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Gitau K, Huang A, Isenberg SR, Stall N, Ailon J, Bell CM, Quinn KL. Association of patient sex with use of palliative care in Ontario, Canada: a population-based study. CMAJ Open 2023; 11:E1025-E1032. [PMID: 37935486 PMCID: PMC10635704 DOI: 10.9778/cmajo.20220232] [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] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND It is unclear whether there are sex-based differences in use of palliative care near the end of life. The objective of this study was to measure the association between sex and palliative care use. METHODS We performed a population-based retrospective cohort study of all patients aged 18 years or older in the last year of life who died in Ontario, Canada, between 2010 and 2018. The primary exposure was patient biologic sex (male or female). The primary outcome was receipt of physician-delivered palliative care; secondary outcomes were approach to in-hospital palliative care and sex concordance of the patient and referring physician. We used multivariable modified Poisson regression to measure the association between patient sex and palliative care receipt, as well as patient-physician sex concordance. RESULTS There were 706 722 patients (354 657 females [50.2%], median age 80 yr [interquartile range 69-87 yr]) in the study cohort, 377 498 (53.4%) of whom received physician-delivered palliative care. After adjustment for age and selected comorbidities, female sex was associated with a 9% relative increase (adjusted relative risk [RR] 1.09, 95% CI 1.08-1.10) in receipt of physician-delivered palliative care. Female patients were 16% more likely than male patients (adjusted RR 1.14, 95% CI 1.14-1.18) to have had their first hospital admission in their final year of life categorized as having a likely palliative intent. Female patients were 18% more likely than male patients (RR 1.18, 95% CI 1.17-1.19) to have had a female referring physician, and male patients were 20% more likely than female patients (adjusted RR 1.20, CI 1.19-1.21) to have had a male referring physician. INTERPRETATION After adjustment for age and comorbidities, male patients were slightly less likely than female patients to have received physician-delivered palliative care, and female patients were more likely than male patients to have had their first hospital admission in their final year of life categorized as having a likely palliative care intent. These results may reflect a between-sex difference in overall end-of-life care preferences or sex differences in decision-making influenced by patient-specific factors; further studies exploring how these factors affect end-of-life decision-making are required.
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Affiliation(s)
- Kevin Gitau
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Anjie Huang
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Sarina R Isenberg
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Nathan Stall
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Jonathan Ailon
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Chaim M Bell
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Kieran L Quinn
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.
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Sodhi A, Cox-Flaherty K, Greer MK, Lat TI, Gao Y, Polineni D, Pisani MA, Bourjeily G, Glassberg MK, D'Ambrosio C. Sex and Gender in Lung Diseases and Sleep Disorders: A State-of-the-Art Review: Part 2. Chest 2023; 163:366-382. [PMID: 36183784 PMCID: PMC10083131 DOI: 10.1016/j.chest.2022.08.2240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
There is now ample evidence that differences in sex and gender contribute to the incidence, susceptibility, presentation, diagnosis, and clinical course of many lung diseases. Some conditions are more prevalent in women, such as pulmonary arterial hypertension and sarcoidosis. Some life stages-such as pregnancy-are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as the higher number of exacerbations experienced by women with cystic fibrosis (CF), more fatigue in women with sarcoidosis, and more difficulty in achieving smoking cessation. Outcomes such as mortality may be different as well, as indicated by the higher mortality in women with CF. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors are often not adequately addressed in clinical trials. Various aspects of lung/sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for all patients. This article is the second part of a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of selected lung diseases. We review the more recent literature and focus on guidelines incorporating sex and gender differences in pulmonary hypertension, CF and non-CF bronchiectasis, sarcoidosis, restless legs syndrome and insomnia, and critical illness. We also provide a summary of the effects of pregnancy on lung diseases and discuss the impact of sex and gender on tobacco use and treatment of nicotine use disorder.
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Affiliation(s)
- Amik Sodhi
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Katherine Cox-Flaherty
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Meredith Kendall Greer
- Division of Pulmonary, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - Tasnim I Lat
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott & White Health, Temple, TX
| | - Yuqing Gao
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Deepika Polineni
- Division of Pulmonary, Critical Care and Sleep Medicine, Washington University at St. Louis, St. Louis, MO
| | - Margaret A Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Ghada Bourjeily
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Marilyn K Glassberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Carolyn D'Ambrosio
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
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Ploch M, Ahmed T, Reyes S, Irizarry-Caro JA, Fossas-Espinosa JE, Shoar S, Amatullah A, Jogimahanti A, Antonioli M, Iliescu CA, Balan P, Naeini PS, Madjid M. Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit. Resuscitation 2022; 181:190-196. [PMID: 36174763 DOI: 10.1016/j.resuscitation.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cardiopulmonary arrest often have a poor prognosis, prompting discussion with families about code status. The impact of socioeconomic factors, demographics, medical comorbidities and medical interventions on code status changes is not well understood. METHODS This retrospective study included adult patients presenting with cardiac arrest to the intensive care unit of a hospital group between 5/1/2010-5/1/2020. We extracted chart data on socioeconomic factors, demographics, and medical comorbidities. RESULTS We identified 1,254 patients, of which 57.5% were males. Age was different across the groups with (61.2 ± 15.5 years) and without (61.2 ± 15.5 years) code status change (p= <0.0001). Code status was changed in 583 patients (46.5%). Among patients with code status change, the highest prevalence was White patients (34.8%), followed by African Americans (30.9%), and Hispanics (25.4%). Compared to patients who did not have a code status change, those with a change in code status were older (66.7 ± 14.8 years vs 61.2 ± 15.5 years). They were also more likely to receive vasopressor/inotropic support (74.6% vs 58.5%), and broad-spectrum antibiotics (70.3% vs 57.7%). Insurance status, ethnicity, religion, education, and salary did not lead to statistically significant changes in code status. CONCLUSIONS In patients with cardiopulmonary arrest, code status change was more likely to be influenced by the presence of medical comorbidities and medical interventions during hospitalization rather than by socioeconomic factors.
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Affiliation(s)
- Michelle Ploch
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Talha Ahmed
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Stephan Reyes
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jorge A Irizarry-Caro
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose E Fossas-Espinosa
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saeed Shoar
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Atia Amatullah
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Arjun Jogimahanti
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Matthew Antonioli
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cesar A Iliescu
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prakash Balan
- Department of Cardiology, Banner University Medical Center, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Payam Safavi Naeini
- Center for Cardiac Arrhythmias and Electrophysiology, Texas Heart Institute, Houston, TX, United States
| | - Mohammad Madjid
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States; Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States.
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Paddley B, Espin S, Indar A, Rose D, Bookey-Bassett S. Communication of Code Status Escalation for Nurses and Physicians in the Intensive Care Unit: A Case Study. Can J Nurs Res 2022; 55:176-184. [PMID: 35538849 DOI: 10.1177/08445621221099117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Interprofessional teams working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient's code status can help clinicians to understand the appropriate life support measures to deliver to patients in this setting. Members of the interprofessional team, such as physicians and nurses, can experience challenges related to communication when the code status is unclear. PURPOSE The purpose of this study was to explore how nurses and physicians in the ICU experience communication of code status escalations. METHODS A qualitative case study approach was used. Participants were physicians and nurses, working in the medical-surgical ICU of a large, urban academic hospital. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. Data were analyzed using qualitative content analysis. RESULTS Thematic findings include: (1) engaging in an interprofessional discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the patient story. The study findings also provide contextual information about participants' experiences of code status communication during the first wave (February 2020 to May 2020) of the COVID-19 pandemic. CONCLUSIONS The results of this study could inform standard communication frameworks or practices related to dissemination of code status decisions among members of the ICU team.
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Affiliation(s)
- Brianna Paddley
- Medical Surgical Intensive Care Unit, 10071St. Michael's Hospital, Toronto, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Canada
| | - Alyssa Indar
- Faculty of Health Sciences and Wellness, 10025Humber College, Toronto, Canada
| | - Don Rose
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Canada
| | - Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Canada
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Bushunow V, Alamgir L, Arnold RM, Bell LF, Ivonye C, Johnson M, Kelsey R, Larbi D, Schenker Y. Palliative Care Attitudes and Experiences among Resident Physicians at Historically Black Colleges and Universities. J Pain Symptom Manage 2022; 63:106-111. [PMID: 34273523 DOI: 10.1016/j.jpainsymman.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT Seriously ill Black patients receive lower quality palliative care than White patients. Equitable access requires palliative care skills training for all physicians. Historically Black Colleges and Universities (HBCUs) play a key role in educating Black physicians and have less access to palliative care resources. OBJECTIVE To investigate palliative care attitudes and experiences among primary care residents at HBCUs. METHODS Internal Medicine and Family Medicine residents at two HBCUs completed an online survey assessing attitudes towards palliative care and teaching and clinical experiences in palliative care. We performed a descriptive analysis of survey items. RESULTS Among 91 residents who completed the survey (response rate 48%), 65% were women and 68% Black. Most (96%) said that learning about palliative care was moderately/very important to their career; however, two-thirds of respondents considered care for dying patients to be depressing and half reported receiving negative messages about palliative care from other physicians. Residents reported receiving less teaching about providing palliative care (5.4 ± 2.3 on 10-point scale) than about managing sepsis (8.3 ± 1.8; P < 0.05). Fewer residents rated their palliative care education as "Excellent" or "Very Good" compared to their overall education (13% vs 70%; P < 0.05). CONCLUSION In the first survey exploring palliative care education at HBCUs, residents viewed palliative care as important but described the quality of their palliative care education as poor. This study highlights opportunities for improving palliative care education at HBCUs as a step toward addressing disparities in serious illness care.
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Affiliation(s)
- Vasilii Bushunow
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Laila Alamgir
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC
| | - Robert M Arnold
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA; Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
| | - Lindsay F Bell
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA; Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
| | - Chinedu Ivonye
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Mark Johnson
- Department of Community and Family Medicine, Howard University College of Medicine, Washington, DC
| | - Riba Kelsey
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Daniel Larbi
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC
| | - Yael Schenker
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA; Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
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Helms J, De Jong A, Einav S. Yentl syndrome and the ICU. Intensive Care Med 2021; 47:594-597. [PMID: 33950371 DOI: 10.1007/s00134-021-06420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Julie Helms
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France. .,Laboratoire d'ImmunoRhumatologie Moléculaire, Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale (INSERM)UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NGFédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, CEDEX 5, Montpellier, France
| | - Sharon Einav
- University Faculty of Medicine, Intensive Care Unit of the Shaare Zedek Medical Medical Centre and 2Hebrew, Jerusalem, Israel
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