• Laura C Hanson, Kathryn L Wessell, Jenny Hanspal, Feng-Chang Lin, Frances A Collichio, Darren DeWalt, Matthew I Milowsky, Donald L Rosenstein, Gary S Winzelberg, William A Wood, and Natalie C Ernecoff.
• Division of Geriatric Medicine, University of North Carolina at Chapel Hill (L.C.H., G.S.W.), Chapel Hill, North Carolina, USA; Palliative Care Program, University of North Carolina at Chapel Hill (L.C.H., J.H., G.S.W.), Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (L.C.H., K.L.W.), Chapel Hill, North Carolina, USA. Electronic address: laura_hanson@med.unc.edu.
• J Pain Symptom Manage. 2021 Sep 1; 62 (3): e56-e64.

ContextThe Collaborative Care Model improves care processes and outcomes but has never been tested for palliative care.ObjectivesTo develop and evaluate a model of collaborative oncology palliative care for Stage IV cancer.MethodsWe conducted a pre-post evaluation of Collaborative Oncology Palliative Care (CO-Pal), enrolling patients with Stage IV lung, breast or genitourinary cancers and acute illness hospitalization. CO-Pal has 4 components: 1) oncologist communication skills training; 2) patient tracking; 3) palliative care needs assessment; and 4) care coordination stratified by high vs. low palliative care need. Health record reviews from hospital admission through 60 days provided data on outcomes - goals-of-care discussions (primary outcome), advance care planning, symptom treatment, specialty palliative care and hospice use, and hospital transfers.ResultsWe enrolled 256 patients (n = 114 pre and n = 142 post-intervention); 60-day mortality was 32%. Comparing patients pre vs post-intervention, CO-Pal did not increase overall goals-of-care discussions, but did increase advance care planning (48% vs 63%, P = 0.021) and hospice use (19% vs 31%, P = 0.034). CO-Pal did not impact symptom treatment, overall treatment plans, or 60-day hospital transfers. During the intervention phase, high-need vs low-need patients had more goals-of-care discussions (60% vs. 15%, P < 0.001) and more use of specialty palliative care (64% vs 22%, P < 0.001) and hospice (44% vs 16%, P < 0.001).ConclusionCollaborative oncology palliative care is efficient and feasible. While it did not increase overall goals-of-care discussions, it was effective to increase overall advance care planning and hospice use for patients with Stage IV cancer.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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