A Population Health Approach to Addressing Palliative Care Needs in Outpatients with Gynecologic Malignancies

Outcomes 1. Describe an innovative program that aimed to proactively, equitably, and efficiently screen for and address palliative care needs in a population of patients with advanced gynecologic cancers.2. Consider how this system could be adapted to routinely assess and address the palliative care needs of various populations. Key Message Through an electronic survey, we proactively screened patients with stage 3 and 4 gynecologic cancers and found high rates of palliative care needs including physical symptoms, emotional distress, practical concerns, and advance care planning needs. Some, but not all, patients accepted services that were tailored to their needs. Introduction/Context Developing systems to routinely, equitably, and efficiently identify and meet palliative care (PC) needs on a population level is a critical frontier for palliative medicine. Methods We sent electronic surveys to outpatients with stage 3 or 4 gynecologic malignancies to assess for PC needs in the following domains: physical symptoms, emotional distress, practical concerns, and advance care planning (ACP). Identified needs were addressed with tailored PC interventions including referral to specialty PC, support groups, social work consultations, and ACP websites/workshops. Results Overall, 64% of patients (137/214) completed the survey to indicate their PC needs. Forty-five percent of patients reported significant physical symptoms and 44% reported emotional distress (median distress level 4/10). A care coordination challenge was reported by 14% and a practical issue by 23%. Twenty-one percent wanted more information about their cancer or treatment options. Fifty-three percent did not have an ACP note in the EHR, 84% did not have an advance directive, and 94% did not have a POLST.Of the 61 patients with physical symptoms, 27 (44%) were already followed by specialty PC. The remaining 34 were offered a PC referral and 17 (50%) accepted. Among the 60 patients reporting emotional distress, 18 (30%) expressed interest in a PC social work consultation, 21 (35%) in a support group, and 22 (37%) in a resiliency class. Among the 31 patients with practical concerns, 21 (68%) wanted to meet with a social worker. Among the 93 patients with no ACP documentation, 45 (48%) were interested in an interactive ACP website, 25 (27%) in an ACP workshop, and 58 (62%) requested an advance directive be sent to them. Conclusions Through an electronic survey we proactively screened patients with advanced gynecologic malignancies and found high rates of PC needs. Receptivity to services was incomplete, a finding that requires further investigation. Keywords Models of Palliative Care Delivery / Quality Improvement