Search

PURPOSE: Older patients with acute leukemia (AL) have a high symptom burden and poor prognosis. Although integration of palliative care (PC) with oncologic care has been shown to improve quality-of-life and end-of-life care in patients with AL, the malignant hematologists at our tertiary care hospital make limited use of PC services and do so late in the disease course. Using the Plan-Do-Study-Act (PDSA) methodology, we aimed to increase early PC utilization by older patients with newly diagnosed AL. METHODS: We instituted the following standardized criteria to trigger inpatient PC consultation: (1) age 70 years and older and (2) new AL diagnosis within 8 weeks. PC consultations were tracked during sequential PDSA cycles in 2021 and compared with baseline rates in 2019. We also assessed the frequency of subsequent PC encounters in patients who received a triggered inpatient PC consult. RESULTS: The baseline PC consultation rate before our intervention was 55%. This increased to 77% and 80% during PDSA cycles 1 and 2, respectively. The median time from diagnosis to first PC consult decreased from 49 days to 7 days. Among patients who received a triggered PC consult, 43% had no subsequent inpatient or outpatient PC encounter after discharge. CONCLUSION: Although standardized PC consultation criteria led to earlier PC consultation in older patients with AL, it did not result in sustained PC follow-up throughout the disease trajectory. Future PDSA cycles will focus on identifying strategies to maintain the integration of PC with oncologic care over time, particularly in the ambulatory setting.

PurposeThe study aims, based on the symbiotic relationship between tourism agencies and various stakeholders, to investigate what “policy-level” partners would advise their “practice-level” counterparts on, first, how the World Heritage Site (WHS) status of monuments can be made attractive for travellers, and second, what steps can be taken by stakeholders to enhance the WHS tourist experience.Design/methodology/approachA qualitative approach involving e-mail interviews was adopted. Content analyses of open-ended exploratory questions put to “policy-level” respondents yielded 10 major themes that can enhance the brand appeal of the WHS.FindingsThe findings offer in-depth solutions for better trip experiences of Heritage Tourists. Insights from the responses under ten thematic areas have direct relevance for application by tourism and hospitality facilitators.Practical implicationsAlthough this study was conducted in India, its findings hold implications for practice throughout the world. They could similarly be incorporated as elements of policy directed at incentivising communication of the value of preserving heritage for future generations.Originality/valueWhile previous research focused on stakeholders for planning and policy making, this study explores the stakeholder's perspective for a more comprehensive understanding of how using the WHS brand can generate more holistic tourism development.