The purpose of this study is to evaluate the clinical outcomes of palliative care consultation teams on the care of hospitalized patients with advanced cancer. Repeated studies have demonstrated high rates of untreated symptom distress, poor doctor-patient communication about the goals of medical care and high levels of fragmentation and discontinuity of medical care between settings. Palliative care consultation teams have been shown in small preliminary studies to improve the identification and treatment of pain and symptoms;to increase the occurrence of goal setting discussions and appropriate discharge planning;and to improve family satisfaction with care. However, these studies have not explicated the structures and processes of care linked to the achievement of these outcomes. This proposal will assess the structure, processes, and clinical outcomes of care among hospitalized persons with advanced cancer that receive palliative care consultation team services as compared to similar patients receiving usual hospital care. We will accomplish this by studying an evidence-based standardized approach to palliative care consultation at five hospitals with well-established palliative care consultation teams, utilizing existing National Comprehensive Cancer Network-American Society of Clinical Oncology practice guidelines and protocols for pain and symptom management, patient-care team communication, and transition management. Employing validated and actionable assessment instruments, we will examine the effect of palliative care consultation teams on patient and family outcomes (pain and symptom intensity, satisfaction with care), process measures (analgesic prescribing, symptom assessment, goals of care discussions, care transition management, and advance care planning), and utilization (hospital and ICU lengths of stay, hospital readmission, and hospital costs) compared to usual care for adults hospitalized with advanced malignancies. We propose to accomplish these aims by conducting a multi-site observational controlled trial of palliative care consultation with adequate power to detect clinically meaningful differences using a novel application of the propensity score method to reduce selection bias. Reproducible structures and processes for the PCCTs will allow successful components of the program to be readily adopted and operationalized at a range of hospital types.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA116227-04
Application #
7676834
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
O'Mara, Ann M
Project Start
2006-09-30
Project End
2011-07-31
Budget Start
2009-08-01
Budget End
2010-07-31
Support Year
4
Fiscal Year
2009
Total Cost
$1,496,472
Indirect Cost
Name
Icahn School of Medicine at Mount Sinai
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
May, Peter; Garrido, Melissa M; Cassel, J Brian et al. (2017) Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from? Palliat Med 31:378-386
May, Peter; Garrido, Melissa M; Cassel, J Brian et al. (2016) Palliative Care Teams' Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities. Health Aff (Millwood) 35:44-53
May, Peter; Garrido, Melissa M; Cassel, J Brian et al. (2016) Using Length of Stay to Control for Unobserved Heterogeneity When Estimating Treatment Effect on Hospital Costs with Observational Data: Issues of Reliability, Robustness, and Usefulness. Health Serv Res 51:2020-43
Teresi, Jeanne A; Ocepek-Welikson, Katja; Ramirez, Mildred et al. (2015) Evaluation of measurement equivalence of the Family Satisfaction with the End-of-Life Care in an ethnically diverse cohort: tests of differential item functioning. Palliat Med 29:83-96
Ornstein, Katherine A; Teresi, Jeanne A; Ocepek-Welikson, Katja et al. (2015) Use of an Item Bank to Develop Two Short-Form FAMCARE Scales to Measure Family Satisfaction With Care in the Setting of Serious Illness. J Pain Symptom Manage 49:894-903.e1-4
Teresi, Jeanne A; Ornstein, Katherine; Ocepek-Welikson, Katja et al. (2014) Performance of the Family Satisfaction with the End-of-Life Care (FAMCARE) measure in an ethnically diverse cohort: psychometric analyses using item response theory. Support Care Cancer 22:399-408
Paris, Julia; Morrison, R Sean (2014) Evaluating the effects of inpatient palliative care consultations on subsequent hospice use and place of death in patients with advanced GI cancers. J Oncol Pract 10:174-7
Garrido, Melissa M; Kelley, Amy S; Paris, Julia et al. (2014) Methods for constructing and assessing propensity scores. Health Serv Res 49:1701-20
Salloum, Ramzi G; Smith, Thomas J; Jensen, Gail A et al. (2012) Survival among non-small cell lung cancer patients with poor performance status after first line chemotherapy. Lung Cancer 77:545-9
Smith, T J; Coyne, P J; Cassel, J B (2012) Practical guidelines for developing new palliative care services: resource management. Ann Oncol 23 Suppl 3:70-5

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