PMID- 37088444
OWN - NLM
STAT- MEDLINE
DCOM- 20230724
LR  - 20231025
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 78
IP  - 2
DP  - 2023 Aug
TI  - Integration of palliative care consultation into the management of patients with 
      chronic limb-threatening ischemia.
PG  - 454-463
LID - S0741-5214(23)00540-2 [pii]
LID - 10.1016/j.jvs.2022.12.069 [doi]
AB  - OBJECTIVE: We assessed the feasibility of integrating palliative care 
      consultation into the routine management of patients with chronic 
      limb-threatening ischemia (CLTI). Additionally, we sought to describe 
      patient-reported outcomes from the palliative care and vascular literature in 
      patients with CLTI receiving a palliative care consultation at our institution. 
      METHODS: This was a single-institution, prospective, observational study that 
      aimed to assess feasibility of incorporating palliative care consultation into 
      the management of patients admitted to our tertiary academic medical center with 
      CLTI by looking at utilization of palliative care before and after implementation 
      of a protocol-based palliative care referral system. A survey comprised of 
      patient-reported outcomes from the palliative care literature was administered to 
      patients before and after palliative consultation. Length of stay and mortality 
      were compared between our study cohort and a historic cohort of patients admitted 
      with CLTI. RESULTS: Over a 14-month enrollment period, 44% of patients (n = 39) 
      with CLTI (rest pain, 36%; tissue loss, 64%) admitted to the vascular service 
      received palliative care consultation, compared with 5% of patients (n = 4) who 
      would have met criteria over the preceding 14 months before our protocol was 
      instituted. The mean age was 69 years, 23% were female, 92% were white, and 49% 
      were able to ambulate independently. Revascularization included bypass (46%), 
      peripheral vascular intervention (23%), and femoral endarterectomy (21%). 
      Additional procedures included minor amputation or wound debridement (26%) and 
      major amputation (15%). No patients received medical management alone. After 
      receiving palliative care consultation, patients reported experiencing less 
      emotional distress than before consultation (P = .03). They also reported being 
      less bothered by uncertainty regarding what to expect from the course of their 
      illness (P = .002). Fewer patients reported being unsure of the purpose of their 
      medical care after palliative care consultation (8%) vs before (18%), although 
      this was not statistically significant (P = .10). Median length of stay was 
      longer in the study group compared with the historic cohort (8 vs 7 days; P = 
      .02). There was no difference in 30-day mortality (3% vs 8%; P = .42) between the 
      study group and the historic cohort (n = 77). CONCLUSIONS: Integrating inpatient 
      palliative care consultation into the routine management of patients with CLTI is 
      feasible and may improve emotional domains of health-related quality of life. 
      This study laid the foundation for future studies on longer term outcomes of 
      patients with CLTI undergoing palliative care consultation as well as the benefit 
      of outpatient palliative care consultation in patients with CLTI.
CI  - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Cattermole, Tessa C
AU  - Cattermole TC
AD  - University of Vermont Medical Center, Burlington, VT. Electronic address: 
      tessa.cattermole@uvmhealth.org.
FAU - Schimmel, McKenna L
AU  - Schimmel ML
AD  - University of Vermont Medical Center, Burlington, VT.
FAU - Carpenter, Rachel L
AU  - Carpenter RL
AD  - University of Vermont Medical Center, Burlington, VT.
FAU - Callas, Peter W
AU  - Callas PW
AD  - University of Vermont College of Medicine, Burlington, VT.
FAU - Gramling, Robert
AU  - Gramling R
AD  - University of Vermont Medical Center, Burlington, VT.
FAU - Bertges, Daniel J
AU  - Bertges DJ
AD  - University of Vermont Medical Center, Burlington, VT.
FAU - Ferranti, Katelynn M
AU  - Ferranti KM
AD  - University of Vermont Medical Center, Burlington, VT.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20230423
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
CIN - J Vasc Surg. 2023 Aug;78(2):473-474. PMID: 37481277
MH  - Humans
MH  - Female
MH  - Aged
MH  - Male
MH  - Chronic Limb-Threatening Ischemia
MH  - Risk Factors
MH  - *Peripheral Arterial Disease/diagnosis/therapy
MH  - Palliative Care
MH  - Quality of Life
MH  - Prospective Studies
MH  - Ischemia/diagnosis/therapy
MH  - Treatment Outcome
MH  - Referral and Consultation
MH  - Limb Salvage/methods
MH  - Retrospective Studies
MH  - Chronic Disease
MH  - *Endovascular Procedures/adverse effects
OTO - NOTNLM
OT  - Chronic limb-threatening ischemia (CLTI)
OT  - Palliative surgery
OT  - Patient-reported outcomes
OT  - Peripheral arterial disease (PAD)
OT  - Surgical palliative care
EDAT- 2023/04/24 00:41
MHDA- 2023/07/24 06:42
CRDT- 2023/04/23 19:36
PHST- 2022/08/29 00:00 [received]
PHST- 2022/11/21 00:00 [revised]
PHST- 2022/12/06 00:00 [accepted]
PHST- 2023/07/24 06:42 [medline]
PHST- 2023/04/24 00:41 [pubmed]
PHST- 2023/04/23 19:36 [entrez]
AID - S0741-5214(23)00540-2 [pii]
AID - 10.1016/j.jvs.2022.12.069 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Aug;78(2):454-463. doi: 10.1016/j.jvs.2022.12.069. Epub 2023 
      Apr 23.