Surgical versus medical team assignment and secondary palliative care services for patients dying in a cardiac hospital

Article

GANDESBERY, Benjamin | DOBBIE, Krista | JOYCE, Emer | HOEKSEMA, Laura | PEREZ PROTTO, Silvia | GORODESKI, Eiran Z.

BACKGROUND: Secondary palliative care (SPC) provides several benefits for patients with cardiovascular disease, but historically, it has been underutilized in this population. Prior research suggests a low rate of SPC consultation by surgical teams in general, but little is known about how surgical teams utilize SPC in the setting of severe cardiovascular disease. AIM: To determine if surgical team assignment affects the probability of SPC for inpatients dying of cardiovascular disease. DESIGN: Retrospective, cohort study. METHODS: We identified all inpatients at a large cardiac hospital who had anticipated death under the care of a cardiology, cardiac surgery, or vascular surgery team in 2016. Our primary outcome was referral to SPC, including palliative medicine consultation or inpatient hospice care. Informed by univariate analysis, we created a multivariable logistic regression model, the significance of which was assessed with the Wald test. RESULTS: Two hundred thirty-seven patients were included in our analysis: 93 (39%) received SPC and 144 (61%) were "missed opportunities." Secondary palliative care was less frequent in patients assigned to a surgical, versus medical, team (11% vs 47%, P < .001). On multivariate analysis, surgical versus medical team assignment was the strongest risk-adjusted predictor of SPC (odds ratio [OR]: 0.10, P < .001). Other predictors of SPC included do not resuscitate status on admission (OR: 14, P < .001), length of stay (OR = 1.05/day, P < .001), and having Medicare (OR = 3.9, P = .002). CONCLUSIONS: Primary inpatient care by a surgical team had a strong inverse relationship with SPC. This suggests a possible cultural barrier within surgical disciplines to SPC.

http://dx.doi.org/10.1177/1049909118819462

Voir la revue «The American journal of hospice and palliative care, 36»

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