Use of ‘Triggers’ for Palliative Care Consultation on Solid Tumor Oncology Service

Key Points

  • Standard use of criteria for palliative care consultation resulted in higher hospice referral rates and lower rates of rehospitalization and postdischarge chemotherapy use.
  • The intervention was associated with an overall increase in support measures following discharge.

In a study reported in the Journal of Oncology Practice, Adelson et al found that using standardized criteria for palliative care consultation on a solid tumor oncology service resulted in increased hospice referral and reduced rates of hospital readmission and chemotherapy use after discharge.

Study Details

The study involved 48 preintervention group and 65 intervention group patients in the Mount Sinai (New York) solid tumor oncology service who met any of the following criteria: advanced solid tumor (stage IV solid tumor or stage III lung or pancreatic cancer); prior hospitalization within 30 days; hospitalization > 7 days; or any active symptoms including pain, nausea or vomiting, dyspnea, delirium, and psychological distress. Intervention group patients were to receive automatic palliative care consultation.

Difference in Outcomes

Compared with patients in the preintervention group, those in the intervention group were more likely to receive palliative care consultation (80% vs 39%, P ≤ .001) and hospice referral (26% vs 14%, P = .03) and had lower 30-day hospital readmission rates (18% vs 35%, P = .04) and reduced use of chemotherapy after discharge (18% vs 44%, P = .03). There was an overall increase in support measures following discharge in the intervention group (P = .004), with these patients being more likely to be discharged home with any home-based services (32% vs 19%, P = .05) and to receive home hospice (15% vs 8%, P = .26) or inpatient hospice (11% vs 6%, P = .41) and less likely to be discharged to subacute rehabilitation facilities (3% vs 13%, P = .05). There was no significant difference between groups in mean length of stay (14 vs 11 days, P = .15) or intensive care unit use (3% vs 10%, P = .11).

The investigators concluded: “To our knowledge, this is the first study to demonstrate that among patients with advanced cancer admitted to an inpatient oncology service, the standardized use of triggers for [palliative care] consultation is associated with substantial impact on 30-day readmission rates, chemotherapy following discharge, hospice referrals, and use of support services following discharge. Expansion of this model to other hospitals and health systems should improve the value of cancer care.”

They noted: “As a result of our findings, Mount Sinai’s current standard of care is to provide every patient on the solid tumor service who meets these criteria with an automatic [palliative care] consultation, and the hospital has expanded the [palliative care] service to meet the clinical need.”

Kerin Adelson, MD, of Yale Cancer Center, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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