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Palliative care consults improve care and reduce hospitalization in advanced cancer patients

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According to a recent study led by researchers from the Icahn School of Medicine at Mount Sinai (NY, USA), patients with advanced stages of cancer that received early referral to palliative care demonstrated decreased utilization of health care services and an increased use of available support services following discharge from hospital.

The study, published recently in the Journal of Oncology Practice, further demonstrated that a systemized process of referrals leads to significant improvements in 30-day readmission rates, hospice referral and chemotherapy treatment post-discharge in advanced cancer parents. It is the first study to highlight that standardized use of triggers for palliative care consults among advanced cancer patients, is associated with noted improvements to a number of quality measures.

The majority of the times, advanced cancer patients have symptoms that significantly affect their emotional health, functional ability and overall quality of life.  Though integrating palliative care improves symptom control and decreases unwanted health care use, many patients are not offered the services.

“As cancer progresses, patients are often at high risk for physical pain and emotional distress,” stated study author Cardinale B. Smith (Icahn School of Medicine at Mount Sinai). “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 30–50%, both measures of poor-quality cancer care.”

Researchers developed standardized criteria, dubbed “triggers”, for palliative care consultations for patients admitted to The Mount Sinai Hospital cancer unit. To be eligible for the study, patients had to meet one or more eligibility criteria: advanced solid tumor cancer, prior hospitalization within 30 days, hospitalization for more than 7 days, or active symptoms.

“Care for patients with advanced cancer is often characterized by time spent on acute-care hospital wards and intensive care units, or receiving invasive procedures, chemotherapy infusions and radiographic imaging. Such interventions drive escalating costs and are often directly in conflict with patients’ prior stated wishes,” Smith continued.

Consults with the palliative team comprises establishing goals of care, using standardized communication protocols as to advance patient care plans, symptom assessment and transition planning as treatment using the Edmonton Symptom Assessment Scale. The team was composed of a board-certified primary care physician, a nurse practitioner, a social worker, as well as a chaplain and two trainees.

“Our results highlight the need to adopt this practice at acute care hospitals across the nation,” concluded Smith. “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.”

Source:

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. doi: 10.1200/JOP.2016.016808 J. Oncol. Pract. [Epub ahead of print] (2017)  Eureka press release  www.eurekalert.org/pub_releases/2017-03/tmsh-pcc031517.php

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