0.62; 95% CI, 0.61-0.64; P <.001) and costs (OR, 0.59; 95% CI, 0.58-0.61; P<.001). Factors associated with high charges were receipt of invasive medical ventilation (P<.001) or systemic therapy (P<.001), Hispanic patients (P<.001), and young age (18-49 years, P<.001). For-profit hospitals were more likely to bill high charges (OR, 5.05; 95% CI, 4.78-5.33, P<.001) but less likely to incur high hospital costs (OR, 0.51; 95% CI, 0.48-0.54, P<.001) than public hospitals. In adjusted generalized linear mixed effects regression, palliative care provision was associated with a $1,293 (-13.4%, P<.001) reduction in costs per hospitalization compared to no palliative care, independent of receipt of invasive care and age. Significant interactions were observed between receipt of palliative care and patient age group (-9.6% for 18-49 years; -14.7% for ≥70 years), receipt of IMV (-6.4% for IMV receipt; -14.0% for no IMV), hospital ownership (-19.6% for for-profit; -10.5% for public), and year of hospitalization (-15.4% for 2010; -8.9% for 2019). Inpatient palliative care is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Assuming inpatient palliative care receipt increases by 50%, we estimate $4,045,000 in annual national savings. Integration of inpatient palliative care may de-escalate costs incurred through low-value inpatient interventions.

Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC): a study protocol for a hybrid type 1 randomized controlled trial

BackgroundThere are persistent racial and ethnic health disparities in end-of-life health outcomes in the United States. African American patients are less likely than White patients to access palliative care, enroll in hospice care, have documented goals of care discussions with their healthcare providers, receive adequate symptom control, or die at home. We developed Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC) to address these disparities. DeCIDE PC is an integrated community health worker (CHW) palliative care intervention that uses community health workers (CHWs) as care team members to enhance the receipt of palliative care for African Americans with advanced cancer. The overall objectives of this study are to (1) assess the effectiveness of the DeCIDE PC intervention in improving palliative care outcomes amongst African American patients with advanced solid organ malignancy and their informal caregivers, and (2) develop generalizable knowledge on how contextual factors influence implementation to facilitate dissemination, uptake, and sustainability of the intervention.MethodsWe will conduct a multicenter, randomized, assessor-blind, parallel-group, pragmatic, hybrid type 1 effectiveness-implementation trial at three cancer centers across the United States. The DeCIDE PC intervention will be delivered over 6 months with CHW support tailored to the individual needs of the patient and caregiver. The primary outcome will be advance care planning. The treatment effect will be modeled using logistic regression. The secondary outcomes are quality of life, quality of communication, hospice care utilization, and patient symptoms.DiscussionWe expect the DeCIDE PC intervention to improve integration of palliative care, reduce multilevel barriers to care, enhance clinic and patient linkage to resources, and ultimately improve palliative care outcomes for African American patients with advanced cancer. If found to be effective, the DeCIDE PC intervention may be a transformative model with the potential to guide large-scale adoption of promising strategies to improve palliative care use and decrease disparities in end-of-life care for African American patients with advanced cancer in the United States.Trial registrationRegistered on ClinicalTrials.gov (NCT05407844). First posted on June 7, 2022.

The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study.

Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths. A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, p < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, p < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, p < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, p < 0.001) but had more unplanned ER visits (50% vs. 35%, p < 0.001), and died more often in acute hospital settings (22% vs. 15%, p < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71-1.92), p < 0.001) and hospital deaths (OR 1.66 (1.51-1.81), p < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC. Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making.

"It doesn't really apply to what I'm going through": a mixed-methods study of barriers to palliative care among patients with advanced ovarian cancer.

Palliative care aims to provide symptom relief and general support for patients with serious illness. Despite experiencing significant treatment side effects, specialty palliative care is under-utilized by patients with advanced ovarian cancer. We explored barriers to palliative care in this population. We conducted a sequential mixed-methods study. Qualitative: we interviewed patients with advanced ovarian cancer (N = 7). Guided by the Social Ecological Model (SEM), interviews assessed intrapersonal, interpersonal, organizational, and policy-level barriers to receipt of specialty palliative care. Interviews were audio-recorded, transcribed, and analyzed with directed content analysis. Quantitative: patients with advanced ovarian cancer (N = 38) completed self-report surveys assessing knowledge about, attitudes towards, and prior experiences with specialty palliative care. Descriptive statistics were used to characterize survey responses. Qualitative analysis identified barriers to specialty palliative care at each SEM level. Intrapersonal factors (e.g., knowledge, attitudes) were most frequently discussed. Other common barriers included insurance coverage and distance/travel time. Survey responses indicated most participants were aware of palliative care (74%) but had mixed attitudes towards palliative care and did not feel they needed for palliative care. No survey respondents had received a physician recommendation for palliative care, and a sizable minority (29%) thought palliative care referral should only take place when patients have no remaining treatment options. Among patients with advanced ovarian cancer, barriers to specialty palliative care exist at multiple levels. Our results underscore the potential value of a multilevel intervention to support receipt of palliative care in this population.

Palliative care as a component of high-value and cost-saving care during hospitalization for metastatic cancer.

6640 Background: Randomized controlled trials have demonstrated that palliative care can improve both quality of life and survival for outpatients with advanced cancer, but there is limited population-based data on the value of inpatient palliative care. We assessed palliative care as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer. We further identified care, patient, and hospital characteristics significantly associated with high costs. Methods: This study analyzed hospitalizations of patients ≥18 years with a primary diagnosis of metastatic cancer from the National Inpatient Sample (covering 97% of the U.S. population) from 2010-2019. We utilized multivariable mixed-effects logistic regression to assess medical services (receipt of palliative care, invasive medical ventilation [IMV], systemic therapy), patient demographics, and hospital characteristics that were associated with higher charges billed to insurance and hospital costs. We utilized generalized linear mixed-effects models to determine cost savings associated with provision of palliative care. Results: Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in 2010 to $56,098 in 2019, while the median hospital cost remained stable at $14,300. Receipt of inpatient palliative care was associated with significantly lower charges (Odds Ratio [OR], 0.62; 95% CI, 0.61-0.64; P &lt; .001) and costs (OR, 0.59; 95%CI, 0.58-0.61; P &lt; .001). Factors associated with high charges were receipt of invasive medical ventilation (P &lt; .001) or systemic therapy (P &lt; .001), Hispanic patients (P &lt; .001), and young age (18-49 years, P &lt; .001). For-profit hospitals were more likely to bill higher charges (OR, 5.05; 95%CI, 4.78-5.33, P &lt; .001) but less likely to incur high hospital costs (OR, 0.51; 95%CI, 0.48-0.54, P &lt; .001) than public hospitals. In adjusted generalized linear mixed effects regression, palliative care provision was associated with a $1,293 (-13.4%, P &lt; .001) reduction in costs per hospitalization compared to no palliative care, independent of receipt of invasive care and age. Significant interactions were observed between receipt of palliative care and patient age group (-9.6% for 18-49 years; -14.7% for ≥70 years), receipt of IMV (-6.4% for IMV receipt; -14.0% for no IMV), hospital ownership (-19.6% for for-profit; -10.5% for public), and year of hospitalization (-15.4% for 2010; -8.9% for 2019). Conclusions: Inpatient palliative care is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Assuming inpatient palliative care receipt increases by 50%, we estimate $4,045,000 in annual national savings. Integration of inpatient palliative care may de-escalate costs incurred through low-value inpatient interventions.