Timing of Palliative Care Referral Before and After Evidence from Trials Supporting Early Palliative Care

The oncologist

article

David Hausner¹  Lisa W. Le⁴  Camilla Zimmermann¹  Colombe Tricou¹  Jean Mathews¹  Deepa Wadhwa⁸  Ashley Pope²  Nadia Swami²  Breffni Hannon¹  Gary Rodin⁵  Monika K. Krzyzanowska⁹ 

[1] Division of Palliative Medicine, Department of Medicine, University of Toronto;Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network;Chaim Sheba Medical Center;Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network;Department of Psychiatry, University of Toronto;Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network;Department of Palliative Care, Centre Hospitalier de Lyon-Sud;BC Cancer – Kelowna;Division of Medical Oncology, University of Toronto;Department of Medical Oncology and Hematology, University Health Network

关键词: Palliative care;    Cancer;    Outpatient clinics;    hospital;    Early medical intervention;    Health services research;    Health care quality;    access and evaluation;    Health services accessibility;    Outcome assessment;    healthcare;   

DOI  :  10.1002/onco.13625

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Evidence from randomized controlled trials has demonstrated benefits in quality of life outcomes from early palliative care concurrent with standard oncology care in patients with advanced cancer. We hypothesized that there would be earlier referral to outpatient palliative care at a comprehensive cancer center following this evidence. Materials and Methods Administrative databases were reviewed for two cohorts of patients: the pre-evidence cohort was seen in outpatient palliative care between June and November 2006, and the post-evidence cohort was seen between June and November 2015. Timing of referral was categorized, according to time from referral to death, as early (>12 months), intermediate (>6 months to 12 months), and late (≤6 months from referral to death). Univariable and multivariable ordinal logistic regression analyses were used to determine demographic and medical factors associated with timing of referral. Results Late referrals decreased from 68.8% pre-evidence to 44.8% post-evidence; early referrals increased from 13.4% to 31.1% ( p < .0001). The median time from palliative care referral to death increased from 3.5 to 7.0 months ( p < .0001); time from diagnosis to referral was also reduced ( p < .05). On multivariable regression analysis, earlier referral to palliative care was associated with post-evidence group ( p < .0001), adjusting for shorter time since diagnosis ( p < .0001), referral for pain and symptom management ( p = .002), and patient sex ( p = .04). Late referrals were reduced to <50% in the breast, gynecological, genitourinary, lung, and gastrointestinal tumor sites. Conclusions Following robust evidence from trials supporting early palliative care for patients with advanced cancer, patients were referred substantially earlier to outpatient palliative care. Implications for Practice Following published evidence demonstrating the benefit of early referral to palliative care for patients with advanced cancer, there was a substantial increase in early referrals to outpatient palliative care at a comprehensive cancer center. The increase in early referrals occurred mainly in tumor sites that have been included in trials of early palliative care. These results indicate that oncologists’ referral practices can change if positive consequences of earlier referral are demonstrated. Future research should focus on demonstrating benefits of early palliative care for tumor sites that have tended to be omitted from early palliative care trials.

【 授权许可】

CC BY|CC BY-NC