Impact of Integrated Oncology- Palliative Care Outpatient Model on Trends of Palliative Care and Hospice Care Referrals From Oncology

Background: A commonly voiced concern of oncologists, regarding the introduction of palliative care, is that patients might be immediately steered to hospice care and away from oncology care.

Objective: To assess the impact of oncology-palliative care collaboration on trends of referrals to palliative and hospice care.

Methods: In January 2015, we implemented an integrated oncology-palliative care clinic model with the following elements:

1. Pre-clinic “huddle” among palliative care and oncology staff to identify palliative care needs for patients;
2. Shared palliative care and oncology clinic appointments;
3. Introduction of palliative care for every new oncology clinic patient, for advance care planning;
4. Concurrent oncology and palliative care follow-up for all high-risk patients (aggressive histology, progressing disease, etc.) for goals of care discussions and symptom management; and
5. Palliative care and oncology staff co-managing oncology patients enrolled in hospice care.

Measurements: We examined the following metrics for FY15, FY16, FY17, and FY18.

1. Total number of palliative care consults;
2. Number of palliative care consults from oncology;
3. Percentage palliative care consults from oncology [(item 2 × 100) / item 1];
4. Total number of referrals to hospice care;
5. Number of referrals to hospice care from oncology; and
6. Percentage hospice care referrals from oncology [(item 5 × 100) / item 4].

Results: During the period of FY15 to FY18, there was a consistent increase in total palliative care consults (355, 394, 549, and 570 respectively). There also was a consistent increase in percentage palliative care consults from oncology (24%, 34%, 38%, and 40% respectively) without an increase in percentage hospice care referrals from oncology.

Conclusion: A common concern is that palliative care in oncology care will result in patients being immediately steered to hospice care and away from continued oncology care. Although it was limited to a single clinical setting, our intervention resulted in increased palliative care consults from oncology without a proportionate increase in hospice care referrals from oncology during the same time-period, suggesting that earlier access to palliative care did not result in immediate transition to hospice care. Palliative care offers opportunities for goals of care conversations and symptom management in oncology care, prior to transition to hospice care. Future implications include robust studies to further test these findings, review of structure and training of oncology-palliative care teams, and systems redesign to develop dyad or shared clinic models.

Background: A commonly voiced concern of oncologists, regarding the introduction of palliative care, is that patients might be immediately steered to hospice care and away from oncology care.

Objective: To assess the impact of oncology-palliative care collaboration on trends of referrals to palliative and hospice care.

Methods: In January 2015, we implemented an integrated oncology-palliative care clinic model with the following elements:

1. Pre-clinic “huddle” among palliative care and oncology staff to identify palliative care needs for patients;
2. Shared palliative care and oncology clinic appointments;
3. Introduction of palliative care for every new oncology clinic patient, for advance care planning;
4. Concurrent oncology and palliative care follow-up for all high-risk patients (aggressive histology, progressing disease, etc.) for goals of care discussions and symptom management; and
5. Palliative care and oncology staff co-managing oncology patients enrolled in hospice care.

Measurements: We examined the following metrics for FY15, FY16, FY17, and FY18.

1. Total number of palliative care consults;
2. Number of palliative care consults from oncology;
3. Percentage palliative care consults from oncology [(item 2 × 100) / item 1];
4. Total number of referrals to hospice care;
5. Number of referrals to hospice care from oncology; and
6. Percentage hospice care referrals from oncology [(item 5 × 100) / item 4].

Results: During the period of FY15 to FY18, there was a consistent increase in total palliative care consults (355, 394, 549, and 570 respectively). There also was a consistent increase in percentage palliative care consults from oncology (24%, 34%, 38%, and 40% respectively) without an increase in percentage hospice care referrals from oncology.

Conclusion: A common concern is that palliative care in oncology care will result in patients being immediately steered to hospice care and away from continued oncology care. Although it was limited to a single clinical setting, our intervention resulted in increased palliative care consults from oncology without a proportionate increase in hospice care referrals from oncology during the same time-period, suggesting that earlier access to palliative care did not result in immediate transition to hospice care. Palliative care offers opportunities for goals of care conversations and symptom management in oncology care, prior to transition to hospice care. Future implications include robust studies to further test these findings, review of structure and training of oncology-palliative care teams, and systems redesign to develop dyad or shared clinic models.

Background: A commonly voiced concern of oncologists, regarding the introduction of palliative care, is that patients might be immediately steered to hospice care and away from oncology care.

Objective: To assess the impact of oncology-palliative care collaboration on trends of referrals to palliative and hospice care.

Methods: In January 2015, we implemented an integrated oncology-palliative care clinic model with the following elements:

1. Pre-clinic “huddle” among palliative care and oncology staff to identify palliative care needs for patients;
2. Shared palliative care and oncology clinic appointments;
3. Introduction of palliative care for every new oncology clinic patient, for advance care planning;
4. Concurrent oncology and palliative care follow-up for all high-risk patients (aggressive histology, progressing disease, etc.) for goals of care discussions and symptom management; and
5. Palliative care and oncology staff co-managing oncology patients enrolled in hospice care.

Measurements: We examined the following metrics for FY15, FY16, FY17, and FY18.

1. Total number of palliative care consults;
2. Number of palliative care consults from oncology;
3. Percentage palliative care consults from oncology [(item 2 × 100) / item 1];
4. Total number of referrals to hospice care;
5. Number of referrals to hospice care from oncology; and
6. Percentage hospice care referrals from oncology [(item 5 × 100) / item 4].

Results: During the period of FY15 to FY18, there was a consistent increase in total palliative care consults (355, 394, 549, and 570 respectively). There also was a consistent increase in percentage palliative care consults from oncology (24%, 34%, 38%, and 40% respectively) without an increase in percentage hospice care referrals from oncology.

Conclusion: A common concern is that palliative care in oncology care will result in patients being immediately steered to hospice care and away from continued oncology care. Although it was limited to a single clinical setting, our intervention resulted in increased palliative care consults from oncology without a proportionate increase in hospice care referrals from oncology during the same time-period, suggesting that earlier access to palliative care did not result in immediate transition to hospice care. Palliative care offers opportunities for goals of care conversations and symptom management in oncology care, prior to transition to hospice care. Future implications include robust studies to further test these findings, review of structure and training of oncology-palliative care teams, and systems redesign to develop dyad or shared clinic models.