A Quantitative Study of Triggered Palliative Care Consultation for Hospitalized Patients With Advanced Cancer

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• 作者：Gabrielle B. Rocque ; MD^a ; ^{grocque@uabmc.edu" class="auth_mail" title="E-mail the corresponding author} ; Toby C. Campbell ; MD^b ; ^c ; Sara K. Johnson ; MD^b ; ^c ; Jonathan King ; MD^b ; Meghan R. Zander^c ; Renae M. Quale ; RN^c ; Jens C. Eickhoff ; PhD^d ; James F. Cleary ; MD^b ; ^c
• 关键词：Triggered palliative care consults ; oncology ; implementation
• 刊名：Journal of Pain and Symptom Management
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：50
• 期：4
• 页码：462-469
• 全文大小：441 K

文摘

Unplanned cancer-related hospital admissions often herald entry into the final phase of life. Hospitalized patients with advanced cancer have a high symptom burden and a short life expectancy, which may warrant palliative care intervention.

Objectives

To identify the impact of implementing triggered palliative care consultation (TPCC) as part of standard care for patients admitted to the solid-tumor oncology service with advanced cancer.

Methods

We conducted a prospective, sequential, three-cohort study to evaluate TPCC feasibility and impact using patient-reported outcomes, electronic medical records to identify resource utilization, and surveys of oncologists' perspectives on TPCC.

Results

Sixty-five patients were evaluated before TPCC implementation (Cohort 1). Seventy patients (Cohort 2) were evaluated after initiation of TPCC, and 68 patients (Cohort 3) were evaluated after modifications based on implementation barriers identified in Cohort 2. The percentage of patients correctly identifying their cancer as incurable increased from 65% in Cohort 1 to 94% in Cohorts 2 and 3. TPCC had minimal impact on hospice utilization, cost of care, survival, patient-reported symptoms, and patient satisfaction, likely because of the limited nature of the intervention. Implementation was challenging, with only 60% of patients in Cohort 2 and 62% in Cohort 3 receiving TPCC. Overall, the intervention was viewed favorably by 74% of oncologists.

Conclusion

Although TPCC was viewed favorably, implementation was logistically challenging because of short stays, high-acuity symptoms, and individual provider resistance. TPCC improved patients' understanding of their cancer. This population demonstrates high palliative care needs, warranting further research into how best to deliver care.