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Palliative Care in Patients with Noncancer Illness.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Palliative Care in Patients with Noncancer Illness./
作者:	Quinn, Kieran L.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2021,
面頁冊數:	237 p.
附註:	Source: Dissertations Abstracts International, Volume: 83-02, Section: B.
Contained By:	Dissertations Abstracts International83-02B.
標題:	Medicine. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28410292
ISBN:	9798522943653

Palliative Care in Patients with Noncancer Illness.
Quinn, Kieran L.

Palliative Care in Patients with Noncancer Illness. - Ann Arbor : ProQuest Dissertations & Theses, 2021 - 237 p.

Source: Dissertations Abstracts International, Volume: 83-02, Section: B.

Thesis (Ph.D.)--University of Toronto (Canada), 2021.

This item is not available from ProQuest Dissertations & Theses.

The evidence base for palliative care is heavily skewed toward patients with cancer, despite the fact that there are twice as many patients with palliative care needs and noncancer illness. This thesis seeks to establish the evidence for clinical practice and policy development for palliative care programs to improve end-of-life care. The first study was a systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness. We found that receipt of palliative care, compared with usual care, was significantly associated with less acute healthcare use and modestly lower symptom burden, and no significant difference in quality of life. The second study measured the association between newly initiated palliative care in the last 6 months of life, healthcare use and location of death in a cohort of adults dying from noncancer illness; and compared these associations with those who die from cancer. We found that among those dying of chronic organ failure, palliative care was associated with a reduction in the rate of emergency department use, hospitalizations and ICU admissions. Palliative care was associated with increased rates of emergency department use and hospitalization in patients dying of dementia, which differed depending upon whether they lived in the community or in a nursing home. In our third study, we measured the association between physician rates of referral to palliative care and location of death in hospitalized adults with serious illness, which include patients dying of cancer and noncancer illness. We found that patients who were cared for by physicians with higher rates of referral to palliative care were less likely to die in hospital and more likely to die at home. Standardizing referral to palliative care may help reduce physician-level variation in referral as a barrier to access. Collectively, these thesis findings highlight the potential benefits of palliative care in patients with select noncancer illness and identify further knowledge gaps for other common noncancer illnesses. Scaling existing palliative care to increase access through sustained investment in physician training and current models of collaborative palliative care may improve end-of-life care, which have significant implications for health policy.

ISBN: 9798522943653Subjects--Topical Terms:

641104
Medicine.
Subjects--Index Terms:

End-of-life care

Palliative Care in Patients with Noncancer Illness.
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