Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients
Article first published online: 22 FEB 2014
© 2014 American Cancer Society
Volume 120, Issue 11, pages 1743–1749, 1 June 2014
How to Cite
Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G. and Bruera, E. (2014), Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer, 120: 1743–1749. doi: 10.1002/cncr.28628
- Issue published online: 20 MAY 2014
- Article first published online: 22 FEB 2014
- Manuscript Accepted: 30 JAN 2014
- Manuscript Revised: 29 JAN 2014
- Manuscript Received: 12 JAN 2014
- chemotherapeutic agents;
- palliative care;
- quality of care
Limited data are available on how the timing and setting of palliative care (PC) referral can affect end-of-life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end-of-life care.
All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end-of-life care indicators.
Among 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P < .001), fewer hospitalizations (48% vs 81%; P < .003), and fewer hospital deaths (17% vs 31%; P = .004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P < .001), fewer hospital admissions (52% vs 86%; P < .001), fewer hospital deaths (18% vs 34%; P = .001), and fewer intensive care unit admissions (4% vs 14%; P = .001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28-0.66; P < .001) was independently associated with less aggressive end-of-life care. Men (OR, 1.63; 95% CI, 1.06-2.50; P = .03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18-5.59; P = .02) were associated with more aggressive end-of-life care.
Patients who were referred to outpatient PC had improved end-of-life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral. Cancer 2014;120:1743–1749. © 2014 American Cancer Society.