Advanced life support resources are required for optimal care of patients undergoing curative therapy, but their use in patients with terminal disease does not improve patient outcomes. A study found that a new multidisciplinary team approach for discussion of end-of-life care issues with patients may help decrease the use of intensive care during hospitalizations of patients with advanced cancer, without reducing the proportion of patients who survive to be discharged from the hospital. Thestudy wasreleased in a presscast today in advance of ASCO?s inaugural 2012 Quality Care Symposium.

The Symposium will take place November 30 ? December 1, 2012, at the Manchester Grand Hyatt in San Diego, CA andincludes more than 330 abstracts covering topics, such as reducing overuse of tests and procedures, improving patient-physician communication, effectively measuring quality of care, and applying advanced health information technology to improve the quality and value of care.

The multidisciplinary team assessed in this study included a range of specialists from the Sidney Kimmel Comprehensive Cancer Centerat Johns Hopkins University.

End-of Life
The findings suggest that engaging a multidisciplinary pain and palliative care team enhances the quality of communication regarding care options for patients with cancer who are nearing the end of life. ?The multidisciplinary team?s goal is to support patients and families to relieve suffering, while still working as hard as ever to help patients with favorable prognoses maximize the length and quality of their lives. A better understanding of the benefits and limitations of intensive care in such circumstances seems to steer more patients towards electing palliative care and withdrawal from ICU support,? said lead author Allen Ray Sing Chen, MD, PhD, MHS, associate professor of oncology and pediatrics at Johns Hopkins University.

Non-code status
Over the first four years of the program, researchers observed a significant, gradual increase (81 to 95%) in no-code status (patient declining to have any lifesaving measures taken in the event of cardiopulmonary arrest), election of palliative care, and withdrawal from ICU support. Although the proportion of patients who received ICU care during their final hospitalization did not change, the proportion of patients receiving mechanical ventilation support for more than 14 days decreased from 10% to 5%.

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During those four years, cancer center staff received regular feedback on each patient?s code status at death (525 patients passed away while hospitalized at the center in that time period). Utilization of ICU care was identified from billing data and chart review. The rates of survival to discharge among patients who received ICU care while hospitalized were monitored as a component of the patient safety dashboard ? a spreadsheet that allows health care leaders to monitor the most important measures of health care quality and alerts them of major hazards in real time.

Multidisciplinary team
The Duffey Pain and Palliative team of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University started in 2007 as a consultative service for patients receiving active treatment. The team, comprised of two nurses, a social worker, a palliative care physician, a pharmacist, a nutritionist and a chaplain, now provides comprehensive services, including symptom control and emotional support for patients before, during, and after hospitalization. ?The team regularly reviews patient cases and discusses strategies for helping patients navigate these difficult decisions,? Chen noted.

Johns Hopkins also provides education on palliative care for medical students and residents, as well as consultation services for the faculty.

Oral Abstract: Session A
Date: Friday, November 30, 2012, 10:30-10:40 AM PST
Location: Douglas Pavilion B
Author: Allen Ray Sing Chen, MD, PhD, MHS, The Armstrong Institute for Patient Safety and Quality The Sidney Kimmel Comprehensive, Cancer Center at Johns Hopkins University Baltimore, Md.
Abstract: #1
Title: Utilization of intensive care resourcesdue to better communication of end-of-life issues.

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