• Kathryn E Norman, Mary K Buss, Kathleen A Lee, Abigail Escobar, Jonathan Thomas, Julia Berg, Nsabimana Uwumugambi, Laura E Dodge, Harry J Han, Carol Pilgrim, and Jonathan C Yeh.
• Department of Internal Medicine, Section of Medical Oncology, Yale New Haven Hospital, New Haven, CT.
• J Pain Symptom Manage. 2024 Nov 18.

ContextEarly, integrated palliative care (PC) improves outcomes in advanced cancer; however, inpatient PC referrals still exceed outpatient referrals nationwide. Recognizing need for enhanced integration, our cancer center implemented a criteria-based PC consultation model in inpatient oncology.ObjectivesTo compare decedent outcomes pre- and post-implementation of a new criteria-based PC consultation model in inpatient oncology.MethodsWe implemented an embedded, interdisciplinary "Palliative Oncology" consult team on the oncology floor. Admitted patients were screened for advanced/metastatic solid cancer or moderate/severe symptoms. The oncology team received prompting regarding eligible patients; PC referral remained at their discretion. We compared outcomes between patients who died pre- (10/1/2019-6/30/2020) and post-implementation (7/1/2020-6/30/2022) by t-test (continuous variables) and chi-square test (categorical variables).ResultsOf 820 decedents, 186 died pre-intervention and 634 died post-intervention. Post-intervention, more decedents saw inpatient PC (59% to 72%, p<.001) and outpatient PC (23% to 34%, p<.01), and had earlier first PC visit before death (76 to 159 days, p<.001). Post-intervention, fewer decedents had hospitalizations (71% to 57%, p<.001) and intensive care encounters (25% to 17%, p<.01) within last 30 days of life. Hospice length-of-stay increased (22 to 36 days, p<.01). There were trends toward fewer emergency room visits within last 30 days of life (51% to 42%, p=.02), less systemic cancer therapy within last 14 days of life (9% to 5%, p=.03), and more deaths at home (41% to 50%, p=.03).ConclusionEmbedded, criteria-based PC consultation in inpatient oncology was associated with earlier PC involvement, longer hospice LOS, and reduced EOL care intensity.Copyright © 2024. Published by Elsevier Inc.

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