Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014

• Published in: Journal of palliative care Vol. 34; no. 4; pp. 232 - 240
• Main Authors: Liu, Xibei, Shen, Jay J., Kim, Pearl, Kim, Sun Jung, Ukken, Johnson, Choi, Younseon, Hwang, In Choel, Lee, Jae-Hoon, Chun, Sung-Youn, Hwang, Jinwook, Choi, Haneul, Yeom, Hyeyoung, Lee, Yong-Jae, Yoo, Ji Won
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-10-2019; SAGE PUBLICATIONS, INC
• Subjects: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Chronic illnesses; Cross-Sectional Studies; Death & dying; Female; Forecasting; Hospice care; Hospitalization; Hospitals; Hospitals - statistics & numerical data; Hospitals - trends; Humans; Life Support Systems - statistics & numerical data; Male; Medical procedures; Middle Aged; Palliative care; Palliative Care - statistics & numerical data; Palliative Care - trends; Pancreatic cancer; Pancreatic Diseases - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patients; Surgery; Terminally Ill - psychology; Terminally Ill - statistics & numerical data; Trends; United States; Young Adult; United States; United States > US; time series analysis; health policy; hospital; palliative care; pancreas
• ISSN: 0825-8597; 2369-5293
• DOI: 10.1177/0825859719827313

Aim:
Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined.
Methods and Materials:
A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ2 statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation.
Results:
Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were −4.19% (P = .008), 2.17%, −1.40%, and 14.03% (P < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation (Ps < .001).
Conclusions:
Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased.