Opinion and Sentiment Analysis of Palliative Care in the Era of COVID-19.

During the COVID-19 pandemic, the value of palliative care has become more evident than ever. The current study quantitatively investigated the perceptions of palliative care emerging from the pandemic experience by analyzing a total of 26,494 English Tweets collected between 1 January 2020 and 1 January 2022. Such an investigation was considered invaluable in the era of more people sharing and seeking healthcare information on social media, as well as the emerging roles of palliative care. Using a web scraping method, we reviewed 6000 randomly selected Tweets and identified four themes in the extracted Tweets: (1) Negative Impact of the Pandemic on Palliative Care; (2) Positive Impact of the Pandemic on Palliative Care; (3) Recognized Benefits of Palliative Care; (4) Myth of Palliative Care. Although a large volume of Tweets focused on the negative impact of COVID-19 on palliative care as expected, we found almost the same volume of Tweets that were focused on the positive impact of COVID-19 on palliative care. We also found a smaller volume of Tweets associated with myths about palliative care. Using these manually classified Tweets, we trained machine learning (ML) algorithms to automatically classify the remaining tweets. The automatic classification of Tweets was found to be effective in classifying the negative impact of the COVID-19.

Use of Auditing and Feedback in an Outpatient Hospice Setting: Quality and Pharmacoeconomic Oversight.

BACKGROUND: Clinicians play an important role in containing pharmaceutical spending at the patient level, as well as ensuring efficacy and quality outcomes, yet little research has examined how to achieve this goal. MEASURES: Using auditing and feedback (A&F) as part of a Pharmacy and Therapeutics (P&T) Committee, we evaluated our community-based hospice program's prescribing habits for opioids, antipsychotics, and antidepressants and calculated oral pharmaceutical prescription costs per-patient-day. Quality of care was reflected by patient pain scores in electronic medical records. INTERVENTION: Our P&T Committee adopted an A&F approach to monitor and assess provider prescribing habits and cost. An already-existing pain quality improvement program assessed care quality. OUTCOMES: Pain relief either improved or was maintained while medication costs were reduced by over $1.00 per-patient-day from 2010 to 2011. CONCLUSIONS/LESSONS LEARNED: An active, hospice P&T Committee featuring A&F can significantly affect medication costs for a hospice program while maintaining or improving patient outcomes.

Alternative routes to oral opioid administration in palliative care: a review and clinical summary.

OBJECTIVE: A major goal of palliative care is to provide comfort, and pain is one of the most common causes of treatable suffering in patients with advanced disease. Opioids are indispensable for pain management in palliative care and can usually be provided by the oral route, which is safe, effective, and of lowest cost in most cases. As patients near the end of life, however, the need for alternate routes of medication increases with up to 70% of patients requiring a nonoral route for opioid administration. In order to optimize patient care, it is imperative that clinicians understand existing available options of opioid administration and their respective advantages and disadvantages. METHODS: We performed a literature review to describe the most commonly used and available routes that can substitute for oral opioid therapy and to provide a summary of factors affecting choice of opioid for use in palliative care in terms of benefits, indications, cautions, and general considerations. RESULTS: Clinical circumstances will largely dictate appropriateness of the route selected. When the oral route is unavailable, subcutaneous, intravenous, and enteral routes are preferred in the palliative care population. The evidence supporting sublingual, buccal, rectal, and transdermal gel routes is mixed. CONCLUSIONS: This review is not designed to be a critical appraisal of the quality of current evidence; rather, it is a summation of that evidence and of current clinical practices regarding alternate routes of opioid administration. In doing so, the overarching goal of this review is to support more informed clinical decision making.

Clinic-based outpatient palliative care before hospice is associated with longer hospice length of service.

CONTEXT: Outpatient nonhospice palliative care has been shown to provide many benefits to patients facing advanced illness, but such services remain uncommon in the U.S. Little is known about the association between clinic-based outpatient palliative care consultation and the timing of hospice enrollment. OBJECTIVES: To determine whether there are differences in hospice length of service (LOS) between patients who were seen vs. patients who were not seen in an outpatient palliative care clinic before enrollment in hospice. METHODS: Using a retrospective study of medical records, a "prior palliative care clinic" group was formed of those hospice patients who had had a nonhospice clinic-based outpatient palliative care consult before hospice admission (n = 354). For those patients, "control" hospice patients without prior clinic-based palliative care were chosen who were matched by age, gender, median income of their zip code, and diagnostic group. Both groups were restricted to patients who died while enrolled in hospice. LOS for these two groups was compared using standard statistical methods of survival analysis. RESULTS: Prior palliative care clinic patients had a median LOS of 24 days, whereas control patients had a median LOS of 15 days (95% CI for difference between the medians 5-13 days). The difference between the LOS distribution curves was statistically significant by the log-rank test (P < 0.001). CONCLUSION: Hospice patients who had clinic-based outpatient palliative consults before hospice enrollment tended, on average, to have a longer LOS in hospice than patients who did not.