• Grace M Yang, Siqin Zhou, Zhizhen Xu, Stella Sl Goh, Xia Zhu, Dawn Qq Chong, Daniel Sw Tan, Ravindran Kanesvaran, Alethea Cp Yee, Patricia Sh Neo, and Yin-Bun Cheung.
• National Cancer Centre Singapore, Singapore.
• Palliat Med. 2021 Sep 1; 35 (8): 1578-1589.

BackgroundThe benefit of specialist palliative care for cancer inpatients is established, but the best method to deliver specialist palliative care is unknown.AimTo compare a consult model versus a co-rounding model; both provide the same content of specialist palliative care to individual patients but differ in the level of integration between palliative care and oncology clinicians.DesignAn open-label, cluster-randomized trial with stepped-wedge design. The primary outcome was hospital length of stay; secondary outcomes were 30-day readmissions and access to specialist palliative care. ClinicalTrials.gov number NCT03330509.Setting/ParticipantsCancer patients admitted to the oncology inpatient service of an acute hospital in Singapore.ResultsA total of 5681 admissions from December 2017 to July 2019 were included, of which 5295 involved stage 3-4 cancer and 1221 received specialist palliative care review. Admissions in the co-rounding model had a shorter hospital length of stay than those in the consult model by 0.70 days (95%CI -0.04 to 1.45, p = 0.065) for all admissions. In the sub-group of stage 3-4 cancer patients, the length of stay was 0.85 days shorter (95%CI 0.05-1.65, p = 0.038). In the sub-group of admissions that received specialist palliative care review, the length of stay was 2.62 days shorter (95%CI 0.63-4.61, p = 0.010). Hospital readmission within 30 days (OR1.03, 95%CI 0.79-1.35, p = 0.822) and access to specialist palliative care (OR1.19, 95%CI 0.90-1.58, p = 0.215) were similar between the consult and co-rounding models.ConclusionsThe co-rounding model was associated with a shorter hospital length of stay. Readmissions within 30 days and access to specialist palliative care were similar.

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