TY - JOUR
T1 - The effect of a multidisciplinary palliative care initiative on end of life care in gynecologic oncology patients
AU - Mullen, Mary M.
AU - Divine, Laura M.
AU - Porcelli, Bree P.
AU - Wilkinson-Ryan, Ivy
AU - Dans, Maria C.
AU - Powell, Matthew A.
AU - Mutch, David G.
AU - Hagemann, Andrea R.
AU - Thaker, Premal H.
N1 - Publisher Copyright:
© 2017
PY - 2017/11
Y1 - 2017/11
N2 - Objectives To evaluate the effect of palliative care (PC) consultation on hospice enrollment and end-of-life care in gynecologic oncology patients. Methods A retrospective chart review of gynecologic oncology patients who died 1 year before and after 2014 implementation of a PC initiative for patients at a single NCI-designated comprehensive cancer center. Patient demographics, admission and procedural history, anti-cancer therapy, and end-of- life care were collected retrospectively. Data was analyzed using Student's t-test, Mann-Whitney U test, Chi-Square test, or Fisher's exact test. Results We identified 308 patients. Median age at death was 63 years (range 17 to 91). Most patients were white (78.2%), married (47.4%), and had ovarian (35.7%) or uterine cancers (35.4%). Introduction of the PC initiative was associated with increased PC consultations (40%, 53%, p = 0.02), increased hospice enrollment (57%, 61%, p = 0.29), and fewer procedures in the last 30 days of life (44%, 31%, p = 0.01). The rate of enrollment to inpatient hospice doubled from 12.5% to 25.7% (p = 0.02) while time from inpatient hospice enrollment to death increased from 1.9 to 6.0 days (p = 0.02). Time from outpatient hospice enrollment to death increased from 26.2 to 35.4 days (p = 0.18). PC consultation was associated with a doubling of outpatient (40%) and inpatient (80%) hospice enrollment. Conclusions The PC quality improvement initiative was associated with more palliative care consults, increased rates of inpatient and outpatient hospice utilization, increased time on hospice, and fewer procedures in the last 30 days of life, although most women were not enrolled until the last days of life.
AB - Objectives To evaluate the effect of palliative care (PC) consultation on hospice enrollment and end-of-life care in gynecologic oncology patients. Methods A retrospective chart review of gynecologic oncology patients who died 1 year before and after 2014 implementation of a PC initiative for patients at a single NCI-designated comprehensive cancer center. Patient demographics, admission and procedural history, anti-cancer therapy, and end-of- life care were collected retrospectively. Data was analyzed using Student's t-test, Mann-Whitney U test, Chi-Square test, or Fisher's exact test. Results We identified 308 patients. Median age at death was 63 years (range 17 to 91). Most patients were white (78.2%), married (47.4%), and had ovarian (35.7%) or uterine cancers (35.4%). Introduction of the PC initiative was associated with increased PC consultations (40%, 53%, p = 0.02), increased hospice enrollment (57%, 61%, p = 0.29), and fewer procedures in the last 30 days of life (44%, 31%, p = 0.01). The rate of enrollment to inpatient hospice doubled from 12.5% to 25.7% (p = 0.02) while time from inpatient hospice enrollment to death increased from 1.9 to 6.0 days (p = 0.02). Time from outpatient hospice enrollment to death increased from 26.2 to 35.4 days (p = 0.18). PC consultation was associated with a doubling of outpatient (40%) and inpatient (80%) hospice enrollment. Conclusions The PC quality improvement initiative was associated with more palliative care consults, increased rates of inpatient and outpatient hospice utilization, increased time on hospice, and fewer procedures in the last 30 days of life, although most women were not enrolled until the last days of life.
KW - End-of-life outcomes
KW - Hospice
KW - Palliative care
UR - http://www.scopus.com/inward/record.url?scp=85026783165&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2017.08.002
DO - 10.1016/j.ygyno.2017.08.002
M3 - Article
C2 - 28784245
AN - SCOPUS:85026783165
SN - 0090-8258
VL - 147
SP - 460
EP - 464
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 2
ER -