Impact of a Criteria-Based Inpatient Palliative Oncology Consultation Model on End-of-Life Outcomes

Kathryn E Norman; Mary K Buss; Kathleen A Lee; Abigail Escobar; Jonathan Thomas; Julia Berg; Nsabimana Uwumugambi; Laura E Dodge; Harry J Han; Carol Pilgrim; Jonathan C Yeh

doi:10.1016/j.jpainsymman.2024.11.011

Impact of a Criteria-Based Inpatient Palliative Oncology Consultation Model on End-of-Life Outcomes

J Pain Symptom Manage. 2024 Nov 19:S0885-3924(24)01126-6. doi: 10.1016/j.jpainsymman.2024.11.011. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine (K.E.N.), Section of Medical Oncology, Yale New Haven Hospital, New Haven, Connecticut, USA.
² Palliative Care Services (M.K.B.), Department of Medicine, UConn Health, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
³ Section of Palliative Care (K.A.L., H.J.H., J.C.Y.), Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Georgetown University School of Medicine (A.E.), Washington, District of Columbia, USA.
⁵ Division of Hematology & Oncology (J.T.), Department of Medicine, University of Florida College of Medicine, Gainesville, Massachusetts, USA.
⁶ Division of Hematology & Oncology (J.B.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Division of Hematology & Oncology (N.U.), Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
⁸ Department of Obstetrics and Gynecology (L.E.D), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Division of Palliative Care (C.P.), Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
¹⁰ Section of Palliative Care (K.A.L., H.J.H., J.C.Y.), Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: [email protected].

PMID: 39566832
DOI: 10.1016/j.jpainsymman.2024.11.011

Abstract

Context: Early, integrated palliative care (PC) improves outcomes in advanced cancer; however, inpatient PC referrals still exceed outpatient referrals nationwide. Recognizing need for enhanced integration, our cancer center implemented a criteria-based PC consultation model in inpatient oncology.

Objectives: To compare decedent outcomes pre- and postimplementation of a new criteria-based PC consultation model in inpatient oncology.

Methods: We implemented an embedded, interdisciplinary "Palliative Oncology" consult team on the oncology floor. Admitted patients were screened for advanced/metastatic solid cancer or moderate/severe symptoms. The oncology team received prompting regarding eligible patients; PC referral remained at their discretion. We compared outcomes between patients who died pre- (10/1/2019-6/30/2020) and postimplementation (7/1/2020-6/30/2022) by t-test (continuous variables) and chi-square test (categorical variables).

Results: Of 820 decedents, 186 died preintervention and 634 died postintervention. Postintervention, more decedents saw inpatient PC (59%-72%, P < 0.001) and outpatient PC (23%-34%, P < 0.01), and had earlier first PC visit before death (76-159 days, P < 0.001). Postintervention, fewer decedents had hospitalizations (71%-57%, P < 0.001) and intensive care encounters (25%-17%, P < 0.01) within last 30 days of life. Hospice length-of-stay increased (22-36 days, P < 0.01). There were trends toward fewer emergency room visits within last 30 days of life (51%-42%, P = 0.02), less systemic cancer therapy within last 14 days of life (9%-5%, P = 0.03), and more deaths at home (41%-50%, P = 0.03).

Conclusion: Embedded, criteria-based PC consultation in inpatient oncology was associated with earlier PC involvement, longer hospice LOS, and reduced EOL care intensity.

Keywords: care delivery; palliative care; supportive oncology.