Early integration or last consultation: in-house palliative care involvement for hospitalized patients in tertiary medicine-a retrospective analysis.

Abstract

Background: The importance of timely integration of palliative care has been confirmed over the past years for any patient suffering from a life-threatening or life-limiting disease. Palliative and supportive care increases quality of life of patients and caregivers in both oncological and non-cancer diseases and should therefore be offered on a needs-based approach and throughout the disease trajectory.

Methods: We analyzEd all in-patient consultation requests of the leading university hospital in Switzerland in 2019. Sociodemographics, symptoms, and specific requests as well as provided support offers were retrieved from the electronic patient files. Demographic and clinical data was analyzed by descriptive statistics between groups. Overall survival from diagnosis and time from consultation to death was analyzed by means of Kaplan-Meier estimates and log-rank test.

Results: We identified 507 in-patient consultation requests from 24 oncological and non-oncological departments in 2019. The final analysis cohort comprised 290 patients, of which 133 women (45.9%). Median overall survival of the population from diagnosis was 21.1 months (CI 15.57-26.72). Median survival from palliative care consultation was 29 days (CI 20.89-37.11), independent of primary diagnosis (p = 0.298) or sex (p = 0.079). A total of 38.9% (N = 140) of consultations were requested concurrently to a tumor-targeted treatment. Palliative care consultations provided more support services than requested (p < 0.001).

Conclusion: Our findings underline the persisting late involvement of palliative care services in the disease trajectory, despite being a concurrently consultable and readily available support service to address patient and caregiver needs.