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Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification

Lauren T Starr1,2, Connie M Ulrich1,3, Paul Junker4

  • 1NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

The American Journal of Hospice & Palliative Care
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PubMed
Summary

Most seriously ill patients receive palliative care consultation (PCC) close to death. Identifying patient profiles for early PCC is crucial for improving end-of-life care discussions and patient outcomes.

Keywords:
communicationend of lifegoals of careintensive carepalliative careracial disparitiesterminal caretiming before death

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Area of Science:

  • Palliative Care Medicine
  • Health Services Research
  • Geriatric Medicine

Background:

  • Early palliative care consultation (PCC) is vital for discussing goals-of-care in seriously ill patients.
  • Understanding risk factors for the timing of these conversations is needed, as late discussions are common in hospitals.

Purpose of the Study:

  • To identify patient profiles associated with the timing of palliative care consultation (PCC) before death.
  • To analyze demographic and clinical factors influencing when seriously ill patients receive PCC.

Main Methods:

  • Secondary analysis of an observational study at an urban academic medical center.
  • Included patients aged 18+ who received PCC and died between July 2014 and October 2016.
  • Classification and Regression Tree modeling used to identify risk factors for PCC timing.

Main Results:

  • 54% of 1141 patients received PCC within 14 days of death; 21% received it over 60 days prior.
  • Hispanic/Other race/ethnicity, intensive care unit (ICU) patients with extreme illness severity, and specific age groups (<46 or >75) were associated with late PCC.
  • ICU patients, regardless of severity, were more likely to receive PCC close to death.

Conclusions:

  • A majority of patients receive palliative care consultation late in their illness trajectory.
  • Complex interactions of patient variables influence PCC timing, highlighting a need for earlier, systematic engagement.
  • Earlier PCC, especially for ICU patients irrespective of illness severity, is recommended to improve end-of-life care planning.