Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service

Abstract

A fully integrated inpatient partnership between PC and medical oncology is associated with significant and clinically meaningful improvements in key health system-related outcomes and indicators of quality cancer care.

Symptom burden in patients with cancer who are experiencing unplanned hospitalization

“…Although we do not intend to suggest that every patient with cancer requires an inpatient palliative care consultation, targeting palliative care resources to meet the needs of the most symptomatic patients may prove to be an effective strategy with which to address the immense symptom burden of all hospitalized patients with cancer. In addition, future studies are needed to test innovative models of care such as an oncology–palliative care co‐rounding system to provide the highest quality care to the most symptomatic hospitalized patients with cancer . The current study data have highlighted the need to focus on the appropriate allocation of supportive and palliative care resources to meet the palliative care needs of the oncology population.…”

Palliative care during and following allogeneic hematopoietic stem cell transplantation

“…There is also some evidence to suggest that models where the palliative care specialist is integrated into the team could also serve to increase the capacity of non-palliative specialist team members to offer palliative care interventions such as goals of care discussions(75). Additional research is needed to test other models of concurrent palliative care such as co-rounding(76, 77) and standardized triggers for palliative care referral(78) that have been found to be effective in improving clinical and health services outcomes as well as quality indicators in the solid tumor setting.…”

Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital – an open-label stepped-wedge cluster-randomized trial

“…2,4 Indeed, specialist palliative care consultation for cancer patients in the acute inpatient hospital setting is associated with better patient outcomes such as shorter hospital length of stay, lower readmission rates, reduced costs and less aggressive care at the end of life. [5][6][7][8][9][10][11][12] Models for specialist palliative care delivery in acute care settings described in a recent review included the inpatient consultation service (consult model) and the inpatient palliative care unit. 13 In the setting where the oncology team remains the primary provider, only the consult model has been described, and the comparative effectiveness of different approaches to specialist palliative care service provision alongside oncology care remains unknown.…”

“…10,21 From the perspective of healthcare professionals, the co-rounding model leads to timely involvement of specialist palliative care, more communication between oncology and specialist palliative care physicians, and better care quality in terms of a more holistic approach to patient care. 10,19,22,23 Furthermore, we hypothesize that this would lead to better patient outcomes downstream in terms of shorter hospital length of stay in the inpatient hospital setting, as the problems that trigger hospital admission are addressed more efficiently and holistically. 10,12 Much of the evidence for the effects of specialist palliative care compares additional palliative care interventions with standard oncology care; there is a lack of studies comparing models of specialist palliative care delivery.…”