Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients

Authors

  • David Hui MD, MSc,

    Corresponding author
    1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Corresponding author: David Hui, MD, MSc, Department of Palliative Care and Rehabilitation Medicine Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; Fax: (713) 792-6092; dhui@mdanderson.org

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  • Sun Hyun Kim MD,

    1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
    2. Department of Family Medicine, Kwandong University, College of Medicine, Republic of Korea
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  • Joyce Roquemore MBA,

    1. Clinical Operations Informatics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Rony Dev MD,

    1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Gary Chisholm MS,

    1. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Eduardo Bruera MD

    1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

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