The following article features coverage from the 2021 ASCO Quality Care Symposium. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

A triggered palliative care referral intervention for patients with relapsed/refractory acute myeloid leukemia (AML) was found to be feasible and improved documentation of advance care planning. These findings were presented during the 2021 ASCO Quality Care Symposium.

Patients with AML have poor outcomes. End-of-life care for these patients is associated with high healthcare utilization, and in general, palliative care remains underutilized in the hematology setting. A triggered referral program was launched to increase referrals to palliative care.

A nurse coordinator reviewed charts of hospitalized patients with hematologic malignancy and identified which patients should be referred to palliative care based on 4 criteria: persistent disease after 2 or more lines of therapy, hospitalization for more than 7 days for symptom management, ECOG performance status >2, and refractory graft-versus-host disease after 3 or more lines of therapy.


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A total of 110 admitted patients with AML were eligible for the program. Half of the patients (64) were admitted prior to the launch of this program.

The pre- and postintervention patients were mean age 60.4 and 60.9 years, and 64% and 78% were men, respectively.

The referral intervention increased palliative care consultations from 22% to 43% (P =.021) and advance care planning from 13% to 28% (P =.049). The program did not have an effect on length of stay (P =.941), 30-day readmission (P =.557), care escalation (P =.318), or nonpalliative chemotherapy after discharge (P =.246).

Among the patients who were screened for palliative care, 54% received a consultation, 18% were declined by the primary team, 14% were not eligible, and 14% did not have a consult with reason unspecified.

Small decreases in healthcare utilization may not have reached significance due to limited power and should be assessed in a larger trial.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Read more of Oncology Nurse Advisor’s coverage of the 2021 ASCO Quality Care Symposium by visiting the conference page.

Reference

Xiang JJ, Prsic EH, Adelson KB, Ozyck R, Prebet T. Impact of an automatic palliative care consultation trigger on healthcare use in patients with relapsed/refractory acute myeloid leukemia. J Clin Oncol. 2021;39(suppl 28):abstr 224. doi:10.1200/JCO.2020.39.28_suppl.224