• J Pain Symptom Manage · Apr 2023

    Just-in-Time Decision Making: Preliminary Findings of a Goals of Care Rapid Response Team.

    • Donna S Zhukovsky, Yvonne Heung, Parema Enriquez, Nelda Itzep, Zhanni Lu, Nico Nortje, Penny Stanton, Angelique Wong, and Eduardo Bruera.
    • Palliative, Rehabilitation and Integrative Medicine (D.S.Z.,Y.H.,P.E.,Z.L.,P.S.,A.W. E.B.), Pediatrics (N.I.). Electronic address: dzhukovs@mdanderson.org.
    • J Pain Symptom Manage. 2023 Apr 1; 65 (4): e337e343e337-e343.

    ContextThe COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOC RRT) to optimize resource utilization balanced with goal-concordant patient care.ObjectivesPrimary study objective was to evaluate feasibility of the GOC RRT by describing the frequency of consultations that occurred from those requested. Secondary objectives included adherence to consultation processes in terms of core team member participation and preliminary efficacy in limiting care escalation.MethodsWe conducted a retrospective chart review of patients referred to GOC RRT (3/23/2020-9/30/2020). Analysis was descriptive. Categorical variables were compared with Fisher's exact or Chi-Square tests and continuous variables with Mann-Whitney U tests.ResultsA total of 89 patients were referred. Eighty-five percent (76 of 89) underwent a total of 95 consultations. Median (range) patient age was 61 (49, 69) years, 54% (48 of 89) male, 19% (17 of 89) Hispanic, 48% (43/89) White, 73% (65 of 89) married/partnered and 66% (59 of 89) Christian. Hematologic malignancies and solid tumors were evenly balanced (53% [47/89] vs. 47% [42 of 89, P = 0.199]). Most patients (82%, 73 of 89) had metastatic disease or relapsed leukemia. Seven percent (6 of 89) had confirmed COVID-19. Sixty-nine percent (61 of 89) died during the index hospitalization. There was no statistically significant difference in demographic or clinical characteristics among groups (no consultation, 1 consultation, >1 consultation). Core team members were present at 64% (61 of 95) of consultations. Care limitation occurred in 74% (56 of 76) of patients.ConclusionGOC RRT consultations were feasible and associated with care limitation. Adherence to core team participation was fair.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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