• J Palliat Med · Dec 2017

    Integrating Palliative and Oncology Care for Patients with Advanced Cancer: A Quality Improvement Intervention.

    • Laura C Hanson, Frances Collichio, Stephen A Bernard, William A Wood, Matt Milowsky, Erin Burgess, Crista J Creedle, Summer Cheek, Lydia Chang, Bhisham Chera, Alexandra Fox, and Feng-Chang Lin.
    • 1 Division of Geriatric Medicine, The University of North Carolina , Chapel Hill, North Carolina.
    • J Palliat Med. 2017 Dec 1; 20 (12): 1366-1371.

    BackgroundPractice guidelines recommend palliative care for patients with advanced cancer, but gaps in access and quality of care persist.ObjectiveTo increase goals-of-care (GOC) communication for hospitalized patients with Stage IV cancer.MethodsAn interdisciplinary team designed a quality improvement intervention to enhance oncology palliative care, including training in communication skills and triggers for palliative care consults.Setting/SubjectsAll adult inpatients with Stage IV cancer and unplanned admission at an 804-bed hospital affiliated with a National Cancer Institute (NCI) Comprehensive Cancer Center.MeasurementsThe primary quality measure was the percentage of patients with Stage IV cancer who had a GOC discussion during hospitalization; secondary measures included screening for pain, dyspnea, spiritual needs, and outcomes of intensive care, hospice, and 30-day readmission.ResultsIn the 11-month study period, n = 330, Stage IV cancer patients were hospitalized. Comparing the first three months with the final three months, rates of GOC discussion increased from 29% to 48% (p = 0.013), and specialty palliative care consultation increased from 18% to 33%, (p = 0.026). Rates of symptom screening, intensive care unit transfer, hospice, and 30-day re-admission did not change overall. However, patients with specialty palliative care more frequently had pain screening (91% vs. 81%, p = 0.020), spiritual assessment (48% vs. 10%, p < 0.001), and hospice referral (39% vs. 9%, p < 0.001), and they were less likely to be re-admitted within 30 days (12% vs. 21%, p = 0.059).DiscussionInterdisciplinary quality improvement was effective to increase GOC discussions and palliative care consults for patients with Stage IV cancer.

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