Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers

Faiz Gani, Zachary O. Enumah, Alison M. Conca-Cheng, Joseph K. Canner, Fabian Johnston

Research output: Contribution to journalArticle

Abstract

Background: Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. Objective: The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. Design: Retrospective, cross-sectional analysis of data from the National Inpatient Sample. Setting and Subjects: Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013. Measurements: In-hospital length of stay (LOS), morbidity, mortality, and total charges. Results: A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5%) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4% vs. 9.4%) and were more likely to develop a postoperative complication (28.3% vs. 45.9%, both p < 0.001). Inpatient mortality was significantly higher among patients who had received PC than those who did not (5.4% vs. 44.1%, p < 0.001). On multivariable analysis, patient age (age ≥75 years: Odds Ratio [OR] = 2.54, 95% CI: 2.33-2.78), comorbidity (CCI >6: OR = 2.60, 95% CI: 2.48-2.74), and admission to larger hospitals (reference small: OR = 1.20, 95% CI: 1.14-1.25) were associated with greater odds of receiving PC (all p < 0.05). Patients who underwent a major operation during their inpatient admission demonstrated 79% lower odds of receiving PC (OR = 0.21, 95% CI: 0.20-0.22, p < 0.001). Conclusions: Among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation. Further research is required to delineate the barriers to the use of PC so as to promote the use of PC among high-risk patients.

Original languageEnglish (US)
Pages (from-to)428-437
Number of pages10
JournalJournal of Palliative Medicine
Volume21
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Gastrointestinal Neoplasms
Palliative Care
Thorax
Inpatients
Length of Stay
Referral and Consultation
Neoplasms
Cross-Sectional Studies

Keywords

  • Cancer
  • End-of-life
  • Inpatient palliative care
  • Palliative care
  • Surgical palliative care

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers. / Gani, Faiz; Enumah, Zachary O.; Conca-Cheng, Alison M.; Canner, Joseph K.; Johnston, Fabian.

In: Journal of Palliative Medicine, Vol. 21, No. 4, 01.04.2018, p. 428-437.

Research output: Contribution to journalArticle

Gani, Faiz ; Enumah, Zachary O. ; Conca-Cheng, Alison M. ; Canner, Joseph K. ; Johnston, Fabian. / Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers. In: Journal of Palliative Medicine. 2018 ; Vol. 21, No. 4. pp. 428-437.
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abstract = "Background: Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. Objective: The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. Design: Retrospective, cross-sectional analysis of data from the National Inpatient Sample. Setting and Subjects: Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013. Measurements: In-hospital length of stay (LOS), morbidity, mortality, and total charges. Results: A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5{\%}) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4{\%} vs. 9.4{\%}) and were more likely to develop a postoperative complication (28.3{\%} vs. 45.9{\%}, both p < 0.001). Inpatient mortality was significantly higher among patients who had received PC than those who did not (5.4{\%} vs. 44.1{\%}, p < 0.001). On multivariable analysis, patient age (age ≥75 years: Odds Ratio [OR] = 2.54, 95{\%} CI: 2.33-2.78), comorbidity (CCI >6: OR = 2.60, 95{\%} CI: 2.48-2.74), and admission to larger hospitals (reference small: OR = 1.20, 95{\%} CI: 1.14-1.25) were associated with greater odds of receiving PC (all p < 0.05). Patients who underwent a major operation during their inpatient admission demonstrated 79{\%} lower odds of receiving PC (OR = 0.21, 95{\%} CI: 0.20-0.22, p < 0.001). Conclusions: Among patients admitted for cancer, PC services were used in 8.5{\%} of patients during their inpatient admission with surgical patients being 79{\%} less likely to receive a PC consultation. Further research is required to delineate the barriers to the use of PC so as to promote the use of PC among high-risk patients.",
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AU - Johnston, Fabian

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N2 - Background: Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. Objective: The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. Design: Retrospective, cross-sectional analysis of data from the National Inpatient Sample. Setting and Subjects: Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013. Measurements: In-hospital length of stay (LOS), morbidity, mortality, and total charges. Results: A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5%) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4% vs. 9.4%) and were more likely to develop a postoperative complication (28.3% vs. 45.9%, both p < 0.001). Inpatient mortality was significantly higher among patients who had received PC than those who did not (5.4% vs. 44.1%, p < 0.001). On multivariable analysis, patient age (age ≥75 years: Odds Ratio [OR] = 2.54, 95% CI: 2.33-2.78), comorbidity (CCI >6: OR = 2.60, 95% CI: 2.48-2.74), and admission to larger hospitals (reference small: OR = 1.20, 95% CI: 1.14-1.25) were associated with greater odds of receiving PC (all p < 0.05). Patients who underwent a major operation during their inpatient admission demonstrated 79% lower odds of receiving PC (OR = 0.21, 95% CI: 0.20-0.22, p < 0.001). Conclusions: Among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation. Further research is required to delineate the barriers to the use of PC so as to promote the use of PC among high-risk patients.

AB - Background: Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. Objective: The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. Design: Retrospective, cross-sectional analysis of data from the National Inpatient Sample. Setting and Subjects: Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013. Measurements: In-hospital length of stay (LOS), morbidity, mortality, and total charges. Results: A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5%) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4% vs. 9.4%) and were more likely to develop a postoperative complication (28.3% vs. 45.9%, both p < 0.001). Inpatient mortality was significantly higher among patients who had received PC than those who did not (5.4% vs. 44.1%, p < 0.001). On multivariable analysis, patient age (age ≥75 years: Odds Ratio [OR] = 2.54, 95% CI: 2.33-2.78), comorbidity (CCI >6: OR = 2.60, 95% CI: 2.48-2.74), and admission to larger hospitals (reference small: OR = 1.20, 95% CI: 1.14-1.25) were associated with greater odds of receiving PC (all p < 0.05). Patients who underwent a major operation during their inpatient admission demonstrated 79% lower odds of receiving PC (OR = 0.21, 95% CI: 0.20-0.22, p < 0.001). Conclusions: Among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation. Further research is required to delineate the barriers to the use of PC so as to promote the use of PC among high-risk patients.

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