A Quantitative Study of Triggered Palliative Care Consultation for Hospitalized Patients With Advanced Cancer

Abstract

Although TPCC was viewed favorably, implementation was logistically challenging because of short stays, high-acuity symptoms, and individual provider resistance. TPCC improved patients' understanding of their cancer. This population demonstrates high palliative care needs, warranting further research into how best to deliver care.

Transition Points for the Routine Integration of Palliative Care in Patients With Advanced Cancer

“…In their study, implementation of triggered referrals resulted in a significant reduction of hospital readmission and increase in hospice involvement. 37 Rocque et al 38 demonstrated improved illness understanding after implementation of triggered palliative care for all hospitalized cancer patients with metastases but minimal impact on patient-reported symptoms, hospice utilization, and cost of care. A future hybrid effectiveness-implementation randomized trial of the cancer-specific transition points defined in this study is warranted to assess if their implementation can change both patient-and system-level outcomes.…”

Characterizing the Nature of Scan Results Discussions: Insights Into Why Patients Misunderstand Their Prognosis

“…The paucity of explicit prognostic communication in the encounters likely contributes to the observed poor illness understanding seen nationally. [1][2][3][4] This makes it difficult to create interactional space to use the main attributes of SDM and PCC-building a consensus about the preferred treatment, 43 creating a clear understanding of the information being discussed, supporting opportunities for patient autonomy, and providing emotional support as needed. 44 Second, oncologists quickly transitionthe conversation from scan-talk to treatment-talk.…”

“…Patients with advanced and incurable cancer generally overestimate their probability for long-term survival and misunderstand the goals of anticancer therapy. 1,2 Weeks et al 3 showed that 69% of patients with metastatic lung cancer and 81% of patients with metastatic colorectal cancer incorrectly believed their chemotherapy was curative in intent; Rocque et al 4 found that only 65% of hospitalized patients with advanced cancer correctly identified their cancer as incurable. In this article, we present an analysis of the nature of talk in the cancer clinic, describing why patients might misunderstand the incurable nature of their disease, and then propose a simple intervention, a question, that we anticipate will improve the quality of prognostic discussions.…”

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

“…Very weak patients or patients close to death who cannot speak for themselves and express their needs and symptom burden are challenging and might have benefitted from an earlier integration of PC; not only for symptom control, but also for decision making [20][21][22]. In addition, insufficient IPCC staffing and logistical problems like short patient stays and difficulty in timing the consultation are challenging issues [23].…”