bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing patients' preferences for palliative care through the dissemination of palliative care research: Impact of socioeconomic status, geography, and depression severity.
Authors: Hoerger Michael , Barkan Tessa , Perry Laura , Voorhees Sara , Rochefort Catherine , Seibert Katherine 
Published: February 2017

109 Background: Approximately 4 out of 5 Americans are unfamiliar with palliative care, a significant barrier to utilization. Accordingly, providing patients with knowledge could empower them to seek palliative care. As a pilot investigation, the EMPOWER Study examined the impact of a psychoeducational intervention on patients’ preferences for palliative care. Methods: Participants were 581 patients with heterogeneous cancer diagnoses recruited through the NIH-sponsored ResearchMatch program. The study used a between-group pre-post design, completed in a single session via the Internet. Random assignment determined whether participants received psychoeducational information summarizing the results of the Temel et al. (2010) palliative care article, using a plain-language and graphical format. Participants completed measures of their health history, demographics, socioeconomic status (education level, financial strain, subjective financial standing), and depression symptom severity and completed a pre-post measure of preferences for palliative care. Results: Relative to controls, participants receiving the intervention experienced an increase in preferences for palliative care (p < .0001). The standardized mean difference in pre-post change was greater than a standard deviation in magnitude (Cohen’s d = 1.03), a “large” effect size by conventional standards. The intervention showed comparable effects across key patient subgroups, including patients of low socioeconomic status, patients living in low-access states, and patients with greater depression symptom severity. Conclusions: Providing patients with knowledge of recent research findings increased preferences for palliative cancer care. The next step is to develop psychoeducational interventions that are grounded in stakeholder input and incorporate a broader evidence base. This line of research has implications for empowering patients and their families to seek care that can improve quality of life.
Variability of physician perspectives toward advance care planning for patients with incurable cancer and congestive heart failure.
Authors: Chandar Manisha , Brockstein Bruce , Zunamon Alan , Silverman Irwin , Dlouhy Sarah , Ashlevitz Kathryn , Tabachow Cory , Ewigman Bernard , Mazzone Theodore , Obel Jennifer Carrie 
Published: February 2017

12 Background: Advance Care Planning (ACP) discussions afford patients and physicians a chance to better understand patients’ values and wishes regarding end-of-life care; however these conversations typically take place late in the course of a disease, or not at all. The goal of this study was to understand attitudes of oncologists, cardiologists, and primary care physicians (PCPs) towards ACP. We also aimed to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system aimed at improving ACP completion rate. Methods: A 23-question cross-sectional online survey was created and distributed to cardiologists, oncologists, primary care physicians and cardiology and oncology support staff at the NorthShore University Health System (NorthShore) from February-March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool. Results: Only 15% of cardiologists felt it was their responsibility to conduct ACP with their congestive heart failure (CHF) patients. In contrast, 68% of oncologists accepted responsibility for ACP in incurable cancer patients. Sixty-eight percent of PCPs felt personally responsible for conducting ACP discussions with CHF patients, while only 34% felt the same about cancer patients. Documentation of ACP in the electronic health record (EHR) was inconsistent among specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient’s family towards these discussions were also significant reported barriers. Conclusions: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study feeling more personal responsibility for carrying out these discussions with cancer patients than cardiologists with their heart failure patients. Robust implementation of ACP across the spectrum of medical illnesses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and ambulatory settings.
Barriers to traditional palliative care for stage IV breast cancer patients, 2003-2012.
Authors: Shi Runhua , Marion Jay M. , Shi Zhenzhen , Diaz Richie R , Mills Glenn Morris 
Published: February 2017

120 Background: Multiple factors may impact ability of patients with Stage IV breast cancer to access traditional palliative care (PC), which centers on disease-altering procedures such as surgery, radiation therapy, and chemotherapy. To further investigate barriers to accessing PC, the National Cancer Data Base data from 2003-2012 was analyzed. Methods: Data was analyzed from 55,490 patients diagnosed with Stage IV breast cancer registered in the National Cancer Data Base. The outcome variable was patient use of PC. The predictor variables included sex, age, race, Charlson Comorbidity index, insurance status, income, education, year diagnosed, distance travelled, facility type, diagnosing/treating facility, and diagnosis to treatment interval. Univariate analysis was used to determine the prevalence of palliative care according to predictor variables. Multivariate Logistic regression was used to investigate the effect of each predictor variable on patient use of PC while adjusting for all other predictive factors. Results: Of the 55,490 Stage IV breast cancer patients analyzed, 17.38% received palliative care. Radiation therapy (8.76%) and chemotherapy, hormone, and other systemic treatments (4.51%) contributed to the bulk of PC. In multivariate analysis, after adjustment for all other predictor variables, race, income, education, distance travelled, and diagnosis to treatment interval were each shown to significantly predict use of PC. Black and Asian patients were 11.4% and 26.1% less likely to use PC than their white peers. Lower zipcode income, higher zipcode education, and shorter distance travelled were predictors of increased PC use. Shorter diagnosis to treatment interval was a predictor of increased PC use; compared to patients with a 31+ day interval, those with a 0-7 day interval were 67.71% more likely to receive PC and 8-31 day interval, 37%. Conclusions: Using univariate and multivariate analysis, we identified factors that may act as barriers to access traditional palliative care for patients diagnosed with Stage IV breast cancer. We observed that race, income, education, distance travelled, and diagnosis to treatment interval significantly predicted the use of palliative care.
Risk factor assessment of hospice patients who are readmitted within 7 days of acute care hospital discharge.
Authors: Wilson Anthony E , Martins-Welch Diana , Earle Bridget , Kozikowski Andrzej , Attivissimo Lori , Rosen Lisa M , Pekmezaris Renee 
Published: February 2017

121 Background: Although 20% of adults 65 and older are re-hospitalized within 30 days of discharge, there is a dearth of research investigating readmission of patients discharged to hospice and the predictors of the readmissions. The study aim was to identify risk factors for hospital readmission within 7 days of discharge to home hospice. Methods: This was a retrospective case control study with cases being patients discharged to home hospice that were readmitted to the hospital within 7 days. Controls were patients discharged to home hospice and not readmitted to the hospital within 7 days. Descriptive statistics were used to describe demographic and clinical characteristics. The chi-square or Fisher’s Exact test were used to compare categorical predictors between cases and controls. The two-sample t-test or the Mann-Whitney test were used to compare continuous predictors between cases and controls. Results: There were 163 subjects; 46 cases (28.22%) and 117 controls (71.78%). The most frequent hospital diagnosis was cancer (56.4%). There was a significant association between 7-day readmission (i.e., case) and age (P < 0.0041), race (P < 0.0008), language (P < 0.0007) and insurance (P < 0.0001). Specifically, cases were significantly younger than controls (69.5 vs. 77.0). Cases were more likely to be Hispanic (15.2 vs. 5.1), Asian (15.2 vs. 5.1) and other (13.0 vs. 2.6) when compared to controls. Cases were more likely to speak Spanish (13.3 vs. 3.5) or other (20.0 vs. 5.3) and less likely to speak English (66.7 vs. 91.2). Cases were less likely to have Medicare (8.7 vs. 82.9) and more likely to have Medicaid (32.6 vs. 4.3), private insurance (13.0 vs. 10.3) or other form of insurance including dual eligibility (45.7 vs. 2.6). Gender, marital status, religion, hospital diagnosis, discharge day, family support at home, symptoms and emergency contact relationship were not significantly association with 7-day readmission. Conclusions: Our data highlights four risk factors, namely age, race, language and insurance status as factors predicting readmission within seven days of acute care hospital discharge. Further study of these predictors may identify opportunities for interventions to obviate these readmissions.
Effect of palliative doctor in medical oncology team on patient outcomes.
Authors: Xu Zhi Zhen , Neo Patricia , Peh Tan Ying , Yee Alethea , Zhu Xia , Yang Grace Meijuan 
Published: February 2017

122 Background: Advanced cancer patients have a high symptom burden and not infrequently have unplanned hospital admissions. In our institution, PM services are provided via a separate consult team rather than an integrated palliative oncology team. Sometimes, PM doctors join the oncology team as integrated members for a few months each as part of their PM fellowship training program. This study aims to explore the effect of this PM doctor. Methods: Patients admitted under the lung and gastrointestinal (GI) oncology teams from June 2013 to June 2014 were studied as this cohort of patients had a higher symptom burden and were more likely to benefit from PM input. The following information for each month was obtained from the computer system: hospital length of stay, formal referrals for a PM consult, 30-day, 60-day and 90-day mortality, and place of death. 2-sample T test was used to compare outcomes when there was a PM doctor in the oncology team for at least half of the month versus when there was not. Results: See table below. The presence of a PM doctor reduced the monthly percentage of formal referrals for PM consults but did not have clinically significant effects on other outcomes. Conclusions: PM doctors were there to learn oncology rather than provide a PM service. However, a reduction of PM referrals suggests that they were still able to meet some of the PM needs of the patients admitted. A new model of PM service provision whereby a PM healthcare professional is integrated within the oncology team warrants further study. [Table: see text]
Is there an unmet need for palliative care in cancer patients admitted to hospital?
Authors: Zhu Xia , Neo Patricia , Peh Tan Ying , Xu Zhi Zhen , Yee Alethea , Yang Grace Meijuan 
Published: February 2017

123 Background: Cancer patients who are admitted to hospital often have symptom problems and progressive functional decline, and may benefit from palliative care (PC) input. The aim of this study was to determine the profile of patients admitted under Lung and Gastrointestinal (GI) oncology teams (as their cohorts of admitted patients probably have more symptom problems) and whether they are being referred for PC input. Methods: Patients admitted from 1 March 2015 to 31 March 2015 were included. The following were recorded: primary site of tumor and whether it was metastatic, whether the admission was planned or unplanned, referral for PC input, outcome of admission and unplanned readmission within 7 days and 30 days. Results: See table below. Conclusions: Although 84% of patient admissions had metastatic cancer and 82% were unplanned admissions, only 21% were referred for PC input. This represents a missed opportunity for PC input, which has been shown to improve outcomes in patients with advanced cancer. However, if all advanced cancer patients who had an unplanned hospital admission were referred for PC, there would be a large increase from the current workload of the PC team. Hence, there is a need to pilot a novel model of PC provision, perhaps one in which a PC healthcare professional joins the oncology team to provide integrated palliative oncology care. [Table: see text]
Outpatient palliative care encounters in stage IV lung cancer care: An institutional review.
Authors: Rizk Sophia , Prsic Elizabeth Horn , Rafelson William , Reagan John Leonard , Taber Angela Marie 
Published: February 2017

128 Background: Palliative Care (PC) is becoming increasingly integrated into standard oncologic care (SC). Previous research suggests that patients receiving PC report better quality of life, and may have prolonged survival. This study evaluates the effect of PC integration in patients diagnosed with stage IV non-small cell lung cancer (NSCLC) at a single institution. Methods: All patients diagnosed with Stage IV NSCLC between January 2010 and January 2013 were considered for inclusion and retrospective analysis of their care. Charts were reviewed to identify patients who received outpatient PC with a licensed PC physician in addition to SC. There were no guidelines regarding the nature of the PC intervention. Retrospective analyses of multiple factors were assessed, including: receipt of chemotherapy and/or radiotherapy, utilization of emergency and sick visits, frequency and timing of hospice referral, and duration of hospice utilization. Overall survival was also assessed. Results: 136 patients fulfilled study inclusion criteria. 29 patients received PC in addition to SC, and 107 received SC alone. No statistically significant difference was noted between the groups with respect to age, sex, lines of chemotherapy administered, number of emergency department visits, or number of clinic sick visits. Hospice was offered more frequently in the PC group; however, there was no difference in the amount of time spent on hospice, and no difference in overall survival. There was a trend towards longer survival in the PC group (220 days vs. 254 days). Patients seen in a multidisciplinary clinic were significantly more likely to receive a PC evaluation (RR 1.28 CI 1.073-1.52, p < 0.006). Conclusions: This retrospective study examines how PC is integrated in actual clinical models. Multidisciplinary clinic patients were more likely to receive PC after controlling for comorbidities. There was no significant difference between PC and SC group outcomes. Although this study is small, it demonstrates common practice patterns, and identifies the need to identify the components of the PC encounter that are important in order to maximize the potential benefits of PC interventions.
Timeliness of end-of-life (EOL) discussions for blood cancers: A national survey of hematologic oncologists.
Authors: Odejide Oreofe Olukemi , Cronin Angel , Condron Nolan , Earle Craig , Wolfe Joanne , Abel Gregory Alan 
Published: February 2017

13 Background: Although timely EOL discussions have been shown to positively impact EOL care for patients with advanced solid tumors, little is known about EOL discussions for patients with blood cancers. Methods: In 2014, we mailed a 30-item survey to a national sample of hematologic oncologists randomly selected from the American Society of Hematology clinical directory. The survey was developed through focus groups (n=20) and cognitive debriefing (n=5) with hematologic oncologists. We report preliminary data regarding timing of EOL discussions. Results: We received 349 surveys from 48 states (response rate: 57.3%). Median age was 52 years, median time in practice was 25 years, and 43% practiced primarily in tertiary centers. Of all respondents, 56% reported that EOL discussions with blood cancer patients typically occur “too late.” The great majority also reported conducting initialdiscussions regarding resuscitation status, desire for hospice care, and preferred site of death at times other than periods of disease stability (Table). In multivariable analysis adjusting for gender, years in practice, and self-reported confidence leading EOL discussions, respondents practicing in tertiary centers were more likely to report that such discussions occur “too late” (OR=1.91, 95% CI [1.22, 2.98]). Similarly, hematologic oncologists practicing in tertiary centers were less likely to report conducting timely initial resuscitation status discussions (before acute hospitalization or before death clearly imminent, OR=0.52, 95% CI [0.33, 0.82]). Conclusions: The majority of hematologic oncologists in our large national cohort reported late EOL discussions. Moreover, clinicians in tertiary centers were more likely to report late discussions, even when prompted about specific EOL topics. Our data suggest that physician-focused interventions to improve timing of EOL discussions for blood cancers should target those practicing in tertiary centers. [Table: see text]
Overcoming barriers to hospice care for children with cancer: Promoting active participation of the oncology team.
Authors: Fernandez Karen S. , Rogers Diane , Look Leigh M. , Antony Reuben 
Published: February 2017

131 Background: The concept of pediatric hospice care is a natural progression of the hospice philosophy as it has been applied to adults, although, there are unique challenges presented by children. At our institution hospice service for children are offered by the adult team. We evaluated the number of children with cancer eligible for hospice between July 2009 and May 2015 and also explored the barriers that prevented hospice enrollment and the experiences of families, and hospice staff. Methods: Retrospective Review, Programmatic Initiative. Results: Thirty-two children diagnosed with cancer died in a 6 year period. Diagnosis breakdown was: Solid tumors 17/32 (53%), brain tumors 8/32 (25%), leukemia/lymphoma 6/32 (19%), 1 rare hematology condition. Twenty-one patients (65%) were 0 – 9.99 years and 11(35%) between 10 – 19.99 years. Fifteen patients (47%) were enrolled in hospice and all died at home except one. 18/32 (56%) children died in the hospital, of those 10/18 (55%) their parents chose the hospital as the site for their children passing, 6/18 (33%) died from an unexpected acute episode that resulted in death, and 2/18 (11%) patients had an acute episode that lead to un-planned patient hospitalization. The identified barriers to establishing and delivering hospice care were: a) family unwillingness to work with the hospice team b) family desire to have the patient die in the hospital c) hospice services not available in the patient’s residential area and, d) low level of comfort in the care of young children on the part of the hospice staff. Families expressed mixed feelings regarding hospice services. Conclusions: Hospice services for children with cancer are underutilized. There are family, institutional and community barriers to hospice enrolment for children with cancer. The great majority of patients still die in the hospital. We propose to improve our regional pediatric hospice service by strengthening collaboration between pediatric oncology, palliative care and hospice to better serve children with cancer at the end of life with a programmatic initiative involving the oncology team. We aim to evaluate the impact of this initiative on families, hospice staff and the oncology team.
Treatment of bone metastases in a rural setting: The effect of Choosing Wisely.
Authors: Lovett Richard Dana 
Published: February 2017

133 Background: In 2013, the American Society of Therapeutic Radiology released its list of Choosing Wisely Initiatives. One of these initiatives was to use fraction schemes which may allow less than 10 fractions for the palliation of bony metastatic disease. Such schemes may use one or five fractions to treat an uncomplicated case of bone metastases. This project looks at a rural radiation practice, both before and after a decision was made to employ the Choosing Wisely guidelines when appropriate. Methods: This is a non-randomized, retrospective analysis of 12 months of bone metastases treatments in a single provider practice comparing the 6 months before Choosing Wisely adoption to the 6 months after. A total of 37 consecutive patients, 63 treatment sites were examined. Comparing to a standard 10 fractions of 300 cGy, fifteen treatment fractions were eliminated before adoption, 84 treatment fractions were saved after the guidelines were published. Results: Because of the bias of the practitioner, 14% of the patients received shorter fraction schedules before the Choosing Wisely adoption, 68% of patients after. As far as radiation treatment charges, $12,000 in treatments were saved before adoption, $69,000 in treatments were saved after. Besides the cost savings for the treatments, there were benefits to the patient and to the caregivers. The average patient receiving a shortened fraction schedule saved 145 miles of commuting during the course of their treatment, and saved 5 hours of commuting and treatment time. Assuming that caregivers were employed, a caregiver bringing a patient in for their treatment saved $170.00 in lost wages during the commuting and treatment time. One patient was hospitalized for her treatment and her hospital stay was reduced by the altered fractionation. No patient in the study required retreatment, the minimum follow up period was 6 months. Conclusions: Shorter fraction schemes when used as clinically appropriate do offer savings, not only to health care payers, but also to patients and to patients’ families. Consideration of Choosing Wisely Initiatives has saved patients time and expense as opposed to a similar time period before the initiative. With patients with pain from metastases, these savings are significant.