Resurrecting treatment histories of dead patients

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 05/2005; 293(13):1591-2; author reply 1592. DOI: 10.1001/jama.293.13.1591-b
Source: PubMed
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    • "Our retrospective design and the use of an established representative GP network allowed us to describe these differences on a population-based level in a representative sample of all deaths in Belgium. While retrospective designs may have their limitations to resurrect certain aspects of the treatment histories of dead patients [31] it is the most appropriate design to make population-based estimates about who received palliative care [32] [33]. This study also has several limitations. "
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    ABSTRACT: To describe how patients with COPD, heart failure, dementia and cancer differ in frequency and timing of referral to palliative care services. We performed a population-based study with the Sentinel Network of General Practitioners in Belgium. Of 2405 registered deaths respectively 5%, 4% and 28% were identified as from COPD, heart failure or cancer and 14% were diagnosed with severe dementia. GPs reported use and timing of palliative care services and treatment goals in the final three months of life. Patients with COPD (20%) were less likely than those with heart failure (34%), severe dementia (37%) or cancer (60%) to be referred to palliative care services (p < 0.001). The median days between referral and death was respectively 10, 12, 14 and 20. Patients with COPD who were not referred more often received treatment with a curative or life-prolonging goal and less often with a palliative or comfort goal than did the other patients who were not referred. Patients with COPD are underserved in terms of palliative care compared to those with other chronic life-limiting diseases. Awareness of palliative care as an option for patients with COPD needs to increase in palliative care services, physicians and the general public.
    Respiratory medicine 06/2013; 107(11). DOI:10.1016/j.rmed.2013.06.003 · 2.92 Impact Factor
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    • "Creating a decedent cohort to retrospectively evaluate services used in a time window prior to death has been criticized (Bach et al. 2004) and defended (Earle and Ayanian 2006; Teno and Mor 2005; Barnato and Lynn 2005) as a method to study end-of-life care. Both sides agree that this approach is reasonable to describe events very close to death (six months is close to death and two weeks is even closer), as used in the present study. "
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    ABSTRACT: This study describes acute care hospital death, physician house calls and home care near the end of life among patients who died of cancer and the factors that are associated with these events and services. It is a population-based retrospective study that uses linked administrative healthcare data. The cohort includes all patients who died of cancer between 2000 and 2004 in Ontario, Canada.Fifty-five per cent of patients died in acute care hospital, 68% received home care in the last 6 months of life and 24% received at least one physician house call in the last 2 weeks of life. Increased age was associated with a decreased likelihood of each event or service. Women were less likely to die in acute care and more likely to receive home care. Residents in low-income neighbourhoods were less likely to receive house calls or home care. Patients who received home care or house calls were less likely to die in acute care.Our observations add to those in the literature, suggesting a need to increase the use of supportive care services at the end of life in hopes of decreasing the need for acute care. They also serve as a baseline for future comparison, which is of particular interest since new government policies directed at end-of-life care were recently introduced.
    Healthcare policy = Politiques de sante 02/2010; 5(3):e125-43. DOI:10.12927/hcpol.2013.21644
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    ABSTRACT: To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death. A total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient. The island of Funen/Denmark. Main outcome--hospital death. Intermediate outcome--TD. A total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI: 0.11-0.29) and the group without TD (OR: 0.08; 95% CI: 0.05-0.13) was inversely associated with hospital death. A dose-response relationship was found in both groups. Persistent involvement by the GP is associated with improved end-of-life care for cancer patients. Provided that temporal relations are taken into account, the mortality follow-back design can be a suitable and ethical research method to highlight and monitor end-of-life cancer care.
    Palliative Medicine 08/2006; 20(5):507-12. DOI:10.1191/0269216306pm1169oa · 2.85 Impact Factor
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