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Background Patients with metastatic non–small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life…

Evaluation and Quality Assessment; End-of-Life Care in ..

Let's rank hospitals by the quality of their end-of-life care

Quality end-of-life care has emerged as an important concept in industrialized countries
Participants completed baseline questionnaires before randomization. Follow-up assessments of quality of life and mood were performed at 12 weeks (or at an outpatient clinic visit within 3 weeks before or after that time point). Participants who had no scheduled clinic visits within this period received the questionnaires by mail. When responses on questionnaires were incomplete, research staff documented the reasons for which the participant did not give a full response.

Quality in End-of-Life Care – Lishman Health Foundation

Pain and symptoms are expertly managed to promote comfort and quality of life at the end of life
This study shows the effect of palliative care when it is provided throughout the continuum of care for advanced lung cancer. Early integration of palliative care with standard oncologic care in patients with metastatic non–small-cell lung cancer resulted in survival that was prolonged by approximately 2 months and clinically meaningful improvements in quality of life and mood. Moreover, this care model resulted in greater documentation of resuscitation preferences in the outpatient electronic medical record, as well as less aggressive care at the end of life. Less aggressive end-of-life care did not adversely affect survival. Rather, patients receiving early palliative care, as compared with those receiving standard care alone, had improved survival. Previous data have shown that a lower quality of life and depressed mood are associated with shorter survival among patients with metastatic non–small-cell lung cancer. We hypothesize that improvements in both of these outcomes among patients assigned to early palliative care may account for the observed survival benefit. In addition, the integration of palliative care with standard oncologic care may facilitate the optimal and appropriate administration of anticancer therapy, especially during the final months of life. With earlier referral to a hospice program, patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival. These hypotheses require further study.

 

care - Dizionario inglese-italiano WordReference

23/05/2016 · Hospice offers quality of life care to people who are terminally ill who are at the end of life and may no longer wish to undergo treatment. .
A total of 151 patients were enrolled in the study (see the figure in the ). The percentage of patients enrolled was similar for each of the thoracic oncologists in the clinic. No significant differences in demographic characteristics or overall survival were seen between the study participants and eligible patients who were not enrolled in the study. The baseline characteristics were well matched between the two study groups (). Known prognostic factors, including age, sex, ECOG performance status, presence or absence of brain metastases, smoking status, and initial anticancer therapy, were also balanced between the study groups. Although genetic testing was not routinely performed, the proportions of patients with mutations in the epidermal growth factor gene () were similar between the study groups among the patients who underwent testing (9% in the palliative care group and 12% in the standard-treatment group, P=0.76). No significant between-group differences were seen in baseline quality of life or mood symptoms.

Objectives. The aim was to examine associations among ADs, quality of life, and estimated costs of care in the week before death.
Metastatic non–small-cell lung cancer, the leading cause of death from cancer worldwide, is a debilitating disease that results in a high burden of symptoms and poor quality of life; the estimated prognosis after the diagnosis has been established is less than 1 year. We previously found that introducing palliative care shortly after diagnosis was feasible and acceptable among outpatients with metastatic non–small-cell lung cancer. The goal of the current study was to examine the effect of early palliative care integrated with standard oncologic care on patient-reported outcomes, the use of health services, and the quality of end-of-life care among patients with metastatic non–small-cell lung cancer. We hypothesized that patients who received early palliative care in the ambulatory care setting, as compared with patients who received standard oncologic care, would have a better quality of life, lower rates of depressive symptoms, and less aggressive end-of-life care.


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The quality of care and the use of medical services for seriously ill patients are key elements in the ongoing debate over reform of the U.S. health care system. Oncologic care is central to this debate, largely because anticancer treatments are often intensive and costly. Comprehensive oncologic services for patients with metastatic disease would ideally improve the patients' quality of life and facilitate the efficient allocation of medical resources. Palliative care, with its focus on management of symptoms, psychosocial support, and assistance with decision making, has the potential to improve the quality of care and reduce the use of medical services. However, palliative care has traditionally been delivered late in the course of disease to patients who are hospitalized in specialized inpatient units or as a consultative service for patients with uncontrolled symptoms. Previous studies have suggested that late referrals to palliative care are inadequate to alter the quality and delivery of care provided to patients with cancer. To have a meaningful effect on patients' quality of life and end-of-life care, palliative care services must be provided earlier in the course of the disease.

Agency for Healthcare Research & Quality

Data were collected from the electronic medical record on the use of health services and end-of-life care, including anticancer therapy, medication prescriptions, referral to hospice, hospital admissions, emergency department visits, and the date and location of death. Patients were classified as having received aggressive care if they met any of the following three criteria: chemotherapy within 14 days before death, no hospice care, or admission to hospice 3 days or less before death. Finally, we assessed whether patients' resuscitation preferences were documented in the outpatient electronic medical record.