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Shafiee F, Sarbaz M, Marouzi P, Banaye Yazdipour A, Kimiafar K. Providing a framework for evaluation disease registry and health outcomes Software: Updating the CIPROS checklist. J Biomed Inform 2024; 149:104574. [PMID: 38101688 DOI: 10.1016/j.jbi.2023.104574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND AIMS Properly designed and implemented registry systems play an important role in improving health outcomes and reducing care costs, and can provide a true representation of clinical practice, disease outcomes, safety, and efficacy. Therefore, the aim of this study was to redesign and develop a checklist with items for a patient registry software system (CIPROS) Checklist. METHOD The study is descriptive-cross-sectional. The extraction of the data elements of the checklist was first done through a comprehensive review of the texts in PubMed, Science Direct and Scopus databases and receiving articles related to the evaluation of registry systems. Based on the extracted data, a five-point Likert scale questionnaire was created and 30 experts in this field were asked for their opinions using the two-step Delphi method. RESULTS A total of 100 information items were determined as a registry software evaluation checklist. This checklist included 12 groups of software architecture factors, development, interfaces and interactivity, semantics and standardization, internationality, data management, data quality and usability, data analysis, security, privacy, organizational, education and public factors. CONCLUSION By using the results of this research, it is possible to identify the defects and possible strengths of the registry software and put it at the disposal of the relevant officials to make a decision in this field. In this way, among the designers and developers of these softwares, the best and most appropriate ones are selected with the needs of the registry programs.
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Affiliation(s)
- Fatemeh Shafiee
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Masoume Sarbaz
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Parviz Marouzi
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alireza Banaye Yazdipour
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Khalil Kimiafar
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
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Johnson AM, Wolf S, Xuan M, Samsa G, Kamal A, Fisher DA. Index Symptoms and Prognosis Awareness of Patients With Pancreatic Cancer: A Multi-Site Palliative Care Collaborative. J Palliat Care 2023; 38:152-156. [PMID: 33730892 DOI: 10.1177/08258597211001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pancreatic cancer has a poor 5-year survival and carries significant morbidity. Pain is a commonly studied symptom in pancreatic cancer; however, few studies examine the frequency of multiple patient-reported symptoms. Our aim is to ascertain patient-reported symptom burden at initial consultation with a palliative care provider and compare patient prognostic awareness to provider estimation of prognosis. METHODS Data were extracted from the standardized Quality Data Collection Tool (QDACT). Adults with pancreatic cancer seen by a palliative care provider were included. Descriptive statistics were used to describe demographic features, symptom prevalence and burden, as well as assess patient prognosis awareness defined by congruence or incongruence with provider estimated prognosis. RESULTS 285 patients were included in our analysis. The average age was 68 years (SD: 12.4), 87.2% were white, 50% male. The mean number of moderate/severe symptoms was 2.6 (SD: 2) out of 9 symptoms. Tiredness (66.7%), appetite (64.5%) and pain (46.2%) had the highest rates of moderate/severe symptom burden. Patients with a prognosis of 1-6 months had the lowest proportion of congruence with provider estimation (56.5%). CONCLUSION Our study suggests targets to improve patient-centered care of pancreatic cancer. Patients commonly have multiple symptoms that are moderate/severe at time of palliative care referral. While pain has been well-reported, tiredness and decreased appetite are more prevalent at initial visit. This emphasizes the importance of assessing multiple symptoms and working closely with palliative care for early referral. Overall, one third of patient prognosis estimates differed from the provider assessment of prognosis. Our data support the importance of early referral to palliative care to manage symptoms and better prepare patients for end-of-life care.
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Affiliation(s)
- Alyson M Johnson
- Division of Gastroenterology and Hepatology, Duke University School of Medicine, Durham, NC, USA
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Mengdi Xuan
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Greg Samsa
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Arif Kamal
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Deborah A Fisher
- Division of Gastroenterology and Hepatology, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
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Soliman AA, Akgün KM, Coffee J, Kapo J, Morrison LJ, Hopkinson E, Schulman-Green D, Feder SL. Quality of Telehealth-Delivered Inpatient Palliative Care During the Early COVID-19 Pandemic. J Pain Symptom Manage 2023; 65:6-15. [PMID: 36206949 PMCID: PMC9532267 DOI: 10.1016/j.jpainsymman.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Consequent to increasing COVID-19 infection rates, the Palliative Care (PC) service at a large New England hospital shifted from in-person to telehealth-delivered PC (TPC). OBJECTIVES We compared the quality of TPC to in-person PC during the early COVID-19 pandemic. METHODS We conducted an electronic health record review of PC consultations of patients hospitalized during three periods: pre-COVID January, 2020-February, 2020 (in-person); peak-COVID March, 2020-June, 2020 (majority TPC); and post-peak September, 2020-October, 2020 (majority in-person). We examined the relationship between these periods and PC delivery characteristics and quality measures using descriptive and bivariate statistics. RESULTS Of 377 patients, 50 were pre-COVID (TPC=0%), 271 peak-COVID (TPC=79.3%), and 56 post-peak (TPC<2%) (representation of PC consult: pre- and post-peak=samples; peak-COVID=all consults). Mean age was 69.3 years (standard deviation=15.5), with 54.9% male, 68.7% White, and 22.8% Black. Age and sex did not differ by period. PC consultations were more likely for goals of care (pre=30.0% vs. peak=53.9% vs. post=57.1%; P = 0.005) or hospice (4.0% vs. 14.4% vs. 5.4%, P = 0.031) during peak-COVID compared to pre-COVID. Rates of assessment of physical (98.0% vs. 63.5% vs. 94.6%, P < 0.001) and psychological symptoms (90.0% vs. 33.1% vs. 67.9%, P < 0.001) were lower during peak relative to pre-COVID and post-peak periods. There were no differences in assessment of patients' social needs, family burden, or goals of care across periods. CONCLUSION The PC service provided high-quality inpatient PC using TPC despite significant strain during the early COVID-19 pandemic. Developing and testing strategies to promote comprehensive symptom control using TPC remains a priority to adjust to potential unmet PC needs.
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Affiliation(s)
| | - Kathleen M Akgün
- VA Connecticut Healthcare System (K.M.A., S.L.F.), Yale School of Medicine, New Haven, CT
| | - Jane Coffee
- Yale School of Nursing (J.C.), West Haven, CT
| | | | | | | | | | - Shelli L Feder
- VA Connecticut Healthcare System (K.M.A., S.L.F.), Yale School of Medicine, New Haven, CT
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Enhanced supportive care for advanced cancer patients: study protocol for a randomized controlled trial. BMC Nurs 2022; 21:338. [PMID: 36461000 PMCID: PMC9716697 DOI: 10.1186/s12912-022-01097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Early palliative care along with standard cancer treatments is recommended in current clinical guidelines to improve the quality of life and survival of cancer patients. This study protocol aims to evaluate the effect of "Enhanced Supportive Care", an early primary palliative care provided by nurses. METHODS A randomized controlled trial (RCT) will be conducted including advanced cancer patients scheduled for first-line palliative chemotherapy (N=360) and their caregivers in South Korea. Participants will be randomly assigned to the intervention or control group in a 1:1 ratio. Participants in the intervention group will receive the "Enhanced Supportive Care", which provides five sessions of symptom management and coping enhancement counseling by nurses. The control group will receive symptom monitoring five times. The primary endpoints are symptoms, coping, and quality of life (QoL) at 3 months. Secondary endpoints are symptoms, coping, and QoL at 6 months, depression and self-efficacy for coping with cancer at 3 and 6 months, symptom and depression change from baseline to 3 months, survival at 6 and 12 months among patients, and depression among caregivers at 3 and 6 months. DISCUSSION This RCT will evaluate the effects of "Enhanced Supportive Care" on symptoms, depression, coping, self-efficacy for coping with cancer, QoL and survival of patients, as well as depression of caregivers. It will provide evidence of a strategy to implement early primary palliative care provided by nurses, which may consequently improve cancer care for newly diagnosed patients with advanced stage cancer. TRIAL REGISTRATION ClinicalTrials.gov, NCT04407013. Registered on May 29, 2020, https://www. CLINICALTRIALS gov/ct2/show/study/NCT04407013 . The protocol version is ESC 1.0.
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Kaufmann TL, Getz KD, Hsu JY, Bennett AV, Takvorian SU, Kamal AH, DeMichele A. Identification of Patient-Reported Outcome Phenotypes Among Oncology Patients With Palliative Care Needs. JCO Oncol Pract 2021; 17:e1473-e1488. [PMID: 33760637 PMCID: PMC8791824 DOI: 10.1200/op.20.00849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Despite evidence-based guidelines recommending early palliative care, it remains unclear how to identify and refer oncology patients, particularly in settings with constrained access to palliative care. We hypothesize that patient-reported outcome (PRO) data can be used to characterize patients with palliative care needs. To determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral. METHODS We conducted a retrospective study of self-reported symptoms on the Edmonton Symptom Assessment System collected from solid tumor oncology patients (n = 745) referred to outpatient palliative care. Data were collected as part of routine clinical care from October 2012 to March 2018 at eight community and academic sites. We applied latent profile analysis to identify PRO phenotypes and examined the association of phenotypes with clinical and demographic characteristics using multinomial logistic regression. RESULTS We identified four PRO phenotypes: (1) Low Symptoms (n = 295, 39.6%), (2) Moderate Pain/Fatigue + Mood (n = 180, 24.2%), (3) Moderate Pain/Fatigue + Appetite + Dyspnea (n = 201, 27.0%), and (4) High Symptoms (n = 69, 9.3%). In a secondary analysis of 421 patients, we found that two brief items assessing social and existential needs aligned with higher severity symptom and psychological distress phenotypes. CONCLUSION Oncology patients referred to outpatient palliative care in a real-world setting can be differentiated into clinically meaningful phenotypes using brief, routinely collected PRO measures. Latent modeling provides a mechanism to use patient-reported data on a population level to identify distinct subgroups of patients with unmet palliative needs.
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Affiliation(s)
- Tara L. Kaufmann
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA,Livestrong Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, TX,Tara L. Kaufmann, MD, MSCE, The University of Texas at Austin, Livestrong Cancer Institutes, Dell Medical School, 1601 Trinity St, Bldg B, Stop Z1100, Austin, TX 78712; e-mail:
| | - Kelly D. Getz
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,University of Pennsylvania, Philadelphia, PA,The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Antonia V. Bennett
- Cancer Outcomes Research Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Samuel U. Takvorian
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Angela DeMichele
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Warraich HJ, Wolf SP, Troy J, Swetz KM, Goldstein NE, Mentz RJ, Jain N, Desai AS, Kamal AH. Differences between patients with cardiovascular disease and cancer referred for palliative care. Am Heart J 2021; 233:5-9. [PMID: 33306993 DOI: 10.1016/j.ahj.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
Our analysis from a national registry shows that compared to cancer, cardiovascular disease patients referred to palliative care are a decade older, have worse functional status and clinician-estimated prognosis. Both groups have very high symptom burden, with cardiovascular disease patients experiencing more dyspnea while pain, nausea, and fatigue are more common in cancer.
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Mc Kenna D, O'Shea J, Tanner L. The Heart of Living and Dying: Upstreaming Advance Care Planning into Community Conversations in the Public Domain in Northern Ireland. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:346-363. [PMID: 33308045 DOI: 10.1080/15524256.2020.1858471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper provides an evaluation of the Heart of Living and Dying (HLD) Initiative. This initiative is a group process that attempts to bring Advance Care Planning (ACP) into the public domain. It encourages participants to consider what matters to them in their living along with their hopes, preferences, and wishes for their final years and end-of-life care. An inductive, interpretive, and naturalistic approach allowed the researcher to study these phenomena in their natural setting i.e., the community. This qualitative study used 5 focus groups with 17 people and employed thematic data analysis to identify key themes. All participants in the HLD speak from a personal perspective irrespective of any professional background. It transpired that 16 respondents worked in health and social care, which subsequently became noteworthy in the findings. Three key themes were identified: (a) feeling emotionally safe enough to have such sensitive conversations is vital; (b) participating in the HLD process increases the confidence of those participants who worked in health and social care, to undertake ACP conversations and (c) planning ahead is a complex, staged process rather than a single record-making event. The Covid-19 pandemic crisis reinforced the need to upstream ACP initiatives such as the HLD, as the norm for everyone, since all of us will one day die. It is recommended that the HLD be incorporated within ACP training given that the experiential nature of it and the use of groups was reported to build confidence in facilitating ACP conversations. A virtual HLD process needs to be developed to adapt to restrictions on gatherings due to Covid 19.
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Affiliation(s)
- Deirdre Mc Kenna
- Southern Health and Social Care Trust, Craigavon, Northern Ireland
| | - Johanna O'Shea
- Applied Social Sciences, Social Work Department, Maynooth University, Co. Kildare, Ireland
| | - Liz Tanner
- Social Work Training Unit, Southern Health and Social Care Trust, Armagh, Northern Ireland
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Kamal AH, Check DK, Bull J, Wolf S, Troy J, Samsa G, Nicolla JM, Harker M, Taylor DH. Associations of Patient Characteristics and Care Setting with Complexity of Specialty Palliative Care Visits. J Palliat Med 2020; 24:83-90. [PMID: 32634037 DOI: 10.1089/jpm.2020.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Information routinely collected during a palliative care consultation request may help predict the level of complexity of that patient encounter. Objectives: We examined whether patient and consultation characteristics, as captured in consultation requests, are associated with the number of unmet palliative care needs that emerge during consultation, as an indicator of complexity. Design: We performed a retrospective cohort analysis of palliative care consultations. Setting: We analyzed quality-of-care data from specialty palliative care consultations contained in the Quality Data Collection Tool of the Global Palliative Care Quality Alliance from 2012 to 2017. Measurements: Using 13 point-of-care assessments of quality of life, symptoms, advance care planning, and prognosis, we created a complexity score ranging from 0 (not complex) to 13 (highest complexity). Using multivariable linear regression, we examined the relationships of consultation setting and patient characteristics with complexity score. Results: Patients in our cohort (N = 3121) had an average complexity score of 6.7 (standard deviation = 3.7). Female gender, nonwhite race, and neurological (e.g., dementia) and noncancer primary diagnosis were associated with increased complexity score. The hospital intensive care unit, compared with the general floor, was associated with higher complexity scores. In contrast, outpatient and residence, compared with the general floor, were associated with lower complexity scores. Conclusion: Patient, disease, and care setting factors known at the time of specialty palliative care consultation request are associated with level of complexity, and they may inform teams about the right service provisions, including time and expertise, required to meet patient needs.
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Affiliation(s)
- Arif H Kamal
- Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Duke Fuqua School of Business, Durham, North Carolina, USA
| | - Devon K Check
- Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke School of Medicine, Durham, North Carolina, USA
| | - Janet Bull
- Four Seasons, Hendersonville, North Carolina, USA
| | - Steven Wolf
- Department of Biostatistics, Duke School of Medicine, Durham, North Carolina, USA
| | - Jesse Troy
- Department of Pediatrics, Duke School of Medicine, Durham, North Carolina, USA
| | - Greg Samsa
- Department of Biostatistics, Duke School of Medicine, Durham, North Carolina, USA
| | - Jonathan M Nicolla
- Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Matthew Harker
- Duke Clinical Research Institute, Duke Margolis Center for Health Policy, Durham, North Carolina, USA
| | - Donald H Taylor
- Duke Clinical Research Institute, Duke Margolis Center for Health Policy, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke Sanford School of Public Policy, Durham, North Carolina, USA
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Harrison KL, Bull JH, Garrett SB, Bonsignore L, Bice T, Hanson LC, Ritchie CS. Community-Based Palliative Care Consultations: Comparing Dementia to Nondementia Serious Illnesses. J Palliat Med 2020; 23:1021-1029. [PMID: 31971857 DOI: 10.1089/jpm.2019.0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about the provision of palliative care to people with dementia (PWD). Objective: To examine demographic and clinical characteristics of PWD versus nondementia serious illnesses receiving community-based palliative care. Design: Retrospective study of people 65+ receiving an initial consultation from a community-based palliative care practice between September 2014 and February 2018 using registry data entered by clinicians into the Quality Data Collection Tool for Palliative Care. Setting: Large not-for-profit organization that provides community-based hospice and palliative care services. Measurements: Demographics, consult characteristics, advance care planning, and caregiver support. Results: Of 3883 older adults receiving a first palliative care consultation from this organization, 22% (855) had a dementia diagnosis. Compared to those with nondementia serious illnesses, PWD were older with more impaired function; 36% had a prognosis of less than six months. More PWD than those without dementia had a proxy decision maker and documented advance directive. A quarter of PWD were full code before consultation; nearly half changed to some limitation afterward. Symptom characteristics were missing for 67% of PWD due to collection through self-report. Caregivers of PWD were responsible for significantly more activities of daily living than caregivers of people with nondementia serious illnesses. Conclusions: This is the first comparison of a large cohort of people with and without dementia receiving a community-based palliative care consult in the United States. Alternative measures of symptom burden should be used in registries to capture data for PWD. Understanding the unique characteristics of PWD will guide future services for this growing population.
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Affiliation(s)
- Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Janet H Bull
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Four Seasons Compassion for Life Hospice, Flat Rock, North Carolina, USA
| | - Sarah B Garrett
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Lindsay Bonsignore
- Four Seasons Compassion for Life Hospice, Flat Rock, North Carolina, USA
| | - Tyler Bice
- Four Seasons Compassion for Life Hospice, Flat Rock, North Carolina, USA
| | - Laura C Hanson
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Lo TJ, Neo PS, Peh TY, Akhileswaran R, Chen WT, Lee A, Wee NT, Jin OY, Poon E, Seah A, Weng SC, Hwang MKY, Cheng GS, Jen LT, An BTS, Ping WY, Ying OW, Mayganathan K, Jin OY, Ying PT, Pin TY, Yee CW, Yin TTP, Ying TY. Improving Quality of Palliative Care Through Implementation of National Guidelines for Palliative Care. J Palliat Med 2019; 22:1439-1444. [DOI: 10.1089/jpm.2018.0345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tong Jen Lo
- Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore
| | - Patricia S.H. Neo
- Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore
| | - Tan Ying Peh
- Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore
| | | | - Wei Ting Chen
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
- Nursing Service, Tan Tock Seng Hospital, Singapore
| | - Angel Lee
- Saint Andrew's Community Hospital, Singapore
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Warraich HJ, Wolf SP, Mentz RJ, Rogers JG, Samsa G, Kamal AH. Characteristics and Trends Among Patients With Cardiovascular Disease Referred to Palliative Care. JAMA Netw Open 2019; 2:e192375. [PMID: 31050773 PMCID: PMC6503632 DOI: 10.1001/jamanetworkopen.2019.2375] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Use of palliative care (PC) for patients with cardiovascular disease (CVD) has increased recently. However, it is unknown if patients are receiving earlier referrals to PC. OBJECTIVE To assess characteristics and trends of patients with CVD referred to PC. DESIGN, SETTING, AND PARTICIPANTS Cohort study in which analysis of data from the multicenter Quality Data Collection Tool for Palliative Care registry from January 2, 2015, through December 29, 2017, included patients with CVD 18 years or older referred to initial PC consultation who had a documented palliative performance score (PPS) . EXPOSURES Patients with CVD who presented for an initial PC visit. MAIN OUTCOMES AND MEASURES The primary outcome was PPS. Secondary outcomes included symptoms and end-of-life documentation. RESULTS Among 1801 patients (mean [SD] age, 77.7 [13.7] years) from 16 sites in the analysis, 875 (48.6%) were women and 1339 (74.3%) were white. A low PPS score (0%-30%), consistent with bedbound status, was recorded for 521 patients (28.9%), with no change through time. The most common moderate to severe symptoms were poor well-being, tiredness, anorexia, and dyspnea. Year of encounter was associated with improved symptoms of pain (odds ratio, 1.25; 95% CI, 1.05-1.50) and with constipation (odds ratio, 1.32; 95% CI, 1.03-1.69). No change through time was noted in other symptoms or end-of-life documentation. Although the proportion of referrals from general medicine increased from 43.2% (167 of 387) in 2015 to 52.9% (410 of 775) in 2017, the proportion of referrals from cardiologists decreased from 16.5% (64 of 387) in 2015 to 10.5% (81 of 775) in 2017. The proportion of patients referred to PC who were black decreased from 11.9% (46 of 387) in 2015 to 6.3% (49 of 775) in 2017. While 69.5% of all patients with CVD (1252 of 1801) had a primary diagnosis of heart failure, the proportion of non-heart failure CVD diagnoses, such as coronary artery disease and valvular heart disease, increased from 25.6% (99 of 387) in 2015 to 30.1% (233 of 775) in 2017. CONCLUSIONS AND RELEVANCE Patients with CVD demonstrated significant symptom burden, and there was no evidence in the registry of change in the PPSs of patients with CVD referred to PC through time. Cardiologists provided comparatively fewer referrals to PC for patients with CVD, and this proportion decreased through time. The proportion of racial and ethnic minorities referred to PC was small and decreased through time. These findings reinforce the need for cardiologists to be more engaged with PC and consider referring appropriate patients with CVD sooner.
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Affiliation(s)
- Haider J. Warraich
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Steven P. Wolf
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Robert J. Mentz
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Joseph G. Rogers
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Greg Samsa
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Arif H. Kamal
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
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12
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Bonsignore L, Bloom N, Steinhauser K, Nichols R, Allen T, Twaddle M, Bull J. Evaluating the Feasibility and Acceptability of a Telehealth Program in a Rural Palliative Care Population: TapCloud for Palliative Care. J Pain Symptom Manage 2018; 56:7-14. [PMID: 29551433 DOI: 10.1016/j.jpainsymman.2018.03.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/09/2018] [Accepted: 03/10/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT The impact of telehealth and remote patient monitoring has not been well established in palliative care populations in rural communities. OBJECTIVES The objectives of this study were to 1) describe a telehealth palliative care program using the TapCloud remote patient monitoring application and videoconferencing; 2) evaluate the feasibility, usability, and acceptability of a telehealth system in palliative care; and 3) use a quality data assessment collection tool in addition to TapCloud ratings of symptom burden and hospice transitions. METHODS A mixed-methods approach was used to assess feasibility, usability, and acceptability. Quantitative assessments included patient symptom burden and improvement, hospice transitions, and advanced directives. Qualitative semistructured interviews on a subpopulation of telehealth patients, caregivers, and providers were performed to learn about their experiences using TapCloud. RESULTS One-hundred one palliative care patients in rural Western North Carolina were enrolled in the program. The mean age of patients enrolled was 72 years, with a majority (60%) being female and a pulmonary diagnosis accounting for the largest percentage of patients (23%). Remote patient monitoring using TapCloud resulted in improved symptom management, and patients in the model had a hospice transition rate of 35%. Patients, caregivers, and providers reported overwhelmingly positive experiences with telehealth with three main advantages: 1) access to clinicians, 2) quick responses, and 3) improved efficiency and quality of care. CONCLUSION This is one of the first articles to describe a telehealth palliative care program and to demonstrate acceptability, feasibility, and usability as well as describe symptom outcomes and hospice transitions.
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Affiliation(s)
| | - Nicholas Bloom
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Reginald Nichols
- Four Seasons Compassion for Life, Flat Rock, North Carolina, USA
| | - Todd Allen
- Four Seasons Compassion for Life, Flat Rock, North Carolina, USA
| | | | - Janet Bull
- Four Seasons Compassion for Life, Flat Rock, North Carolina, USA
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13
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Virdun C, Luckett T, Lorenz KA, Phillips J. National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan. BMJ Support Palliat Care 2018; 8:145-154. [DOI: 10.1136/bmjspcare-2017-001432] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 11/03/2022]
Abstract
BackgroundThe importance of measuring the quality of end-of-life care provision is undisputed, but determining how best to achieve this is yet to be confirmed. This study sought to identify and describe national end-of-life care quality indicators and supporting policies used by countries leading in their end-of-life care provision.MethodsA systematic environmental scan that included a web search to identify relevant national policies and indicators; hand searching for additional materials; information from experts listed for the top 10 (n=15) countries ranked in the ‘quality of care’ category of the 2015 Quality of Death Index study; and snowballing from Index experts.FindingsTen countries (66%) have national policy support for end-of-life care measurement, five have national indicator sets, with two indicator sets suitable for all service providers. No countries mandate indicator use, and there is limited evidence of consumer engagement in development of indicators. Two thirds of the 128 identified indicators are outcomes measures (62%), and 38% are process measures. Most indicators pertain to symptom management (38%), social care (32%) or care delivery (27%).InterpretationsMeasurement of end-of-life care quality varies globally and rarely covers all care domains or service providers. There is a need to reduce duplication of indicator development, involve consumers, consider all care providers and ensure measurable and relevant indicators to improve end-of-life care experiences for patients and families.
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Hochman MJ, Yu Y, Wolf SP, Samsa GP, Kamal AH, LeBlanc TW. Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies. J Pain Symptom Manage 2018; 55:82-88.e1. [PMID: 28887271 PMCID: PMC5921902 DOI: 10.1016/j.jpainsymman.2017.08.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Hematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests that these patients have a sizable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited. OBJECTIVES To compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services. METHODS Using a novel data registry of initial palliative care encounters, we performed a cross-sectional analysis of cancer patients receiving care across 17 sites within the Global Palliative Care Quality Alliance. We compared clinically-significant symptoms (rated as four or greater in severity) between hematologic and solid tumor patients and performed multivariate logistic regression analyses examining the relationship between symptom burden and tumor type. RESULTS We identified 1235 cancer patients, 108 of which had hematologic malignancies. Pain, dyspnea, nausea, and anorexia burden were as high among patients with hematologic as those with solid malignancies. Blood cancer patients had higher rates of clinically-significant tiredness (51% vs. 42%; P = 0.03) than solid tumor patients. Finally, blood cancer patients had greater odds of being tired (odds ratio 2.19; CI 1.22-3.91) and drowsy (odds ratio 1.81; CI 1.07-3.07) than solid tumor patients independent of age, gender, race, and performance status. CONCLUSIONS Hematologic and solid tumor patients have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population.
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Affiliation(s)
| | - Yinxi Yu
- Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven P Wolf
- Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Greg P Samsa
- Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arif H Kamal
- Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Duke Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - Thomas W LeBlanc
- Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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15
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Kamal AH, Taylor DH, Neely B, Harker M, Bhullar P, Morris J, Bonsignore L, Bull J. One Size Does Not Fit All: Disease Profiles of Serious Illness Patients Receiving Specialty Palliative Care. J Pain Symptom Manage 2017; 54:476-483. [PMID: 28751079 DOI: 10.1016/j.jpainsymman.2017.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Understanding the symptom profiles of seriously ill patients who receive palliative care, especially noncancer diagnoses where the data are sparse and are critical to better targeting our resources to the needs of patients. METHODS We performed a retrospective, multicohort study of patients evaluated during their first consultative palliative care visit in a community-based palliative care registry. We placed into one of seven major disease categories based on clinician-reported primary diagnosis for consultation. Our primary aim of this analysis was to determine the univariate association between several patient-specific characteristics (e.g., demographics, care of setting, initial screening score) and the primary diagnosis. RESULTS We evaluated the first visit consultation records of 1615 patients. Most prevalent diagnosis was Neurologic (564; 35%), followed by Cardiovascular (266; 16%), Pulmonary (229; 14%), and Cancer (208; 13%). Patients in the study with the highest symptom burden were those diagnosed with cancer or pulmonary disease, with 45% and 37% of cancer and pulmonary patients, respectively, having two or more moderate-to-severe symptoms; 26% of cardiovascular disease patients reported two or more moderate-to-severe symptoms, whereas 11% reported three or more. Patients with a neurologic or infectious diagnosis had less symptom burden, but a large percentage of neurologic patients were unable to respond. DISCUSSION This study is one of the first to describe symptom burden and functional scores by diagnostic categories and care settings across a community-based interdisciplinary specialty palliative care program. Results demonstrated statistically significant and clinically relevant differences among settings of care, functional status, and symptom profiles between patients with various serious illnesses.
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Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute and Fuqua School of Business, Duke University, Durham, USA.
| | - Donald H Taylor
- Sanford School of Public Policy, Duke University, Durham, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Benjamin Neely
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Matthew Harker
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - John Morris
- Four Seasons, Hendersonville, North Carolina, USA
| | | | - Janet Bull
- Four Seasons, Hendersonville, North Carolina, USA
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16
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Bull J, Kamal AH, Harker M, Taylor DH, Bonsignore L, Morris J, Massie L, Singh Bhullar P, Howell M, Hendrix M, Bennett D, Abernethy A. Standardization and Scaling of a Community-Based Palliative Care Model. J Palliat Med 2017; 20:1237-1243. [PMID: 28813635 DOI: 10.1089/jpm.2017.0027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although limited, the descriptions of Community-Based Palliative Care (CBPC) demonstrates variability in team structures, eligibility, and standardization across care settings. OBJECTIVE In 2014, Four Seasons Compassion for Life, a nonprofit hospice and palliative care (PC) organization in Western North Carolina (WNC), was awarded a Centers for Medicare and Medicaid Services Health Care Innovation (CMMI) Award to expand upon their existing innovative model to implement, evaluate, and demonstrate CBPC in the United States. The objective of this article is to describe the processes and challenges of scaling and standardizing the CBPC model. DESIGN Four Season's CBPC model serves patients in both inpatient and outpatient settings using an interdisciplinary team to address symptom management, psychosocial/spiritual care, advance care planning, and patient/family education. Medicare beneficiaries who are ≥65 years of age with a life-limiting illness were eligible for the CMMI project. RESULTS The CBPC model was scaled across numerous counties in WNC and Upstate South Carolina. Over the first two years of the project, scaling occurred into 21 counties with the addition of 2 large hospitals, 52 nursing facilities, and 2 new clinics. To improve efficiency and effectiveness, a PC screening referral guide and a risk stratification approach were developed and implemented. Care processes, including patient referral and initial visit, were mapped. CONCLUSION This article describes an interdisciplinary CBPC model in all care settings to individuals with life-limiting illness and offers guidance for risk stratification assessments and mapping care processes that may help PC programs as they develop and work to improve efficiencies.
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Affiliation(s)
- Janet Bull
- 1 Four Seasons Compassion for Life , Flat Rock, North Carolina
| | - Arif H Kamal
- 2 Duke University Medical Center , Durham, North Carolina
| | - Matthew Harker
- 2 Duke University Medical Center , Durham, North Carolina
| | | | | | - John Morris
- 1 Four Seasons Compassion for Life , Flat Rock, North Carolina
| | - Lisa Massie
- 1 Four Seasons Compassion for Life , Flat Rock, North Carolina
| | | | - Mary Howell
- 1 Four Seasons Compassion for Life , Flat Rock, North Carolina
| | - Mark Hendrix
- 1 Four Seasons Compassion for Life , Flat Rock, North Carolina
| | - Deeana Bennett
- 1 Four Seasons Compassion for Life , Flat Rock, North Carolina
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Bostwick D, Wolf S, Samsa G, Bull J, Taylor DH, Johnson KS, Kamal AH. Comparing the Palliative Care Needs of Those With Cancer to Those With Common Non-Cancer Serious Illness. J Pain Symptom Manage 2017; 53:1079-1084.e1. [PMID: 28457746 DOI: 10.1016/j.jpainsymman.2017.02.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 01/26/2017] [Accepted: 02/08/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Historically, palliative care has been focused on those with cancer. Although these ties persist, palliative care is rapidly integrating into the care of patients with common, non-cancer serious illnesses. Despite this, the bulk of literature informing palliative care practices stems from the care of cancer patients. OBJECTIVES We compared functionality, advanced care planning, hospital admissions, prognosis, quality of life, pain, dyspnea, fatigue, and depression between patients with cancer and three non-cancer diagnoses-end-stage renal disease (ESRD), heart failure (HF), and chronic obstructive pulmonary disease (COPD). METHODS We conducted a cross-sectional, retrospective analysis of the characteristics and symptoms of patient's with ESRD, HF, COPD, and cancer at time of first specialty palliative care referral. Using a web-based point of care quality assessment and reporting tool, Quality Data and Collection Tool-Palliative care, this analysis evaluated all eligible patients who received a palliative care consultation between October 1, 2012 and November 25, 2014. Data were obtained from 13 participating sites. The primary outcome for the study was functionality using the palliative performance scale. Hospital admission in the last 30 days, prognosis, patient's understanding of prognosis, advanced care planning including code status and appointed decision maker, pain, fatigue, depression, and dyspnea were also evaluated as secondary outcomes. We tested for an association between our outcomes with disease type (cancer vs. non-cancer) fitting multivariable logistic regression models. RESULTS We found that the patients with primary diagnoses other than cancer were less functional at time of referral (odds ratio: 1.6; 95% CI: 1.1, 2.3; P < 0.05). CONCLUSION Patients with COPD, ESRD, and HF were less functional and more likely to be hospitalized at time of referral to palliative care than cancer patients. These findings may be reflective of the slower and more varied trajectory of non-cancer serious illness. One aim of palliative care for those with non-cancer severe illness should be directed toward improving and assisting with functionality and decreasing frequency of hospital admissions. These interventions could take place in the palliative care office, but could also be integrated into hospital discharge plans.
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Affiliation(s)
- Doran Bostwick
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Greg Samsa
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Janet Bull
- Four Seasons, Hendersonville, North Carolina, USA
| | - Donald H Taylor
- Sanford School of Public Policy, Durham, North Carolina, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arif H Kamal
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA.
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Currow DC, Davidson PM, Higginson IJ. “Outcomes” Is Not an Oxymoron in Hospice/Palliative Care. J Palliat Med 2016; 19:1128-1129. [DOI: 10.1089/jpm.2016.0427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David C. Currow
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Southern Adelaide Palliative Services, Daw Park, South Australia, Australia
| | | | - Irene J. Higginson
- Cicely Saunders Institute, King's College London, England, United Kingdom
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