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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 4 of 4 Research Studies DisplayedEaton TL, Lincoln TE, Lewis A
Palliative care in survivors of critical illness: a qualitative study of post-intensive care unit program clinicians.
This paper’s goal was to understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and to explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. The authors conducted semistructured interviews with 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. All clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. These clinician-level facilitators promoted palliative care strategies including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers discussed included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers mentioned were time constraints, cost, and lack of specialty palliative care services.
AHRQ-funded; HS027210.
Citation: Eaton TL, Lincoln TE, Lewis A .
Palliative care in survivors of critical illness: a qualitative study of post-intensive care unit program clinicians.
J Palliat Med 2023 Dec; 26(12):1644-53. doi: 10.1089/jpm.2023.0034..
Keywords: Palliative Care, Critical Care
Guo W, Cai S, Caprio T
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
This study’s objective was to examine the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. This cohort study included Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). The authors found end-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08] and direct care worker staffing (IRR = 1.22). Greater regulatory specificity of direct care worker training (IRR = 0.75) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15) and training (IRR = 0.79) and transitions within 30 days of death. There were significant variations in the number of care transitions in different states.
AHRQ-funded; HS026893.
Citation: Guo W, Cai S, Caprio T .
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
J Am Med Dir Assoc 2023 Jun; 24(6):827-32.e3. doi: 10.1016/j.jamda.2023.02.002..
Keywords: Transitions of Care, Long-Term Care, Policy, Palliative Care, Elderly
Wu A, Zhou J, Quinlan N
Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: insights from a level 1 trauma center.
The purpose of this study was to identify variables and outcomes related to inpatient palliative care (PC) consultation for patients age 65+ with traumatic brain injuries (TBI). The researchers included individuals over age 65 presenting from January 2013-September 2020 with TBI and intracranial hemorrhage. The study found that inpatient PC consultation was uncommon; with only 4% of 576 patients receiving. Features associated with likelihood of consultation were severe TBI and pre-existing dementia. Patients with PC consults had longer overall and intensive care unit (ICU) length of stays (LOS), more days intubated and higher costs. However, those patients with earlier-than-average PC consultation had shorter overall and ICU LOS as well as fewer ventilator days on a ventilator and lower costs. The study concluded that older patients with TBI have a greater likelihood of receiving PC consultation based on pre-existing dementia and severe TBI and patients with PC consultations had worse LOS and higher costs, but those impacts were diminished by earlier involvement from the PC.
AHRQ-funded; HS028747.
Citation: Wu A, Zhou J, Quinlan N .
Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: insights from a level 1 trauma center.
J Clin Neurosci 2023 Feb; 108:1-5. doi: 10.1016/j.jocn.2022.12.013..
Keywords: Elderly, Palliative Care, Hospitalization, Brain Injury
Stockdill ML, Dionne-Odom JN, Wells R
African American recruitment in early heart failure palliative care trials: outcomes and comparison with the ENABLE CHF-PC randomized trial.
This study examined African American (AA) clinical trial recruitment and enrollment in a palliative care randomized controlled trial (RCT) for heart failure (HF) patients and compared patient baseline characteristics to other HF palliative care RCTs. The authors used the ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends: Comprehensive Heartcare for Patients and Caregivers) RCT using bivariate statistics to compare racial and patient characteristics and differences through recruitment stages. They then compared the baseline sample characteristics among three palliative HF trials. They screened 785 patients, of whom 566 with NYHA classification III-IV were approached, with 461 enrolled and then 415 randomized. African Americans were more likely to consent than Caucasians (55%), were younger, had a lower ejection fraction, were more likely to be single, and lack an advanced directive. AAs reported higher goal setting, care coordination, and used more “denial” coping strategies. Compared to two recent HF RCTs, the ENABLE CHF-PC sample had a higher proportion of AAs.
AHRQ-funded; HS013852.
Citation: Stockdill ML, Dionne-Odom JN, Wells R .
African American recruitment in early heart failure palliative care trials: outcomes and comparison with the ENABLE CHF-PC randomized trial.
J Palliat Care 2023 Jan;38(1):52-61. doi: 10.1177/0825859720975978..
Keywords: Racial and Ethnic Minorities, Palliative Care, Heart Disease and Health, Cardiovascular Conditions