Research Article
Inpatient Palliative Care Consultation for Women with Gynecologic Malignancies
Nicole S Nevadunsky1*, Zahava Brodt1, SerifeEti2, Peter A Selwyn3, Ann Van Arsdale1, Bruce Rapkin4 and Gary L Goldberg11Department of Obstetrics & Gynecology and Women’s Health, Division of Gynecologic Oncology, Albert Einstein Cancer Center, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA
2Department of Palliative medicine, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, NY, USA
3Department of Family and Social Medicine, Department of Psychiatry and Behavioral Sciences, Department of Epidemiology & Population Health, Department of Medicine, Albert Einstein College of Medicine Department of Family and Social Medicine, Montefiore Medical Center, NY, USA
4Department of Epidemiology & Population Health, Albert Einstein College of Medicine Department of Family and Social Medicine, Montefiore Medical Center, NY, USA
- *Corresponding Author:
- Nicole S Nevadunsky
Department of Obstetrics
Gynecology and Women’s Health
Albert Einstein College of Medicine
Montefiore Medical Center
3332 Rochambeau Ave Bronx
New York 10467, USA
Tel: 718-920-4794
Fax: 718-920-6313
E-mail: nnevadun@montefiore.org
Received date: August 24, 2013; Accepted date: September 23, 2013; Published date: September 27, 2013
Citation: Nevadunsky NS, Brodt Z, SerifeEti, Selwyn PA, Arsdale AV, et al. (2013) Inpatient Palliative Care Consultation for Women with Gynecologic Malignancies. J Palliat Care Med 3:160. doi:10.4172/2165-7386.1000160
Copyright: © 2013 Nevadunsky NS et al., This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: Recommendations to improve end-of-life cancer care include integration of palliative care into standard cancer care. There is limited information regarding palliative care for ethnic and racial minority women with gynecologic malignancies. The purpose of this study was to determine the impact of clinical, socio-demographic, and provider factors on palliative medicineconsultation.
Methods: After IRB approval, patients with gynecologic malignancies who received a palliative medicine consultation from January 1, 2008 until June 1, 2010 were identified. Abstracted data included demographics, reason/s for consultation, and outcomes. Results were described and comparison made using Fisher’s Exact Test, Student’s T analysis, and Kaplan-Meier time to event analysis with SPSS software.
Results: 84 patients were referred for palliative medicine consultation. Ethnic/racial distribution was Black (37%), White (39%), and Hispanic (16%). The reason/s for consultation included pain (45%), goals of care (46%), and bowel obstruction (4%), dyspnea (4%). Median number of days from the initial consultation until death by Kaplan-Meier time to event analysis, which is a proxy metric for timely consultation was 35 days [Range 0-1005 days].Younger patients (<60) were less likely to be DNR (p=0.03, 60% verses 79.5%) or referred to hospice (p=0.02, 9% versus 33%). “Goals of care” was the consultation reason in 61% of patients of medical sub-specialists vs. 26% of Gynecologic Oncologists (p=0.003). 28% of patients from medical sub-specialists died in the hospital verses 8% of gynecologic oncologist referred patients (p=0.02).
Conclusions: These data suggest that there may be barriers to the implementation of palliative medicine for women with gynecologic malignancies. Providers may be influenced by patient age as well as their own specialty background. Reasons for the barriers to access in these women need to be further explored.
