title: Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients.
abstract: OBJECTIVE
  To examine the impact of oncologist awareness of palliative care (PC), the intervention of the PC team (PCT) and multidisciplinary decision-making on three quality indicators of end-of-life (EOL) care.
  
  
  METHODS
  Cochin Academic Hospital, Paris, 2007-2008.
  
  
  METHODS
  A 521 decedent case series study nested in a cohort of 735 metastatic cancer patients previously treated with chemotherapy. Indicators were location of death, number of emergency room (ER) visits in last month of life and chemotherapy administration in last 14 days of life. Multivariable logistic regression models were used to estimate associations between indicators and oncologist's awareness of PC, PCT intervention and case discussions at weekly onco-palliative meetings (OPMs).
  
  
  RESULTS
  58 (11%) patients died at home, 45 (9%) in an intensive care unit or ER, and 253 (49%) in an acute care hospital; 185 (36%) patients visited the ER in last month of life and 75 (14%) received chemotherapy in last 14 days of life. Only the OPM (n=179, 34%) independently decreases the odds of receiving chemotherapy in last 14 days of life (OR 0.5, 95% CI 0.2 to 0.9) and of dying in an acute care setting (0.3, 0.1 to 0.5). PCT intervention (n=300, 58%) did not independently improve any indicators. Among patients seen by the PCT, early PCT intervention had no impact on indicators, whereas the OPM reduced the odds of persistent chemotherapy in the last 14 days of life.
  
  
  CONCLUSIONS
  Multidisciplinary decision-making with oncologists and the PCT is the most critical parameter for improving EOL care.
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Public Health Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Colombet
authors.forename: Vincent
authors.initials: V
authors.lastname: Montheil
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Durand
authors.forename: Florence
authors.initials: F
authors.lastname: Gillaizeau
authors.forename: Ralph
authors.initials: R
authors.lastname: Niarra
authors.forename: Cécile
authors.initials: C
authors.lastname: Jaeger
authors.forename: Jérôme
authors.initials: J
authors.lastname: Alexandre
authors.forename: François
authors.initials: F
authors.lastname: Goldwasser
authors.forename: Pascale
authors.initials: P
authors.lastname: Vinant
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team; D010820:Physicians; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D016019:Survival Analysis; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards
chemical_list: D000970:Antineoplastic Agents