National trends in palliative care use among older adults with cardiopulmonary and malignant conditions.
Shelli L Feder, Raymond A Jean, Lori Bastian and 1 others
PMID 32115242WHAT IT FOUND
Palliative care consultations rose from 2008 to 2014, but older heart failure and COPD patients received less than cancer patients.
Consultation was most likely at age 85 plus, lower in for-profit hospitals, and lower for Black and Hispanic heart failure or COPD patients.
Key findings
01Palliative care consultation rates rose from 2008 to 2014 for heart failure, COPD, and malignant conditions.
02Older adults hospitalized with heart failure or COPD had lower palliative care consultation rates than those with malignant conditions.
03Older adults with heart failure or COPD were more likely to receive palliative care consultation if they were aged 85 plus, white, or hospitalized in non-for-profit settings.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Palliative care consultation was identified from discharge coding, so care not coded or delivered by non-specialists may have been missed. The coding may underestimate true palliative care use because sensitivity can vary. The study could not classify disease severity, which may affect whether palliative care was appropriate. The sample included all discharges, not only people who died in hospital, so some patients may not have had unmet palliative care needs. Race data were often missing, especially in earlier years, and missing race was kept as its own category.
Declared interests
The supplied text lists NIH extramural and U.S. government, non-PHS research support. No author conflict-of-interest statement is provided.
The easy way to misread this
Do not read the rising palliative care consultation rates as proof that palliative care improved outcomes. This study counted coded hospital consultations and did not measure symptoms, quality of life, mortality, or whether each patient needed palliative care.