Reducing Futile Acute Care Services for Terminally Ill Patients With Cancer: The Dignity Project.

Autor:	Salama H; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Al Mutairi N; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Damlaj M; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alolayan A; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Binahmed A; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Salama H; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Tlayjeh H; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia., Alhejazi A; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Lawrence M; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia., Shehata H; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia., Shami M; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia., Alkaiyat M; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Jazieh AR; Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Jazyk:	angličtina
Zdroj:	JCO oncology practice [JCO Oncol Pract] 2021 Nov; Vol. 17 (11), pp. e1794-e1802. Date of Electronic Publication: 2021 Apr 27.
DOI:	10.1200/OP.20.00922
Abstrakt:	Purpose: Patients with terminal diseases frequently undergo interventions that are futile and may be detrimental to their quality of life. We conducted a quality improvement project aimed to reduce the utilization of futile acute care services (ACSs) for patients with cancer treated with a palliative intent. Methods: A multidisciplinary team reviewed the records of terminally ill patients with cancer who died between November 2017 and May 2018, during their admission at our institution. The review aimed to assess the magnitude of improper utilization of ACSs and admission to the intensive care unit (ICU). Lack of timely documentation of the goals of care (GOCs) was the main reason for this problem. We defined timely documentation as the availability of electronic documentation of patients' GOC before the need for ACSs. Interventions were implemented to improve the process; postintervention data were captured and compared with the baseline data. Results: After the delivery of staff education and the implementation of mandatory documentation of the GOCs in the healthcare electronic record system, the timely documentation of the GOCs for patients with a palliative intent increased significantly from 59% at baseline to 83% in the postintervention phase. The impact of this intervention led to a decrease in admissions to the ICU from 26% to 12% and an estimated annual cost saving of $777,600 in US dollars. Conclusion: Our interventions resulted in improved documentation of the GOCs and decrease in the utilization of ACSs including ICU admissions and the associated cost. Competing Interests: Nashmia Al MutairiConsulting or Advisory Role: AstraZeneca Abdul Rahman JaziehResearch Funding: MSD Oncology, AstraZeneca, PfizerTravel, Accommodations, Expenses: AstraZeneca, Bristol-Myers SquibbNo other potential conflicts of interest were reported.
Databáze:	MEDLINE
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