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Effect of the serious illness care program on health care utilization at the end of life for patients with cancer
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Objectives: To determine the effect of the Serious Illness Care Program on health care utilization at the end of life in oncology.
Design: Analysis of the secondary outcome of health care utilization as part of a cluster-randomized clinical trial that ran from 2012 to 2016. Clinicians in the intervention group received training, coaching, and system supports to have discussions with patients using a Serious Illness Conversation Guide (SICG); clinicians in the control arm followed usual care.
Setting/Subject: Patients with advanced cancer who died within two years of enrollment at the Dana-Farber Cancer Institute.
Measurement: Health care utilization was abstracted from the electronic medical record using the National Quality Forum (NQF)-endorsed indicators of aggressive cancer care at the end of life and scored from 0 to 6 (one point for each aggressive indicator); t tests and chi-square tests were used to determine differences between intervention and control patients.
Results: The charts of 159 patients who died were reviewed. Neither the main outcome of mean number of aggressive indicators (0.9 vs. 0.9, p = 0.84) nor the proportion of patients with any aggressive care (49% intervention [95% CI: 40–57] vs. 54% control [95% CI: 42–67]) differed between patients in the intervention and control groups.
Conclusion: In this analysis of a secondary outcome from a randomized clinical trial of the Serious Illness Care Program, intervention and control patients had similar end-of-life health care utilization as measured by the mean number of NQF-endorsed indicators. Future research efforts should focus on studying the strategies by which communication about patients' prognosis, values, and goals leads to personalized care plans.
http://dx.doi.org/10.1089/jpm.2019.0437
Voir la revue «JOURNAL OF PALLIATIVE MEDICINE, 23»
Autres numéros de la revue «JOURNAL OF PALLIATIVE MEDICINE»
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