Background: The Lifespan Cancer Institute (LCI) initiated ClinicalPath in 2018 as an evidence-based decision tool to support oncologists in providing high quality care. The prognostic question used by the decision tool, “would you be surprised if this patient died in the next year,” is a validated question for predicting poor prognosis for patients with stage III, IV or extensive stage cancer. The palliative care (PC) team hypothesized that if an oncologist answered “no, I would not be surprised,” the patient would benefit from a PC consultation. The LCI prioritized efforts to provide PC upstream in the disease process by reviewing the “would not be surprised” patients and offering consultation to the ordering oncologist if deemed appropriate by the PC physician. Methods: Patients navigated through ClinicalPath from Jan to Dec 2019 were analyzed to allow for one full year after the last navigation for those marked as “would be surprised” and “would not be surprised,” and frequency of PC consultation was evaluated. Results: 729 patients triggered the prognostic question in 914 total navigations. Of those navigations, oncologists selected “I would not be surprised if patient died within the next year” 54% of the time. In 45% of decisions, the oncologist selected “I would be surprised if patient died within the next year,” suggesting that the oncologist expected the patient to live a year or more. 53% of the patients were categorized as Stage IV or extensive stage. The most common diseases were gastrointestinal malignancies, followed by thoracic and then neuro-oncology. Among the patients whose oncologist selected “I would be surprised,” 36% of patients had died within 365 days of the decision, 13% died more than a year after and 51% are still alive. Among the patients whose oncologist selected “I would not be surprised,” 60% died within 365 days of the decision and an additional 16% have since died, with 24% still alive at this time. PC consultation increased since initiation of the palliative physician conducting prognostic clinical review. In a review from Nov 19-April 20 (1157 visits) and Nov 20-April 21 (1656 visits), overall PC visits increased by 43%. Conclusions: LCI’s data aligns with prior published data that suggest the prognostic question is valid. We further examined if this question could be used as a screening tool to initiate a PC consultation since patients with a poor prognosis benefit from PC. 56% of patients navigated through the system had a PC consult at some time during their disease course, and 54% of those patients saw PC as an inpatient only. A simple screening process for those patients that were navigated to “I would not be surprised” is a way of providing earlier integration of PC. This prognostic question, which relies heavily on oncologist “gut feeling “or “intuition,” is a helpful indicator that PC consultation is appropriate and can be used effectively to ensure earlier integration of PC for oncology patients.