Palliative Oncology: Patient Outcomes and Lessons Learned from a Novel Criteria-based Inpatient Consult Service

Outcomes 1. Through structured discussion with our team's recent service chiefs, participants will be able to describe strategic program development lessons and challenges encountered during the creation of a criteria-based palliative care consultation service.2. Upon successful completion, participants will be able to evaluate how a criteria-based inpatient palliative care service affected care utilization and end-of-life quality outcomes for patients with advanced cancer. Key Message We created an embedded, criteria-based, inpatient palliative care (PC) consult service as a pragmatic step toward improving PC integration at our cancer center. Despite significant implementation challenges during the COVID pandemic, the service was associated with earlier, more frequent PC exposure, decreased end-of-life care intensity, and longer hospice length-of-stay. Introduction/Context Recognizing the importance of earlier PC, we designed and implemented a novel “Palliative Oncology” consultation service in inpatient oncology with an enhanced role for social work (SW) and chaplaincy. Objectives Describe Palliative Oncology service; report pre/post end-of-life quality outcomes; reflect on lessons learned from implementation. Methods We embedded a specialist PC team on the oncology floor: 1 physician, 1 nurse practitioner, 2 SW, and 2 chaplains. Admitted patients were screened for two referral criteria: 1) advanced/metastatic solid cancer, or 2) moderate/severe symptoms. The oncology team was informed of patients meeting criteria; referrals remained at discretion of the oncology team. Through chart review, we compared outcomes of decedents admitted before (10/1/19-6/30/2020) or after (7/1/2020-9/30/21) service implementation using t-test (continuous variables) and χ2 test (categorical variables). Results Of 820 decedents, 186 died pre-intervention and 634 post-intervention. Post-intervention, more decedents saw inpatient PC (72% vs. 59%, p<.001) and outpatient PC (34% vs. 23%, p<.01), had more PC visits (11.1 vs. 8.9, p<.05), and had their first PC visit sooner before death (159 vs. 76 days, p<.001). Post-intervention decedents were less likely to have ED (41% vs. 52%, p< 0.05), hospital (57% vs. 71%, p<.001), or ICU encounters (17% vs. 25%; p<.01) in the last 30 days of life, or to receive systemic cancer therapy in the last 14 days of life (5% vs. 9%, p<.05). Hospice referrals remained stable, (67% vs. 60%, p=.09), but hospice length-of-stay increased (36 vs. 22 days, p<.05), as did frequency of death at home (50% vs. 41%, p<.05). There were no between-group differences in age at cancer diagnosis or death, gender, race/ethnicity, insurance, or primary cancer. Conclusion Despite implementation challenges during the COVID pandemic, a criteria-based, interdisciplinary PC consult service in inpatient oncology was associated with earlier, more intense PC and improved end-of-life quality outcomes. Keywords Models of Palliative Care Delivery / Patient Outcome