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palliative care consultation

Also see: - palliative care - criteria for consideration of palliative care consult Clinical significance: - palliative care consultation in the MICU does not increase MICU or in hospital mortality, but may decrease MICU stay [1,2] - family members generally rate inpatient palliative care units better than standard care [2] - palliative care units generally have lower costs than standard care [2] - palliative care consultation is cost effective [3] - palliative care units do not have lower mortality than standard care [2] - among inpatients with advanced cancer, palliative care consultation was associated with lower hospital costs [5] - palliative care consultation in nursing homes reduces end-of-life hospitalizations & emergency department visits [7] - patients may complete advance directives & POLST forms during the consultation [8] - early palliative care consultation associated with likelihood of DNR code status, increased hospice use, & diminished utilitzation of ICU resources [9] - palliative care consultation for cancer patients at the end-of-life may reduce inappropriate antibiotic prescribing (also see antimicrobial stewardship) [10]

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criteria for consideration of palliative care consult palliative care

General

consultation

References

  1. Norton SA et al, Proactive palliative care in the medical intensive care unit: Effects of length of stay for selected high-risk patients. Crit Care Med 2007, 35:1530 PMID: 17452930 - Luce JM and White DB The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States. Am J Respir Crit Care Med 2007, 175:1104 PMID: 17379853
  2. Casarett D, Johnson M, Smith D, Richardson D. The optimal delivery of palliative care: A national comparison of the outcomes of consultation teams vs inpatient units. Arch Intern Med 2011; 171(7):649-655. PMID: 21482838 - Chai E, Meier DE. Invited Commentary: Identifying the effective components of palliative care: Comment on "The Optimal Delivery of Palliative Care." Arch Intern Med 2011; 171(7):655-656 PMID: 21482839
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  4. Morrison RS, Penrod JD, Cassel JB et al Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008 Sep 8;168(16):1783-90. PMID: 18779466
  5. May P et al. Prospective cohort study of hospital palliative care teams for inpatients with advanced cancer: Earlier consultation is associated with larger cost-saving effect. J Clin Oncol 2015 Sep 1; 33:2745 PMID: 26056178 http://jco.ascopubs.org/content/33/25/2745
  6. Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med. 2011 Jan;14(1):17-23. PMID: 21133809
  7. Miller SC, Dahal R, Lima JC et al Palliative Care Consultations in Nursing Homes and End-of-Life Hospitalizations. J Pain Symptom Manage. 2016 Sep 17. PMID: 27650008 - Miller SC, Lima JC, Intrator O, Martin E, Bull J, Hanson LC. Palliative care consultations in nursing homes and reductions in acute care use and potentially burdensome end-of-life transitions. J Am Geriatr Soc 2016 Nov; 64:2280 PMID: 27641157
  8. Bischoff K, O'Riordan DL, Marks AK, Sudore R, Pantilat SZ. Care planning for inpatients referred for palliative care consultation. JAMA Intern Med 2017 Nov 20; PMID: 29159371
  9. Ma J, Chi S, Buettner B et al. Early palliative care consultation in the medical ICU: A cluster randomized crossover trial. Crit Care Med 2019 Dec; 47:1707 PMID: 31609772
  10. Kim JH et al. The impact of palliative care consultation on reducing antibiotic overuse in hospitalized patients with terminal cancer at the end of life: A propensity score-weighting study. J Antimicrob Chemother 2022 Nov 25; dkac405; [e-pub]. PMID: 36424671 https://academic.oup.com/jac/advance-article-abstract/doi/10.1093/jac/dkac405/6845777