• Gulcan Bagcivan, J Nicholas Dionne-Odom, Jennifer Frost, Margaret Plunkett, Lisa A Stephens, Peggy Bishop, Richard A Taylor, Zhongze Li, Rodney Tucker, and Marie Bakitas.
• 1 UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA.
• Palliat Med. 2018 Jan 1; 32 (1): 59-68.

BackgroundEarly outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters.AimDescribe the evaluation and treatment recommendations made in early outpatient palliative care consultations.DesignOutpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated.Setting/ParticipantsOutpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US.ResultsIn all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants.ConclusionOutpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom indicators versus reliance on oncologist referral.

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