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MASCC Survey for Palliative Care

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MASCC Survey for Palliative Care Mellar P Davis MD FCCP FAAHPM MASCC Survey for Palliative Care 183 respondents completed at least part of the survey. – PowerPoint PPT presentation

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Title: MASCC Survey for Palliative Care


1
MASCC Survey for Palliative Care
Mellar P Davis MD FCCP FAAHPM
2
MASCC Survey for Palliative Care
  • 183 respondents completed at least part of the
    survey.
  • 19 (10) were from NCI designated cancer centers
    (15 of which were comprehensive cancer centers).
  • 34 (19) were from ESMO designated centers.
  • 65 (36) were from other cancer centers.
  • 45 (25) were from urban hospitals/clinics.
  • 7 (4) were from rural hospitals/clinics.
  • 11 (6) were from hospice centers.

3
MASCC Survey for Palliative Care
  • The questions scored on a 0-10 scale are
    reported both uncoded and arbitrarily coded with
    scores of 0-3 indicating a negative response, 4-7
    a neutral response, and 8-10 a positive response

4
Availability
  • Overall most institutions (83) had PC
    available sometime during the past 10 years, most
    (93) are under the leadership of an M.D., most
    (91) have at least one PC physician on staff,
    and most (84) have dedicated inpatient beds for
    cancer care

5
Service Structure
  • The most commonly offered PC services are
    consultation/mobile team service (72) and
    PC/supportive care clinics (64), with 52 of
    respondents indicating that both services are
    available at their institutions
  • Only 39 of respondents indicated that dedicated
    PC acute care beds were available, and 21
    indicated that there was institution-operated
    hospice.

6
Barriers
  • The barriers to PC access most commonly noted
    were
  • Limited budget (55)
  • Lack of adequately trained PC physicians and
    nurses (40)
  • Poor reimbursement (32)
  • 5 of respondents identified lack of evidence
    that PC improves patient outcome as a barrier
  • 4 indicated that a potentially negative impact
    on the hospitals national ranking was a barrier

7
Effectiveness
  • In general respondents indicated that the
    effectiveness and quality of their PC program has
    improved a bit over the past 5 years (median 1
    level change in effectiveness and median 2 level
    change in quality, plt.0001 in both cases
    Wilcoxon signed rank test)
  • 2 of centers indicating effectiveness has
    decreased
  • 63 effectiveness has increased
  • 3 indicating the quality has decreased
  • 69 quality increased

8
Research
  • Respondents were in general agreement that
    stronger integration of PC into oncology practice
    would benefit patients, and that more research
    funding should go to PC (median score of 10 for
    both questions).
  • However only 17 indicated that their institution
    was likely (scores 8-10) to increase PC funding.

9
Increasing Staff
  • Respondents were generally neutral regarding
    future hiring plans the median scores for
    increasing staffing of PC M.D.s, mid-level
    providers, and PC nurses were all 5 with roughly
    equal numbers of respondents indicating they are
    likely (scores 8-10) and unlikely (scores 0-3) to
    hire each type of provider.

10
Palliative Beds
  • Respondents tended to have a slight negative bias
    in terms of plans to increase the number of PC
    acute beds at their institutions median score
    was 4
  • 49 of respondents indicating they are unlikely
    (scores 0-3) to increase the number
  • 18 indicating the number is likely (scores 8-10)
    to be increased.

11
Comparisons
  • The respondents from the different institution
    types answered a number of questions similarly
    (e.g. program leadership, several barriers to PC
    access, effectiveness of pain management
    services, need for stronger integration of PC
    into oncology practice, the likelihood of
    increasing PC nursing staff, and the likelihood
    of increasing the number of PC acute beds),
    however they also differed in a number of ways

12
Comparisons
  • Cancer centers (NCI, ESMO, other) tended to have
    had PC services available sometime during the
    past 10 years more frequently than urban
    hospitals/clinics (85-100 vs 64, p.0002).
  • Cancer centers (NCI, ESMO, other) tended to have
    PC physicians on staff more frequently than urban
    hospitals/clinics (95-100 vs 72), p.0004.

13
Comparisons
  • NCI and ESMO designated centers tended to offer
    PC services more frequently than urban
    hospitals/clinics, with other cancer centers
    varying between the two (plt.005 for all services
    except dedicated PC acute care beds and
    institutional-based hospice).
  • ESMO designated centers had dedicated PC acute
    care beds more frequently than other institutions
    (76 vs 24-32), plt.0001.

14
Comparisons
  • ESMO designated centers considered poor
    reimbursement a barrier to PC access more
    frequently than other types of institutions (53
    vs 23-32), p.02.
  • NCI and ESMO designated centers tended to score
    the quality of their PC services higher than
    urban hospitals/clinics, with other cancer
    centers between the two (63-71 of NCI and ESMO
    designated centers gave scores of 8-10 versus 53
    of other cancer centers, and 33 of urban
    hospitals/clinics), p.001

15
Comparisons
  • Cancer centers (NCI, ESMO, other) tended to score
    the likelihood of increasing PC physicians higher
    than urban hospitals/clinics (12-25 of cancer
    centers gave scores of 0-3 and 35-39 gave scores
    of 8-10, compared to 37 and 12, respectively,
    for urban hospitals/clinics), p.007

16
Comparisons
  • Cancer centers (NCI, ESMO, other) had dedicated
    beds for cancer patients more frequently than
    urban hospitals/clinics (84-91 vs 69), p.01

17
Comparisons
  • Respondents from NCI and ESMO designated centers
    tended to answer the survey similarly, however
    there were some differences
  • Dedicated PC acute care beds greater with ESMO
  • ESMO designated centers scored the current
    effectiveness of their pain management programs
    higher than respondents from NCI designated
    centers (79 of ESMO designated centers scored
    8-10 while none gave a score lt4, compared to 56
    and 6, respectively for NCI designated centers),
    p.05

18
Summary
  • Most institutions had PC available sometime
    during the past 10 years
  • Most commonly offered PC services are
    consultation/mobile team service and
    PC/supportive care clinics
  • Barriers to PC access were limited budget, lack
    of adequately trained PC physicians and nurses
    and poor reimbursement

19
Summary
  • In general respondents indicated that
    effectiveness and quality of their PC program has
    improved
  • Respondents were in general agreement that
    stronger integration of PC into oncology practice
    would benefit patients, and that more research
    funding should go to PC

20
Summary
  • Respondents were generally neutral regarding
    future hiring plans
  • Only 17 indicated that their institution was
    likely (scores 8-10) to increase PC funding
  • Respondents tended to have a negative bias in
    terms of plans to increase the number of PC acute
    beds
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