Oncology patients with advanced disease benefit from palliative care consultations triggered by standardized criteria, research shows.
Palliative care in very sick patients can reduce their distress and that of caregivers and decrease unwanted healthcare use. Yet some patients are not offered palliative care.
Standardizing the criteria that trigger palliative care consultations for patients with advanced cancers may help. Standardization has been shown to improve quality of care and reduce 30-day readmissions, according to a study published in The Journal of Oncology Practice.
Patients on an inpatient solid tumor service received an "automatic" palliative care consultation when they met at least one of the following four criteria, or "triggers:"
- Had an advanced solid tumor
- Prior hospitalization within 30 days
- Hospitalization greater than seven days
- Active symptoms
Patients who met the criteria and triggered an automatic consultation received palliative care consultations 80% of the time vs. 39% among control subjects. Hospice referrals were greater among the intervention group (26%) compared to the control group (14%).
"Patients with advanced cancer admitted to an acute care hospital often have short life expectancies and high morbidity," said the study's lead author Kerin Adelson, MD, assistant professor of medical oncology at Yale Cancer Center and Chief Quality Officer and Deputy Chief Medical Officer for Smilow Cancer Hospital in media release.
"For these patients, the integration of palliative care has improved symptom burden, reduced patient and caregiver distress, increased referral to hospice, and improved outcomes."
The study shows that rates of 30-day readmissions dropped to 18% among those who received the automatic palliative care consultation compared to 35% in the control group. While length of stay was unaffected, patients in the intervention group received less chemotherapy after discharge (18%) than the control subjects (44%).
Guidelines from the American Society of Clinical Oncologists call for palliative care to be integrated into standard oncology care for all patients diagnosed with cancer.
"Economically, we face a national crisis as costs escalate exponentially and patients continue to receive non-beneficial and burdensome health interventions at the end of life," write Adelson and her co-authors in the published study.
"This pattern of care harms the quality of life in a population with little time left to live; we face an urgent need to revise our policies and practices in caring for patients with advanced cancer."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.