Discharge Events Improved With Standardized Inpatient Palliative Care Consultation

Patients with advanced cancer are often at high risk for emotional distress and can benefit from consultation.
Patients with advanced cancer are often at high risk for emotional distress and can benefit from consultation.

Standardized inpatient palliative care consultation in advanced cancer was found to improve 30-day readmission rates, hospice referrals, and use of postdischarge support services, according to a paper published in the Journal of Oncology Practice.1 

“As cancer progresses, patients are often at high risk for physical pain and emotional distress. Health care utilization is extremely high once cancer progresses, with hospital readmission rates as high as 40% and death in the acute care setting ranging from 30% to 50% — both measures of poor-quality cancer care,” study author Cardinale B. Smith, MD, of Hematology and Medical Oncology and Geriatrics and Palliative Medicine at Mount Sinai, said in a press release.2

According to the researchers, hospitalization of patients with advanced cancer is associated with higher morbidity and shorter life expectancy. Likewise, they are at higher risk for emotional distress, pain, and financial difficulties as the cancer progresses.

Palliative care is an underutilized service that is associated with reduced health care costs, better understanding of prognosis, improved quality of life, and improved burden of symptoms and distress.

Investigators conducted a prospective cohort study at Mount Sinai in New York City in patients with advanced solid tumors (stage IV solid tumor or stage III lung/pancreatic cancer) who had either hospitalization more than 7 days or prior admission within 30 days, and active symptoms of pain, nausea, vomiting, dyspnea, emotional distress, or delirium. The identified patients triggered an automatic palliative care consultation.

Overall, the researchers found a significant increase in the amount of palliative care consultations (39% to 80%, P <.001) and hospice referrals (14% to 26%, P =.03). Furthermore, chemotherapy after discharge (44% to 18%, P =.03) and 30-day readmission rates decreased (35% to 18%, P =.04). Postdischarge support such as home hospice and home services increased as well (P =.004). No differences were observed for the length of hospital stay (P =.15) or the rate of ICU use (P =.11).1

“Our results highlight the need to adopt this practice at acute care hospitals across the nation. Palliative care involvement helps patients understand their prognosis, establish goals of care, and formulate discharge plans in line with those goals, and this study is the first to confirm the impact of using standardized criteria and automatic palliative care consultation on quality of cancer care,” Dr Smith said.2

References

1. Adelson K, Paris J, Horton JR, et al. Standardized criteria for palliative care consultation on a solid tumor oncology service reduces downstream health care use. J Oncol Pract. 2017 Mar 17. doi: 10.1200/JOP.2016.016808 [Epub ahead of print]

2. Palliative care consults for patients with advanced cancers reduces hospitalization and improves quality of care [news release]. New York, NY: Mount Sinai; March 17, 2017. http://www.mountsinai.org/about-us/newsroom/press-releases/palliative-care-consults-for-patients-with-advanced-cancers-reduces-hospitalization-and-improves-quality-of-care. Accessed March 21, 2017.

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