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

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.