Impact of Palliative Care on End-of-Life Services for Patients Dying in a Hospital
In a single-center retrospective analysis reported in the Journal of Oncology Practice, Wiesenthal et al found that among patients dying in a hospital, those with palliative care in place at final admission received less diagnostic testing and other services not associated with promoting patient comfort.
Study Details
The study involved data on 695 adult patients with solid tumors from the Memorial Sloan Kettering Cancer Center who died in the tertiary care center after a hospital stay of ≥ 3 days between December 2012 and November 2014.
Cancer Treatments and Diagnostic Procedures
Of the 695 patients, 21% received outpatient palliative care, 46% received inpatient palliative care only, and 33% received no palliative care. Overall, during their final admission, 11.2% of patients received radiation therapy and 12.5% received tumor-directed therapy, with no differences on the basis of palliative care involvement (P = .09 to .17).
In the last 3 days of life, imaging tests occurred in 43.5% of patients with outpatient palliative care, 47.3% of those with inpatient palliative care, and 58.1% of those with no palliative care (P = .048 vs others); the difference largely reflected less use of x-ray studies among those with palliative care (38.1% and 41.1% vs 52.0%, P = .051). A lower proportion of patients with outpatient palliative care (42.2%) had venipuncture blood draws compared with those with inpatient palliative care only (45.1%) or those with no palliative care (55.9%; P = .050).
Other Treatments and Services
Patients with outpatient palliative care were less likely to receive anticoagulants (41.5%) compared with those with inpatient palliative care only (46.7%) and those without palliative care (59.8%; P = .005) and were less likely to receive statin therapy (4.8% vs 6.6% and 13.5%; P = .024). Patients with outpatient or inpatient-only palliative care were more likely to receive psychotherapeutic agents (55.8% and 56.4% vs 39.7%; P = .002), possibly contributing to an improved end-of-life experience.
Patients with inpatient palliative care only (16.9%) were more likely to have chaplaincy or social work consultations than those with outpatient (10.9%) or no palliative care (5.2%; P = .001). Do-not-resuscitate orders were in place within 6 months before final admission for more patients with outpatient palliative care (22%) vs those with inpatient-only (8%) or no palliative care (12%; P = .002).
The investigators concluded: “In this retrospective cohort of patients with solid tumor dying in [a] hospital, few patients received cancer-directed therapies at the end of life. Involvement of [palliative care] was associated with a decrease in diagnostic testing and other services not clearly promoting comfort as patients approached death.”
The study was supported by a grant from the National Cancer Institute.
Alison Wiesenthal, MD, of Memorial Sloan Kettering 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®.
