Utilization Of Palliative Care Services Research Articles

Palliative care service utilization and associated factors among cancer patients at oncology units of public hospitals in Addis Ababa, Ethiopia.

Palliative care helps patients and their families deal with the hardships that come with a life-threatening illness. However, patients were not fully utilizing the palliative care services provided by healthcare facilities for a number of reasons. In Ethiopia, there hasn't been any research done on the variables that influence the utilization of palliative care services. To assess palliative care service utilization & associated factors affecting cancer patients at public hospitals oncology units in Addis Ababa, Ethiopia. An institution-based cross-sectional study design was carried out. A structured and pre-tested questionnaire was administered to 404 participants at Tikur Anbesa Specialized Hospital and Saint Paul's Hospital Millennium Medical College from July 4 to August 2, 2022. A systematic random sampling technique was used to select the study participants. The data was collected by ODK-Collect version 3.5 software and exported to excel and then to SPSS version 25 for recoding, cleaning, and analysis. Logistic regression model was employed. P-values <0.05 were regarded as statistically significant. About 404 participants' responded questionnaire giving a 97.6% response rate. The extent of Palliative care service utilization was 35.4% [95% CI: 31.4, 40.3%]. College or university education were 2.3 times more likely and living in a distance of <23 km from PC service centers were 1.8 times more likely to use palliative care services. Factors hindering palliative care service utilization were inability to read & write, treatment side effects, long distance to a health institution, and low satisfaction with the health care service. The extent of palliative care service utilization which was low. Factors to palliative care service utilization were clients' education level, treatment side effects, distance to a health institution, and patients' satisfaction. Interventions to enhance health education and counseling of cancer patients, early detection and management of treatment side effects and accessibility of palliative care services for cancer patients should be emphasized and implemented by all concerned stakeholders.

Avoidable emergency department visits among palliative care cancer patients: novel insights from Saudi Arabia and the Middle East

BackgroundSeveral studies emerging from developed countries have highlighted a significant number of potentially avoidable emergency department (ED) visits by cancer patients during the end-of-life period. However, there is a paucity of information from developing nations regarding palliative care practices and the utilization of the ED by palliative care patients. Herein, we aim to characterize ED admissions among patients receiving palliative care at our tertiary center in Saudi Arabia.MethodsThis is a retrospective, cross-sectional study evaluating ED visits amongst adult patients with advanced cancer who were receiving treatment under the palliative care department. This study took place over a period of 12 months from July 2021 through to July 2022. Three palliative care specialist physicians independently and blindly reviewed each patient’s ED visits and determined whether the visit was avoidable or unavoidable.ResultsA total of 243 patients were included in the final analysis, of which 189 (78.1%) patients had unavoidable visits and 53 (21.9%) patient visits were classified as avoidable. A significantly higher proportion of breast cancer patients presented with unavoidable admissions (14.3% vs. 3.8%, P = 0.037) compared to other cancer types. The incidence of dyspnea (23.8% vs. 5.7%, P < 0.001) and fevers/chills (23.3% vs. 5.7%, P = 0.005) was significantly higher in patients with unavoidable visits. Patients with avoidable visits had a significantly greater proportion of visits for dehydration (13.2% vs. 2.1%, P = 0.002). Notably, although hospital stay was significantly longer in the unavoidable group (P = 0.045), mortality for palliative care patients—regardless of whether their ED visit was avoidable or unavoidable—was not statistically different (P=-0.069).ConclusionTo our knowledge, this is the largest and most comprehensive study from Saudi Arabia and the Middle East providing insights into the utilization of palliative care services in the region and the propensity of advanced cancer patients towards visiting the ED. Future studies ought to explore interventions to reduce the frequency of avoidable ED visits.

Rural-urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer.

To assess trends and rural-urban disparities in palliative care utilization among patients with metastatic breast cancer. We analyzed data from the 2004-2019 National Cancer Database. Palliative care services, including surgery, radiotherapy, systemic therapy, and/or other pain management, were provided to control pain or alleviate symptoms; utilization was dichotomized as "yes/no." Rural-urban residence, defined by the US Department of Agriculture Economic Research Service's Rural-Urban Continuum Codes, was categorized as "rural/urban/metropolitan." Multivariable logistic regression was used to examine rural-urban differences in palliative care use. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. Of 133,500 patients (mean age 62.4 [SD=14.2] years), 86.7%, 11.7%, and 1.6% resided in metropolitan, urban, and rural areas, respectively; 72.5% were White, 17.0% Black, 5.8% Hispanic, and 2.7% Asian. Overall, 20.3% used palliative care, with a significant increase from 15.6% in 2004-2005 to 24.5% in 2008-2019 (7.0% increase per year; p-value for trend <0.001). In urban areas, 23.3% received palliative care, compared to 21.0% in rural and 19.9% in metropolitan areas (p<0.001). After covariate adjustment, patients residing in rural (AOR=0.84; 95% CI: 0.73-0.98) or metropolitan (AOR=0.85, 95% CI: 0.80-0.89) areas had lower odds of having used palliative care than those in urban areas. In this national, racially diverse sample of patients with metastatic breast cancer, the utilization of palliative care services increased over time, though remained suboptimal. Further, our findings highlight rural-urban disparities in palliative care use and suggest the potential need to promote these services while addressing geographic access inequities for this patient population.

Trends in Specialty Palliative Care Service Utilization and In-Hospital Outcomes for Patients With Amyotrophic Lateral Sclerosis.

Background: Hospitalized people with amyotrophic lateral sclerosis (ALS) may benefit from specialty palliative care services (sPCS). Objective: To describe access to in-hospital sPCS for people with ALS (pALS). Methods: We compared years 2010-2011 to 2018-2019, and conducted trend analyses of sPCS from 2010 to 2019 stratified by race. Results: Of 103,193 pALS admitted during the study period, 13,885 (13.4%) received sPCS. Rates of sPCS increased over time (2010-2011: 8.9% vs. 2018-2019: 16.6%; p < 0.01). From 2010 to 2019, there was an increase in sPCS (p-trend<0.01) for all studied racial groups. Conclusions: Access to palliative care has increased over time for pALS admitted to hospitals in the United States.

Factors affecting need and utilization of palliative care services among Ethiopian women in an oncology department: A hospital-based cross-sectional study.

Palliative care, which aims to alleviate physical and emotional distress from cancer, is underutilized in many African healthcare systems. Therefore, there is a lack of data on the need and utilization of palliative care services among women with breast cancer in Ethiopia. The goal of this study was to identify the level of need and utilization of palliative care services and identify associated factors among women in an oncology department of Hawassa comprehensive and specialized hospitals. Hospital-based cross-sectional study. A total of 121 women age ⩾18 years old with breast cancer participated from 1 August to 30 October 2021. A hospital-based consecutive sampling technique was used. Data regarding the need and utilization of palliative care services were collected via questionnaire and interview, entered using EpiData 4.6.0.6, and analyzed by SPSS version 25. Variables with p < 0.25 were considered for multivariate analysis, and those with p < 0.05 indicate an association with palliative care utilization. Seventy-two (59.5%) had worse utilization of palliative care services, with higher odds in rural areas (adjusted odds ratio = 11.82). The study findings indicated that more than half of the study participants had worse utilization of palliative care services, with rural living being a contributing factor.

Trends in utilisation of palliative care services in COVID-19 patients and their impact on hospital resources in the USA: insights from the national inpatient sample

ObjectivesPoor prognosis and lack of effective therapeutic options have made palliative care an integral part of the management of severe COVID-19. However, clinical studies on the role of palliative care...

Abstract 13526: Palliative Care Service Utilization in End-Stage Heart Failure: A Propensity Matched Nationwide Analysis

Background: Palliative care services (PCS) is crucial in the care of end-stage heart failure (ESHF) patients. However, there is limited data on the utilization rates and the predictors PCS in ESHF patients. Research question: What is the frequency of PCS utilization, and what are the predictors of PCS use in ESHF patients? Methods: ESHF admissions were identified from the National Inpatient Sample database from 2018 – 2020. The identified admissions were stratified based on the use of PCS. The primary outcomes were the rate of utilization, and the predictors of PCS use in ESHF patients. Multivariate logistic regression and propensity matching were used to adjust for confounders. Results: In total, 147,140 ESHF admissions were identified, of which only 6.2% (9170) had PCS use. Patients with PCS were older(71.66 years vs 63.78 years; p&lt;0.001), and were less likely to be of African American race (13.7% vs 17%; p&lt;0.001). They were more likely to have a do-not-resuscitate (DNR) status (66.1% vs 10.2%; p&lt;0.001), be frail (42.4% vs 18.3%), and have had a cardiac arrest event(2.5% vs 0.8%;p&lt;0.001). The major predictors of PCS use were DNR status (adjusted odds ratio[aOR]:13.38, 95%CI: 11.73 – 15.27; p&lt;0.001), cardiogenic shock (aOR: 3.54, 95%CI: 3.02 – 4.15; p&lt;0.001), cardiac arrest during the current admission (aOR: 1.57, 95%CI: 1.01 – 2.44; p&lt;0.001), &amp; urban teaching hospital status (aOR: 1.69, 95%CI: 1.36 – 2.09; p&lt;0.001) Fig 1 . A matched pair of 8255 patients were identified in both groups. The ESHF patients with PCS had a higher in-hospital mortality (aOR: 3.30; 95%CI: 2.73 – 3.99; p&lt;0.001), and were less likely to receive a heart transplant (aOR: 0.25; 95%CI: 0.12 – 0.50; p&lt;0.001) Tab 1. Conclusion: Palliative care services are significant underutilized in the United States. DNR status, cardiogenic shock, respiratory failure, cardiac arrest, and admission to an urban teaching hospital were the major predictors of PCS use in ESHF.

Survey of NCI-designated cancer centers on the utilization of palliative care in patients with pancreatic cancer.

248 Background: Pancreatic cancer, known as one of the deadliest cancers, has a high demand for palliative care. However, there remains a considerable amount of uncertainty regarding the nature of palliative care treatment to this specific patient demographic across the United States. This study aims to assess the utilization of palliative care in pancreatic cancer patients and explore the variations in timing and emphasis of palliative care involvement. Methods: We conducted a survey assessing utilization of palliative care in pancreatic cancer patients. We targeted palliative care directors at all 65 National Cancer Institute (NCI) cancer centers. The physicians were invited to voluntarily participate in the study. Responses were collected by email between May 30, 2023, and June 22, 2023. 1) Does your palliative care and/or oncology team have a policy to get involved with every pancreatic cancer patient (yes or no)? 2) When palliative care is involved with pancreatic cancer patients, in what setting are you typically/primarily first asked to be involved (early in the patient’s treatment journey, focusing more to assist with symptom management, or later in the patient’s treatment journey, focusing more on end-of-life discussions such as explaining hospice)? Results: We received responses from palliative care leaders at 65 NCI-designated palliative care centers, and thus 100% of the targeted population sample. Out of these centers, 64 indicated that there was no established policy for palliative care involvement with every pancreatic cancer patient. Among the respondents, 38 centers started intervention early, primarily focusing on symptom management, while 15 centers started palliative care late in the treatment process, with a focus on end-of-life discussions. Additionally, 12 centers reported that they first intervene both early and late when treating pancreatic cancer. Conclusions: The utilization of palliative care services improves various outcome measures. Pancreatic cancer has one of the lowest survival rates and is associated with significant morbidity. Our findings suggest an increasing recognition among medical centers of the need for palliative care services for pancreatic cancer patients. However, there is variation in the timing and emphasis of palliative care involvement, suggesting a need for further exploration in this area. Notably, there is a growing trend to integrate palliative care at an early stage. Future research should explore barriers to accessing palliative care, distinguish between inpatient and outpatient services, and compare outcomes of early versus late palliative care intervention. By addressing these areas, healthcare providers can enhance the quality of care and improve outcomes for pancreatic cancer patients.

Assessing the utilization of palliative care services in the management of patients with metastatic pancreatic adenocarcinoma.

256 Background: Pancreatic Cancer is known to be associated with poor survival outcomes and high symptom burden. Integration of early palliative care has been associated with improved end of life care, including reduced hospitalizations and emergency room visits. We conducted a retrospective study to determine the utilization rates of specialist palliative care in patients diagnosed with metastatic pancreatic cancer at an academic teaching hospital and summarize the impact on end-of-life care. Methods: A database of patients diagnosed with metastatic pancreatic cancer on index presentation from 2011 and 2022 was analyzed for utilization of specialist palliative care. Patients who transitioned cancer care to other centers and those who were lost to follow-up were excluded. Data on patient demographics, treatment course, and end-of-life care were collected, and descriptive statistics were used to summarize the data. Results: In our study, 168 patients met the inclusion criteria. The average age of diagnosis was 66 years with a diverse ethnic composition, including White (35.7%), African American (26.8%), and Hispanic (15.5%) patients. Among the cohort, 126 out of 168 (75%) patients were seen by palliative care at least once, with 79 (62.7%) of them initially seen during one of the hospitalizations, and 47 (37.3%) were seen by palliative care outpatient for the first time. The median duration between pancreatic cancer diagnosis and first encounter with palliative care was 145 days (IQR 305 days). No significant differences were found in terms of age, race, sex, ethnicity or insurance type between patients who received palliative care and those who did not. The median time from consultation to death was 57 days and 36.5% patients received palliative care only within one month of their death. Patients who received palliative care were more likely to have a DNR/DNI code status (86.7% vs. 13.3%, p &lt; 0.001) and were more likely to be enrolled in hospice care (86.3% vs. 13.7%, p &lt; 0.001). Conclusions: Early involvement of specialist palliative care in management of patients with metastatic pancreatic cancer may lead to optimization of health care services with earlier hospice referrals and comfort directed care at the end of life. Further research is warranted to explore the impact of palliative care on patient outcomes, quality of life, and the potential benefits of aligning treatment decisions with patients' end-of-life preferences.

Factors Influencing Progressive Utilization of Palliative Care Services among Cancer Patients in Kenya: The Case of Nairobi Hospice.

The rising cases of non-communicable diseases, specifically cancer, have led to the integration of palliative care in their management. However, only 10% of cancer patients have access to palliative care. Healthcare utilization is an important step in disease management as it aids individuals in accessing opportunities for the prevention and treatment of diseases. The study applied the binary probit model to estimate the progressive utilization of palliative care services by cancer patients. The aim of the study was to determine factors influencing the progressive utilization of palliative care by cancer patients. A cross-sectional data survey was conducted for 169 cancer patients seeking palliative care at the Nairobi Hospice in 2013. For each patient, the predisposing, enabling, and need (PEN) factors were analyzed as key criteria for applying progressive utilization of palliative care at the Nairobi Hospice as compared to those residing in other counties in the study. Descriptive statistics showed that 27% of patients studied resided in Nairobi County, where 61% were female, 62% were married, 35% had primary education, 44% were self-employed, and 59% had medical insurance. Probit regression and marginal effects showed that employment and religion were significant in determining the progressive utilization of palliative care. Employment status and religion are consequently the main factors that both governments and health-focused non-governmental organizations need to consider increasing the probability of progressively utilizing palliative care to improve the quality of life of cancer patients.

End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review.

Towards the end of life (EOL), persons with parkinsonism (PwP) have complex needs and can present with unique palliative care (PC) challenges. There are no widely accepted guidelines to aid neurologists, hospitalists, or PC clinicians in managing the symptoms of PwP at EOL. We examined a population of PwP at EOL, aiming to describe trends of in-hospital management and utilization of PC services. All PwP admitted to two hospitals during 2018 (N = 727) were examined retrospectively, assessing those who died in hospital or were discharged with hospice (EOL group, N = 35) and comparing them to the main cohort. Their demographics, clinical data, engagement of multidisciplinary and palliative services, code status changes, invasive care, frequency of admissions, and medication administration were assessed. Among the EOL group, 8 expired in hospital, and 27 were discharged to hospice. Forty-six percent of EOL patients received a PC consultation during their admission. The median interval from admission to death was 37 days. Seventy-seven percent had a full code status on admission. Compared to hospice patients, those who expired in hospital had higher rates of invasive procedures and intensive care unit transfers (41% vs. 75%, in both variables), and lower rates of PC involvement (52% vs. 25%). The transition of code status change for the EOL group from Full code to Do Not Resuscitate (DNR) occurred at a median 4-5 days from admission. For patients that passed in the hospital, the median days from transition of code status to death was 0(IQR 0-1). Levodopa dose deviations were frequent in both EOL and non-EOL group, but contraindicated medications were infrequently administered (11% in EOL group vs. 9% in non-EOL group). Our data suggest a low utilization of PC services and delayed discussions of goals of care. More work is needed to raise awareness of inpatient teams managing PwP regarding the unique but common challenges facing PwP with advanced disease. A brief narrative review summarizing the suggested management of symptoms common to hospitalized PwP near EOL is provided.

Factors associated with utilization of palliative care among hospitalized patients with cholangiocarcinoma.

e24159 Background: Cholangiocarcinoma has a rising incidence and a low 5-year survival rate. Patients with this malignancy have a very high symptom burden, however, there are only a few studies reported on the prevalence of palliative care utilization in this population. This study examines the prevalence, sociodemographic, hospital-level, and patient-related factors associated with the utilization of palliative care among hospitalized patients with cholangiocarcinoma in the United States. Methods: Data from the National Inpatient Sample, 2016–2020, were used to conduct retrospective cohort analyses. Descriptive analyses were performed to evaluate the prevalence of palliative care consultations among hospitalized patients with a diagnosis of cholangiocarcinoma. Multivariable logistic regression models were used to examine the factors associated with the receipt of palliative care in this population. Results: Approximately 17.9% of our cohort received palliative care during their hospital stay. Cholangiocarcinoma patients aged 65 years and older were more likely to receive palliative care (AOR: 1.19; 95% CI: 1.06–1.32) compared to those less than 65 years. Female patients had 10% higher odds (95% CI: 1.02–1.18) of palliative care utilization relative to their male counterparts. Compared to patients on Medicare, those with Medicaid (AOR: 1.50; 95% CI: 1.29–1.75), private (AOR: 1.27; 95% CI: 1.13–1.42) or other insurance types (AOR: 2.31; 95% CI: 1.95–2.75) were more likely to receive palliative care during their hospital stay. While patients who had elective admissions were less likely (AOR: 0.45; 95% CI: 0.40–0.51) to utilize palliative care relative to those admitted non-electively, those admitted to urban teaching hospitals had 25% higher odds (AOR: 1.29; 95% CI: 1.06–1.57) of palliative care utilization when compared to patients admitted to rural hospitals. Additionally, hospitalized patients with a diagnosis of intrahepatic cholangiocarcinoma had 1.39 times higher odds (95% CI: 1.25–1.55) of receiving palliative care when compared to patients diagnosed with extrahepatic cholangiocarcinoma. Other factors associated with palliative care utilization were hospital region, Charlson comorbidity index and patient disposition. Conclusions: Palliative care consultations among hospitalized patients diagnosed with cholangiocarcinoma remain suboptimal. Our study highlights some of the sociodemographic and hospital-level barriers to the utilization of palliative care services which should guide healthcare providers on areas to improve upon with the goal of improving access to palliative care among hospitalized patients with cholangiocarcinoma.

Utilization of palliative care and its associated factors among adult cancer patients in Hawassa University Comprehensive Specialized Hospital Oncology Center, Hawassa, Ethiopia, 2021: a cross-sectional study

Objective To assess the utilization of palliative care(PC) and its associated factors among adult cancer patients in Hawassa University Comprehensive Specialized Hospital (HUCSH) oncology center, Hawassa, Ethiopia, 2021. Methods An institution-based cross-sectional study was conducted among adult cancer patients. A randomly selected adult cancer patients (≥ 18 years of age) attending their treatment at HUCSH oncology center PC unit were included. Data was collected from June to August, 2021. It was aimed to interview 185 patients. A structured questionnaire was used to collect the data. Data entry was done using Epi-Data version 4.6 and bivariate and multivariate logistic regression models were used in SPSS for analysis. Result Out of 180 study respondents, 66% of participants were aged 50 years or older. Sixty-three percent were characterized to have a better utilization of PC services. Patients aged below 50 years (adjusted odds radio (AOR): 2.7; 95%-CI (1.13-6.63)), higher educational status (grade 9 to 12 or college/university graduation (AOR: 1.46; 95%-CI (0.41-5.21)) and AOR: 3.23; 95%-CI 0.98-10.61)) respectively, higher income >5500 Birr (AOR: 2.7; 95%-CI (0.51-5.76)), and good accessibility of PC services (AOR: 2.99; 95%-CI (1.21-3.28)) were significantly associated with better utilization of PC services. Conclusion The current study revealed two thirds of patients had better utilization of PC services. Older patients with low educational status and income, and those living in rural areas had worse access to PC services. It is recommended to improve information provision about PC especially for older patients and patients with low education and to improve accessibility for patients in suburban and rural areas.

Utilization of Palliative Care Services Among Patients With Malignant Brain Tumors: An Analysis of the National Inpatient Sample (2016-2019).

Recent advances in treatment of malignant brain tumors have improved outcomes. However, patients continue to experience significant disability. Palliative care helps patients with advanced illnesses improve their quality of life. There is a paucity of clinical studies examining palliative care usage among patients with malignant brain tumors. To assess if there were any patterns in palliative care utilization among patients hospitalized with malignant brain tumors. A retrospective cohort representing hospitalizations for malignant brain tumors was created from The National Inpatient Sample (2016-2019). Palliative care utilization was identified by ICD-10 code. Univariable and multivariable logistic regression models, accounting for the sample design, were built to evaluate the demographic variables associated with palliative care consultation in all patients and fatal hospitalizations. 375 010 patients admitted with a malignant brain tumor were included in this study. Over the whole cohort, 15.0% of patients used palliative care. In fatal hospitalizations, Black and Hispanic patients had 28% lower odds of receiving a palliative care consultation compared with White patients (odds ratio for both = 0.72; P = .02). For fatal hospitalizations, patients insured privately were 34% more likely to use palliative care services compared with patients insured with Medicare (odds ratio = 1.34, P = .006). Palliative care is underutilized among all patients with malignant brain tumors. Within this population, disparities in utilization are exacerbated by sociodemographic factors. Prospective studies investigating utilization disparities across race and insurance status are necessary to improve access to palliative care services for this population.

Palliative and End-of-Life Care Access for Immigrants Living in High-income Countries: A Scoping Review.

This scoping review aimed to explore what is known about palliative and End-of-Life (EOL) care access by immigrants with culturally and linguistically diverse (CALD) background living in high-income Organization for Economic Co-operation and Development (OECD) countries. CaLD immigrants have low utilization of palliative care services with patients' family members taking up the role of caring, leading to immigrants not fully benefiting from the specialized services that are offered to alleviate suffering and promote quality of life. While there is some research in this area mainly in Europe, it cannot be said about all high-income OECD countries. Achieving person-centered care in high-income countries, requires identifying and addressing barriers to care access, especially by immigrants with CaLD background. Five-stage methodological framework by Arksey and O'Malley was used to undertake the review. Immigrants in OECD countries experience challenges in accessing palliative and EOL care services. The review also identified limited literature on the subject and establishes need for more research on the subject.

Why the Individual Provider Approach to Pediatric Palliative Care Consultation Exacerbates Healthcare Disparities: A Moral Argument for Standard Referral Criteria

Pediatric palliative care is specialized medical care for children who live with serious and life-limiting illnesses, with the central goal to improve quality of life for both children and their families. Presently, a majority of pediatric palliative care referrals are based on the traditional consultative model, in which primary providers serve as the gatekeepers to palliative care access. It is well-known that racial and ethnic healthcare disparities exist across the continuum of care, fraught with healthcare providers' biases that impact the care delivered. This includes the referral practices, allocation and utilization of palliative care services, and leaving vulnerable children and families with potentially unmet palliative care needs. We make the moral argument that the establishment of standard referral criteria for pediatric palliative care services is one simple step that must be taken to begin to address and hopefully ameliorate the impact of providers' biases and disparities that exist within pediatric palliative care.

Palliative Care Utilization Among Hospitalized Patients With Common Chronic Conditions in the United States.

Objective: Limited data exist around the receipt of palliative care (PC) in patients hospitalized with common chronic conditions. We studied the independent predictors, temporal trends in rates of PC utilization in patients hospitalized with acute exacerbation of common chronic diseases. Methods: Population-based cohort study of all hospitalizations with an acute exacerbation of heart disease (HD), cerebrovascular accident (CVA), cancer (CA), and chronic lower respiratory disease (CLRD). Patients aged ≥18 years or older between January 1, 2004, and December 31, 2017, referred for inpatient PC were extracted from the National Inpatient Sample. Poisson regression analyses were used to estimate temporal trends. Results: Between 2004 and 2017, of 91,877,531 hospitalizations, 55.2%, 13.9%, 17.2%, and 13.8% hospitalizations were related to HD, CVA, CA, and CLRD, respectively. There was a temporal increase in the uptake of PC across all disease groups. Age-adjusted estimated rates of PC per 100,000 hospitalizations/year were highest for CA (2308 (95% CI 2249-2366) to 10,794 (95% CI 10,652-10,936)), whereas the CLRD cohort had the lowest rates of PC referrals (255 (95% CI 231-278) to 1882 (95% CI 1821-1943)) between 2004 and 2017, respectively. In the subgroup analysis of patients who died during hospitalization, the CVA group had the highest uptake of PC per 100,000 hospitalizations/year (4979 (95% CI 4918-5040)) followed by CA (4241 (95% CI 4189-4292)), HD (3250 (95% CI 3211-3289)) and CLRD (3248 (95% CI 3162-3405)). Conclusion: PC service utilization is increasing but remains disparate, particularly in patients that die during hospital admission from common chronic conditions. These findings highlight the need to develop a multidisciplinary, patient-centered approach to improve access to PC services in these patients.

The Landscape of Outpatient Palliative Care in Germany: Results from a Retrospective Analysis of 14,792 Patients.

Palliative care comprises multiprofessional, integrated, person-centered healthcare services for patients and their families facing problems related to progressive or advanced diseases and limited life expectancy. Although non-oncology patients' needs are similar to those of tumor patients, they are often underestimated. The purpose of our study was to investigate the actual utilization of palliative care services in Germany, especially in the outpatient setting. Using the IQVIA Disease Analyzer database, a total of 14,792 outpatients from 805 primary care practices in Germany with documented palliative care and related diagnosis between 2018 and 2021 were analyzed. Proportions of different diagnoses among patients receiving outpatient palliative care were stratified by gender and different age groups. The most common underlying diagnosis for outpatient palliative care was cancer (55%), followed by heart failure (16%) and dementia (8%), with age- and sex-specific differences found in the proportion of diagnoses for utilization. While the relative proportions of cancers decreased with age (87% in the 18- to 50-year-old age group versus 37% in the 80-plus age group), the proportion of palliative care related to heart failure increased in the older population (2% in the 18- to 50-year-old age group versus 25% in the 80-plus age group). This study provides an overview of the situation of outpatient palliative care in Germany and shows age- and gender-specific trends regarding the underlying medical diagnoses. Based on these data, palliative care should be adapted to current demographic developments.

Awareness and Utilization of Palliative Care Among Advanced Cancer Patients in Asia.

To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia. This study aimed to investigate PC awareness and its predictors, utilization of PC services, and perceived utilization barriers among advanced cancer patients from select hospitals in Asian LMICs. This cross-sectional study analyzed data of 759 advanced cancer patients at major hospitals of four LMICs in Asia (i.e., Bangladesh, Philippines, Sri Lanka, and Vietnam). The predictors of PC awareness were investigated using multivariable logistic regression. Overall PC awareness was 30.8% (n = 234). Patients with higher education (OR=1.0; CI=1.0,1.1), from upper-middle or high-income households (compared to low-income) (OR=2.0; CI=1.2,3.3), awareness of disease severity (OR=1.5; CI=1.0,2.2), and higher pain severity (OR=1.1; CI=1.0,1.2) had higher odds of PC awareness. Compared to patients who perceived themselves as being very informed about disease trajectory, those who were unsure (OR=0.5; CI=0.3,0.8) or uninformed (OR=0.5; CI=0.3,0.9) had lower odds of PC awareness. The PC utilization rate was 35.0% (n = 82) among those with PC awareness, and 47.8% (n = 66) among patients recommended PC by a healthcare professional (n = 138). The most cited PC utilization barriers were currently receiving anti-cancer treatment (n = 43; 33.9%), and having insufficient information about PC (n = 41; 32.3%). The low awareness of PC services in these major hospitals in Asian LMICs highlights that more effort may be required to promote the awareness of PC in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.

Trigger-based pathways to increase utilization of palliative care services for cancer patients: A multi-disciplinary approach.

e24007 Background: Palliative care involves services to improve the quality of life for chronically ill patients and their care teams. Use of palliative care has shown to decrease the utilization of resources and increase clarity of goals of care. Although acceptance of palliative care principles has been improving, we conducted a multidisciplinary project to increase the utilization of palliative care consult (PCC) and follow its effect of hospital-based outcome. Methods: IRB approved study involving patients on medical floors and in the ICU were conducted over 3 months with 1-month pre-intervention phase (PIP). We developed PCC triggers based on medical literature for the ICU and Medical floors to identify at risk patients likely to benefit from PCC on admission. Trigger questionnaire included but was not limited to the problem list at admission, comorbidities, requirements and availability of social support, and age &gt; 80 years which were reviewed by the primary Nursing staff at admission assessment. Patients meeting any one of the triggers were eligible for PCC. The RNs would reach out to the primary team to notify them of patient’s eligibility for PCC. We adopted “opt in” model to request approval of the PCC. Outcomes measures included rate of PCC among triggered, code status change, and discharge planning. Triggers for pre-intervention were filled by EHR review. All the categorical variables were compared by chi-square test. Results: 344 (Median age - 69, 50.58% Female) patients were enrolled during the study with 93 (27.03%) cancer patients. 93/121 (76.86%) of PIP patients and 160/223 (71.74%) of intervention phase (IP) patients triggered the PCC. During PIP, proportion of triggered non-cancer and cancer patients referred for PCC were 9/73 (12.33%) and 6/20 (30.00%) respectively. During IP, proportion of triggered patients referred for PCC significantly increased compared to PIP to 28/99 (28.28%, p-value – 0.01) and 38/61 (62.30%, p-value – 0.01) for both non-cancer and cancer patients, respectively. During the IP, PCC was recommended significantly more times (p-value – 0.00) in cancer patients than non-cancer patients. Among all with PCC involved, 4/17 (23.59%) PIP and 8/59 (13.56%, p-value – 0.56) IP full-code cancer patients changed code status to DNR. Among the cancer patients, 10 (6 from ICU and 4 from medical floor) patients were discharged to home hospice compared to none in pre-intervention phase. Conclusions: Application of trigger-based pathways leads to early and increase utilization of palliative care services for all patients by identifying patients to benefit from early PCC. Among cancer patients, we found improvement in utilization of hospice services and clarification of their code status at discharge. Further studies are needed to standardize the procedure for increased integration of PCC into our hospital’s clinical models of care.