• Isabelle Colombet, Vincent Montheil, Jean-Philippe Durand, Florence Gillaizeau, Ralph Niarra, Cécile Jaeger, Jérôme Alexandre, François Goldwasser, and Pascale Vinant.
• Université Paris Descartes, Sorbonne Paris Cité, Public Health Paris, France.
• BMJ Support Palliat Care. 2012 Sep 1;2(3):239-47.

ObjectiveTo examine the impact of oncologist awareness of palliative care (PC), the intervention of the PC team (PCT) and multidisciplinary decision-making on three quality indicators of end-of-life (EOL) care.SettingCochin Academic Hospital, Paris, 2007-2008.Design And ParticipantsA 521 decedent case series study nested in a cohort of 735 metastatic cancer patients previously treated with chemotherapy. Indicators were location of death, number of emergency room (ER) visits in last month of life and chemotherapy administration in last 14 days of life. Multivariable logistic regression models were used to estimate associations between indicators and oncologist's awareness of PC, PCT intervention and case discussions at weekly onco-palliative meetings (OPMs).Results58 (11%) patients died at home, 45 (9%) in an intensive care unit or ER, and 253 (49%) in an acute care hospital; 185 (36%) patients visited the ER in last month of life and 75 (14%) received chemotherapy in last 14 days of life. Only the OPM (n=179, 34%) independently decreases the odds of receiving chemotherapy in last 14 days of life (OR 0.5, 95% CI 0.2 to 0.9) and of dying in an acute care setting (0.3, 0.1 to 0.5). PCT intervention (n=300, 58%) did not independently improve any indicators. Among patients seen by the PCT, early PCT intervention had no impact on indicators, whereas the OPM reduced the odds of persistent chemotherapy in the last 14 days of life.ConclusionMultidisciplinary decision-making with oncologists and the PCT is the most critical parameter for improving EOL care.

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