Trigger-based pathways to increase utilization of palliative care services for cancer patients: A multi-disciplinary approach.

Authors

null

Vinit Singh

Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ

Vinit Singh , Charmee Vyas , Harshil Fichadiya , Shira Goldberg , Nicole Keegan , Patricia Ostrander-Coffey , Gretchen Nicolosi , Bomina Lim , Diane Lopes , Kristen Gebel , Jessica Preston , Tia Kelly , Diann Johnston , Kenneth Granet

Organizations

Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, Monmouth Medical center, Long Branch, NJ, Monmouth Medical Center, Long Branch, NJ

Research Funding

No funding received

Background: Palliative care involves services to improve the quality of life for chronically ill patients and their care teams. Use of palliative care has shown to decrease the utilization of resources and increase clarity of goals of care. Although acceptance of palliative care principles has been improving, we conducted a multidisciplinary project to increase the utilization of palliative care consult (PCC) and follow its effect of hospital-based outcome. Methods: IRB approved study involving patients on medical floors and in the ICU were conducted over 3 months with 1-month pre-intervention phase (PIP). We developed PCC triggers based on medical literature for the ICU and Medical floors to identify at risk patients likely to benefit from PCC on admission. Trigger questionnaire included but was not limited to the problem list at admission, comorbidities, requirements and availability of social support, and age > 80 years which were reviewed by the primary Nursing staff at admission assessment. Patients meeting any one of the triggers were eligible for PCC. The RNs would reach out to the primary team to notify them of patient’s eligibility for PCC. We adopted “opt in” model to request approval of the PCC. Outcomes measures included rate of PCC among triggered, code status change, and discharge planning. Triggers for pre-intervention were filled by EHR review. All the categorical variables were compared by chi-square test. Results: 344 (Median age - 69, 50.58% Female) patients were enrolled during the study with 93 (27.03%) cancer patients. 93/121 (76.86%) of PIP patients and 160/223 (71.74%) of intervention phase (IP) patients triggered the PCC. During PIP, proportion of triggered non-cancer and cancer patients referred for PCC were 9/73 (12.33%) and 6/20 (30.00%) respectively. During IP, proportion of triggered patients referred for PCC significantly increased compared to PIP to 28/99 (28.28%, p-value – 0.01) and 38/61 (62.30%, p-value – 0.01) for both non-cancer and cancer patients, respectively. During the IP, PCC was recommended significantly more times (p-value – 0.00) in cancer patients than non-cancer patients. Among all with PCC involved, 4/17 (23.59%) PIP and 8/59 (13.56%, p-value – 0.56) IP full-code cancer patients changed code status to DNR. Among the cancer patients, 10 (6 from ICU and 4 from medical floor) patients were discharged to home hospice compared to none in pre-intervention phase. Conclusions: Application of trigger-based pathways leads to early and increase utilization of palliative care services for all patients by identifying patients to benefit from early PCC. Among cancer patients, we found improvement in utilization of hospice services and clarification of their code status at discharge. Further studies are needed to standardize the procedure for increased integration of PCC into our hospital’s clinical models of care.

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Symptoms and Survivorship

Track

Symptom Science and Palliative Care

Sub Track

End-of-Life Care

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr e24007)

DOI

10.1200/JCO.2022.40.16_suppl.e24007

Abstract #

e24007

Abstract Disclosures

Similar Abstracts

First Author: Amy Foster

Abstract

2022 ASCO Quality Care Symposium

Drivers of palliative care and hospice use among patients with advanced lung cancer.

First Author: Megan C. Edmonds

First Author: Christine Ann Garcia