The COVID-19 pandemic created surges of rapidly deteriorating patients straining health care necessitating the evaluation of novel models of palliative care (PC) integration to reduce patient ...suffering and hospital strain.
To evaluate an integrated PC model's effect on code status change.
This is an observational retrospective study.
Urban quaternary referral center in the southeastern United States from April 6th to August 20th, 2020.
All patients admitted to our medical intensive care unit and stepdown unit were diagnosed with COVID-19.
Code status change, multivariate regression on patient characteristics.
In total, 79.7% (98/123) patients were full code at admission. After PC consultation, 33.3% (41/123) patients remained full code, 13.0% (16/123) were do not resuscitate (DNR), and 53.6% (66/123) changed to DNR/do not intubate (DNI). An ordinal logistic model determined that consultation location (odds ratio OR 3.35,
= 0.017) and patient age (OR 1.09,
< 0.001) were predictive of code status change to DNR/DNI.
Within an integrated PC model, PC consultation was associated with code status change. The effect of an integrated PC model warrants further study in comparison with a traditional PC model in a similar patient cohort.
Abstract only Introduction: Despite great strides in management, stroke remains a significant cause of disability and death. Families are often abruptly confronted with critical decisions about ...end-of-life care; providers must balance these concerns with urgent medical or surgical treatment and an uncertain prognosis. This trial examined early Palliative Care (PC) consultation as a means to assist acutely ill patients and their families. Methods: This interdisciplinary, prospective, randomized trial used alternating days to dichotomize patients into a control group who received routine care, including PC consultation if appropriate, and an intervention group, who had PC consultation on the day after admission. Inclusion criteria were a diagnosis of acute ischemic or hemorrhagic stroke, admission to the neurological intensive care unit, and any one of: NIHSS > 14, baseline severe cognitive dysfunction, premorbid modified Rankin score > 3, metastatic cancer, intubation at admission, prior stroke with disability, readmission within 30 days, or admission from a nursing facility. PC consultation identified surrogate decision makers, addressed advance care directives and code status, and co-facilitated multidisciplinary meetings. Outcome measures were identification of a surrogate, documentation of code status, discharge destination and length of stay. Results: We enrolled 50 patients in the PC intervention group. Of the 64 patients in the control group, 18 had PC consultations as routine care; 46 (72%) did not have PC consults. There were no differences between the groups in surrogate identification, documentation of code status or discharge destination. However, compared with the 46 control patients without PC consultation, the intervention group had a significantly higher rate of surrogate identification (98% vs. 87%), χ2 (1) = 4.32, p = 0.037, and code status documentation (94% vs. 78%), χ2 (1) = 5.07, p = 0.024. Length of stay data is pending; not all patients had been discharged at the time of submission. Conclusion: Palliative Care consultation, particularly when pursued early in a patient’s hospitalization for acute stroke allows for clear documentation of a surrogate and delineation of code status, both critical to a patient’s trajectory after acute stroke.
Introduction:
Advance care planning (ACP) is a fluid discussion between patients and providers to define preferences for future medical care. In the acute care setting, ACP is limited due to lack of ...structured process for identifying persons who may benefit from ACP. This quality improvement (QI) project aimed to increase the frequency of ACP discussions and documentation of preferences by targeting geriatric patients with an episodic disease trajectory for ACP.
Methods:
This project used an intervention and comparison group design to target English-speaking, geriatric adults at a large academic medical center with a diagnosis of NYHA class III/IV HF and/or GOLD criteria III/IV COPD for ACP discussions. The intervention group was compared to a group with a range of diagnoses who were approached in a non-systematic way.
Results:
Thirteen (n = 13) participants completed all aspects of the QI project. Results showed a non-significant increase in the number of patients with a diagnosis of HF and/or COPD who participated in an ACP discussion when compared to the comparison group (n = 20, p = 0.131), as well as a non-significant increase in the number of ACP tools documented in the HER (53.8% compared to 30%) (x = 1.877, p = 0.171).
Conclusion:
While this project demonstrated non-significant statistical results in the incidence and documentation of an ACP tool, this project increased the number of ACP discussions had, which is clinically significant.
Objective:
To identify common themes and topics that patients nearing the end of life want to discuss when sharing their life stories.
Methods:
Twenty audio-recorded transcripts of open-ended ...interviews of patients cared for by a palliative care team when approaching the end of life were analyzed using a qualitative analysis.
Results:
Qualitative analysis revealed that the primary contextual factors that patients drew upon to generate his or her life story are life events (including upbringing, job, education, travel, trauma, hardships, special events, military history, and hobbies), family and support system, and values and beliefs. Participants used their current medical condition, which included mortality, morbidity, and prognosis, to frame their life story.
Conclusion:
Patients facing serious illness incorporate four major themes when reflecting upon their lives to create their personal life story: life events, family and support system, values and beliefs, and current medical condition.
Introduction Surgical oncology patients have a high symptom burden and increased risk of morbidity. The aim of palliative care is to evaluate and treat the patient in a holistic manner focusing on ...the unique attributes of each patient. This goal-concordant approach could help surgical patients cope with the stress and uncertainty that often accompany serious illness and surgery, improving overall outcomes. This qualitative analysis sought to explore whether unmet specialist palliative care or end-of-life needs exist in this population. Methods Qualitative interviews were completed with a subset of participants in a randomized, controlled trial of a specialist palliative care intervention for patients undergoing abdominal oncologic surgery. The interview guide sought to elicit respondents’ perceptions of palliative care and end-of-life needs perioperatively and postoperatively. Recurring themes were identified by two independent coders. Results Analysis of 47 interview transcripts revealed few serious concerns about end-of-life issues, however appreciation for the supportive presence offered by palliative care was present. Among participants who received specialist palliative care, many found the intervention helpful, but few were able to articulate issues that the intervention improved. Conclusion These findings suggest low levels of unmet palliative care needs among this population, which is consistent with the results of the parent trial. Targeting patients with a higher symptom burden perioperatively may allow for improved symptom management and better adherence to the treatment plan postoperatively, as well as be a more focused use of specialist palliative care clinicians’ efforts.
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