Association of Patient-Centered Elements of Care and Palliative Care Among Patients With Advanced Lung Cancer.

Autor:	Schweiger L; Center to Improve Veteran Involvement in Care, Health Services Research & Development, VA, Portland Health Care System, Portland, OR.; Division of Pulmonary, Allergy, and Critical Care Medicine, 15959Oregon Health and Science University, Portland, OR, USA.; Knight Cancer Institute, 15959Oregon Health and Science University, Portland, OR, USA., Vranas KC; Center to Improve Veteran Involvement in Care, Health Services Research & Development, VA, Portland Health Care System, Portland, OR.; Division of Pulmonary, Allergy, and Critical Care Medicine, 15959Oregon Health and Science University, Portland, OR, USA.; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA.; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR, USA., Furuno JP; Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR, USA., Hansen L; School of Nursing, 15959Oregon Health and Science University, Portland, OR, USA., Slatore CG; Center to Improve Veteran Involvement in Care, Health Services Research & Development, VA, Portland Health Care System, Portland, OR.; Division of Pulmonary, Allergy, and Critical Care Medicine, 15959Oregon Health and Science University, Portland, OR, USA.; Knight Cancer Institute, 15959Oregon Health and Science University, Portland, OR, USA.; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR, USA., Sullivan DR; Center to Improve Veteran Involvement in Care, Health Services Research & Development, VA, Portland Health Care System, Portland, OR.; Division of Pulmonary, Allergy, and Critical Care Medicine, 15959Oregon Health and Science University, Portland, OR, USA.; Knight Cancer Institute, 15959Oregon Health and Science University, Portland, OR, USA.
Jazyk:	angličtina
Zdroj:	The American journal of hospice & palliative care [Am J Hosp Palliat Care] 2023 Jan; Vol. 40 (1), pp. 18-26. Date of Electronic Publication: 2022 Oct 03.
DOI:	10.1177/10499091221130944
Abstrakt:	Context: Palliative care (PC) is associated with improved quality of life, survival, and decreased healthcare use at the end of life among lung cancer patients. However, the specific elements of palliative care that may contribute to these benefits are unclear. Objectives: To evaluate the associations of PC and its setting of delivery with prescriptions of symptom management medications, advance care planning (ACP), hospice enrollment, and home health care (HHC) receipt. Methods: Retrospective, cohort study of patients with advanced stage (IIIB/IV) lung cancer in the Veterans Health Administration (VA) diagnosed from 2007-2013; with follow-up through 2017. Propensity score methods were used with inverse probability of treatment weighting and logistic regression modeling, adjusting for patient and tumor characteristics. Results: Among 23 142 patients, 57% received PC. Compared to non-receipt of PC, PC in any setting (inpatient or outpatient) was associated with increased prescriptions of pain medications (Adjusted Odds Ratio (aOR) = 1.63, 95% CI: 1.45-1.83), constipation regimen with pain medications (aOR = 2.04, 95% CI: 1.63-2.54), and antidepressants (aOR = 1.78, 95% CI: 1.52-2.09). PC was also associated with increased ACP (aOR = 1.52, 95% CI: 1.37-1.67) and hospice enrollment (aOR = 1.39, 95% CI:1.31-1.47), and decreased HHC (aOR = 0.79, 95% CI: 0.70-.90) compared to non-receipt of PC. Receipt of PC in outpatient settings was associated with increased prescriptions of pain medications (aOR = 2.54, 95% CI: 2.13-3.04) and antidepressants (aOR = 1.76, 95% CI: 1.46-2.12), and hospice enrollment (aOR = 2.09, 95% CI: 1.90-2.31) compared to receipt of PC in inpatient settings. Conclusions: PC is associated with increased use of symptom management medications, ACP, and hospice enrollment, especially when delivered in outpatient settings. These elements of care elucidate potential mechanisms for improved outcomes associated with PC and provide a framework for a primary palliative care approach among non-palliative care clinicians.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu