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- Cancer (3)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 12 of 12 Research Studies DisplayedChyr LC, DeGroot L, Waldfogel JM
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
The purpose of this study was to assess the implementation of models for integrating palliative care into ambulatory care for adults with noncancer serious chronic illness. Between January 2000 to May 2020, the researchers reviewed 3 electronic databases and included qualitative, mixed methods studies, and randomized and nonrandomized controlled trial studies. Quantitative analysis included 14 studies of 2,934 US adult patients. The study found that when compared to usual care the models assessed were not more effective for improving patient health-related quality of life (HRQOL) or for patient depressive symptom scores. Qualitative analysis included 5 studies of 146 patients. There was variance in patient preferences for appropriate timing of palliative care; barriers to implementation included costs, additional visits, and travel. The researchers concluded that models were not more effective than usual care for improving HRQOL or depressive symptom scores and may have little to no effect on decreasing overall symptom burden but were more effective for increasing AD documentation.
AHRQ-funded; 2902015000061
Citation: Chyr LC, DeGroot L, Waldfogel JM .
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
Ann Fam Med 2022 Jan-Feb;20(1):77-83. doi: 10.1370/afm.2754..
Keywords: Chronic Conditions, Palliative Care, Implementation, Patient-Centered Healthcare, Quality of Life
Marcus KL, Kao PC, Ma C
Symptoms and suffering at end of life for children with complex chronic conditions.
The objective of this study was to evaluate symptoms and suffering at end of life for children with noncancer, noncardiac complex chronic conditions (CCCs), as well as parental distress related to their child’s suffering. Nearly one-third of bereaved parents of children with CCCs who completed the survey reported high suffering in their child's final days of life. Parental preparedness was associated with lower perceived suffering. The authors concluded that future research should target symptoms contributing to parent and child distress and assess whether enhancing parent preparedness reduces perceived child suffering.
AHRQ-funded; HS022986.
Citation: Marcus KL, Kao PC, Ma C .
Symptoms and suffering at end of life for children with complex chronic conditions.
J Pain Symptom Manage 2022 Jan; 63(1):88-97. doi: 10.1016/j.jpainsymman.2021.07.010..
Keywords: Children/Adolescents, Chronic Conditions, Palliative Care, Pain
Bogetz JF, Revette A, DeCourcey DD
Clinical care strategies that support parents of children with complex chronic conditions.
This paper examines the best clinical care strategies that support parents of children with complex chronic conditions facing inpatient and end-of-life care in the ICU. Qualitative analysis of 21 open-response items from the cross-sectional “Survey of Caring for Children with Complex Chronic Conditions” was done. Open-ended responses from 110 of 114 survey respondents who were parents of children who received care at a large academic institution and died between 2006 and 2015 were analyzed. Most of the children had congenital/chromosomal complex chronic conditions and had died an average of 3.9 years prior to their parents’ study participation. The respondents emphasized the relational aspects of clinical care including inclusivity of their expertise on their child’s needs, recognition of their unique experiences as parents, and maintenance of connection with clinicians through bereavement.
AHRQ-funded; HS022986.
Citation: Bogetz JF, Revette A, DeCourcey DD .
Clinical care strategies that support parents of children with complex chronic conditions.
Pediatr Crit Care Med 2021 Jul;22(7):595-602. doi: 10.1097/pcc.0000000000002726..
Keywords: Children/Adolescents, Chronic Conditions, Palliative Care, Inpatient Care
Lee K, Gani F, Canner JK
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
The primary objective of this study was to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Hospital admissions of patients with advanced cancers were identified through the National Inpatient Dataset. Findings showed that death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There were significant racial disparities in the utilization of IPCC for patients with advanced cancer.
AHRQ-funded; HS024736.
Citation: Lee K, Gani F, Canner JK .
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
Am J Hosp Palliat Care 2021 Jun;38(6):539-46. doi: 10.1177/1049909120922779..
Keywords: Healthcare Cost and Utilization Project (HCUP), Palliative Care, Cancer, Disparities, Racial and Ethnic Minorities, Healthcare Utilization, Inpatient Care, Chronic Conditions
Bogetz JF, Revette A, Rosenberg AR
"I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions.
This study’s goal was to elucidate aspects important to preparedness at end of life (EOL) among bereaved parents of children with complex chronic conditions (CCCs). Participants answered 21 open-response queries on communication, decision-making, and EOL experiences as part of the Survey of Caring for Children with CCCs. Findings showed that most bereaved parents of children with CCCs described feeling unprepared for their child's EOL, despite palliative care and advance care planning, suggesting preparedness is a nuanced concept beyond "readiness." Recommendations included more research to identify supportive elements among parents facing their child's EOL.
AHRQ-funded; HS022986.
Citation: Bogetz JF, Revette A, Rosenberg AR .
"I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions.
J Pain Symptom Manage 2020 Dec;60(6):1154-62.e1. doi: 10.1016/j.jpainsymman.2020.06.035..
Keywords: Children/Adolescents, Caregiving, Mortality, Chronic Conditions, Palliative Care
Knutzen KE, Schifferdecker KE, Murray GF
Role of norms in variation in cancer centers' end-of-life quality: qualitative case study protocol.
AHRQ-funded; HS022242.
Citation: Knutzen KE, Schifferdecker KE, Murray GF .
Role of norms in variation in cancer centers' end-of-life quality: qualitative case study protocol.
BMC Palliat Care 2020 Aug 27;19(1):136. doi: 10.1186/s12904-020-00641-x..
Keywords: Cancer, Quality of Life, Palliative Care, Quality of Care, Chronic Conditions
Hadler RA, Curtis BR, Ikejiani DZ
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
This cohort study examined individuals with New York Heart Association Class II-IV disease attitude towards palliative care (PC). Participants were recruited from inpatient and outpatient settings at an academic quaternary care hospital. They were given semistructured interviews discussing perceptions, knowledge, and preferences regarding PC, and also barriers to to PC delivery by facilitators. They interviewed 27 adults with heart failure (mean age 63, 85% white, 63% male). Participants frequently confused PC with hospice but once corrected they expressed variable preferences for primary versus specialist services. Preferences for primary versus specialist PC were based on different factors. Although there was more understanding of PC after the interviews, triggers for initiation remained focused on late-stage disease.
AHRQ-funded; HS022989.
Citation: Hadler RA, Curtis BR, Ikejiani DZ .
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
J Palliat Med 2020 Jul;23(7):915-21. doi: 10.1089/jpm.2019.0451..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Palliative Care, Clinician-Patient Communication, Communication, Chronic Conditions
Iyer AS, Goodrich CA, Dransfield MT
End-of-life spending and healthcare utilization among older adults with chronic obstructive pulmonary disease.
This study examined end-of-life spending and healthcare utilization among Medicare beneficiaries aged 65 years or older with chronic obstructive pulmonary disease (COPD) who died during the period 2013-2014. Data on 146,240 decedents with COPD was investigated from 306 hospital referral regions (HRRs). The overall spending during the last 2 years of life varied significantly nationwide. Inpatient care accounted for 40.2% of spending, with 82% of decedents admitted to the hospital for 13.7±3.1 days and 55%±11% admitted to an intensive care unit for 3-7 days. Skilled nursing facilities accounted for 11.6% of spending and were utilized by 31-45% of decedents for 14-23 days. Hospitals were utilized by 39-56% of decedents and accounted for 10.3% of spending.
AHRQ-funded; HS023009.
Citation: Iyer AS, Goodrich CA, Dransfield MT .
End-of-life spending and healthcare utilization among older adults with chronic obstructive pulmonary disease.
Am J Med 2020 Jul;133(7):817-24.e1. doi: 10.1016/j.amjmed.2019.11.024..
Keywords: Elderly, Healthcare Utilization, Respiratory Conditions, Chronic Conditions, Healthcare Costs, Palliative Care
Iyer AS, Benzo RP, Bakitas MA
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
This editorial discusses palliative care and intensive care in chronic obstructive pulmonary disease and comments on an article by Shen, et al., published, in 2018, in the Journal of Palliative Care, entitled “Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.”
AHRQ-funded; HS023009.
Citation: Iyer AS, Benzo RP, Bakitas MA .
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
J Palliat Care 2018 Jul;33(3):123-24. doi: 10.1177/0825859718782505..
Keywords: Chronic Conditions, Respiratory Conditions, Critical Care, Elderly, Palliative Care, Quality of Care
DeCourcey DD, Silverman M, Oladunjoye A
Patterns of care at the end of life for children and young adults with life-threatening complex chronic conditions.
The purpose of this study, which used a cross sectional survey, was to characterize patterns of care at the end of life for children and young adults with life-threatening complex chronic conditions (LT-CCCs) and to compare them by LT-CCC type. The investigators concluded that significant differences in patterns of care at the end of life existed depending on LT-CCC type. They suggest that attention to these patterns is important to ensure equal access to palliative care and targeted improvements in end-of-life care for these populations.
AHRQ-funded; HS022986.
Citation: DeCourcey DD, Silverman M, Oladunjoye A .
Patterns of care at the end of life for children and young adults with life-threatening complex chronic conditions.
J Pediatr 2018 Feb;193:196-203.e2. doi: 10.1016/j.jpeds.2017.09.078..
Keywords: Children/Adolescents, Chronic Conditions, Palliative Care, Practice Patterns, Young Adults
Ananth P, Melvin P, Feudtner C
Hospital use in the last year of life for children with life-threatening complex chronic conditions.
The researchers assessed hospital resource use in children by type and number of life-threatening complex chronic conditions (LT-CCCs). They found that hospital use for children with LT-CCCs in the last year of life varies significantly across the type and number of conditions. Children with hematologic/ immunologic or multiple conditions have the greatest hospital use.
AHRQ-funded; HS023092.
Citation: Ananth P, Melvin P, Feudtner C .
Hospital use in the last year of life for children with life-threatening complex chronic conditions.
Pediatrics 2015 Nov;136(5):938-46. doi: 10.1542/peds.2015-0260..
Keywords: Chronic Conditions, Children/Adolescents, Hospitalization, Palliative Care
Kavalieratos D, Kamal AH, Abernethy AP
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
This study characterized the unresolved symptom and treatment needs which patients with heart failure and those with cancer present to palliative care. It found that patients with HF presented with fewer unresolved symptoms; however, they were more likely to report dyspnea and more commonly experienced dyspnea-related treatment gaps.
AHRQ-funded; HS000032; HS017587
Citation: Kavalieratos D, Kamal AH, Abernethy AP .
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
J Palliat Med. 2014 Apr;17(4):475-81. doi: 10.1089/jpm.2013.0526..
Keywords: Palliative Care, Cancer, Heart Disease and Health, Chronic Conditions