Changes in the Care Setting of First Consults to Palliative and Supportive Care Over a Seven-Year Period

• Published in: Journal of pain and symptom management 2019-01, Vol.57 (1), p.86-92
• Main Authors: Prado, Bernard L., Haider, Ali, Naqvi, Syed, Pestana, Roberto C., Williams, Janet L., Dibaj, Seyedeh, Liu, Diane, Allo, Julio, De La Cruz, Vera, Bruera, Eduardo
• Format: Article
• Language: English
• Subjects: Cancer; cancer care; Death & dying; Hematologic cancer; hematological cancer; Inpatient care; Intensive care; intensive care unit; Optimization; Palliative care; Palliative care integration; Patients; supportive care
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2018.10.269

Optimal benefits from palliative care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. The objective of this study was to determine the proportion of PC1 over time in the outpatient, ICU, and inpatient non-ICU settings. We also examined patients' baseline characteristics and the timing of PC access (from PC1 to death) by the setting of PC1. We retrospectively evaluated consecutive cancer patients' records at our cancer center to ascertain the annual number of PC1 and its distribution across settings (2011–2017). ICU PC1 (n = 309) and a random sample of an equal number of outpatient and inpatient non-ICU PC1 were reviewed to retrieve patients' characteristics and death date. PC1 total annual number increased by 58% from 2011 (n = 2286) to 2017 (n = 3615). We found a significant decrease in the proportion of ICU PC1 (from 2.3% in 2011 to 1% in 2017, P