Using standardised criteria for palliative care referal improves cancer care

Categories: Research.

During the three-month pilot, conducted at Mount Sinai Hospital, all patients hospitalised with late-stage, metastatic solid tumours and uncontrolled symptoms were offered a palliative care consultation.

This simple offer resulted in 82% of patients having a palliative care consultation, compared with 41% of similar patients in the six weeks before the intervention was offered routinely.

Readmission to the hospital within 30 days of discharge during the study decreased from 36% to 17% and use of hospice services rose from 14% to 25%. In addition, the mortality index (expected over actual deaths) in the oncology service dropped dramatically, to 0.59 in the study group from 1.35 in similar patients during the year prior to the study.

Project lead Kerin Adelson, MD, said: “This demonstrates that making palliative care a routine part of cancer care results in improved outcomes and more patient-cantered care.”

Numerous studies have demonstrated the benefits of palliative care to cancer patients, families, clinicians and health systems, and The American Society of Clinical Oncology (ASCO) recommends routinely offering palliative care alongside standard oncologic care to all patients with metastatic cancer or uncontrolled symptoms.

However, palliative care services are often underutilised for cancer patients. Dr Adelson explains that this is often because oncologists equate palliative care with end of life care and feel that calling in a palliative care specialist is an admission of defeat.

Dr Adelson said: “Failure to identify patients who could most benefit from palliative care often results in inadequate pain control, emotional distress for patients and caregivers, and overuse of aggressive medical interventions. By increasing access to palliative care services, we hoped to help patients clarify their own treatment goals and, in turn, align our clinical goals with those of our patients.” 

R. Sean Morrison, MD, Director of the Hertzberg Palliative Care Institute at Mount Sinai, said: “Findings like Dr Adelson’s provide a strong case for making palliative care consultation a core component of cancer treatment from the time of diagnosis.

“Our goal is to use the results of this project to develop interventions within our hospital to ensure that all people with a serious illness, not just cancer patients, are actively screened for palliative care needs and have those needs addressed—either by the primary treatment team or through the extra layer of support of the palliative care service.”

The study findings are to be presented at ASCO’s upcoming 2013 Quality Care Symposium, taking place in San Diego on 1-2 November.

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