Improving end-of-life care in GI oncology patients.

Abstract

172 Background: In FY17, there were 108 patients with cancer who died on an inpatient unit at UVA, and of these, 17 patients (16%) died with incurable advanced stage GI cancer. In addition, 54% of these GI cancer patients did not have an outpatient palliative care consult prior to their time of death. Lack of early palliative care consultation leads to poor end of life care, compromises quality of life for patients and their families, and promotes the overutilization of healthcare. Methods: We participated in the ASCO Quality Training Program for this project. Our first aim (AIM#1) was to increase inpatient palliative care consults by 25% in patients with advanced stage GI cancers who were considered unscheduled admissions by hospital day 2. Our second aim (AIM#2) was to increase outpatient palliative care referrals by 25% in patients with pancreatic and hepatobiliary cancers by the second visit. We conducted these aims at UVA from August 2017 to February 2018. The intervention was to remind the GI oncologists and the house staff to place the palliative care consult. Results: From our pre-intervention data for AIM#1, 33 patients with advanced GI cancer (34%) had a palliative care consult in the inpatient setting from July 2017 to July 2018. Post intervention data showed that 14 patients (73%) had a palliative care consult, 10 patients (71%) with palliative care consult went to hospice, 11 patients (59%) have died since our intervention with only 1 death occuring in the inpatient setting and 1 patient with an readmission. From our pre-intervention data for AIM#2, 24 advanced GI cancer patients (5.5%) had a palliative care referral, and post-intervention 11 patients (21%) had a palliative care referral. Of the 11 patients with palliative care referrals, 6 patients (55%) went to hospice. Conclusions: We met both of our primary inpatient and outpatient aims to increase palliative care consults for advanced stage GI oncology patients. Our data clearly shows a benefit of early palliative care referral in GI oncology patients both in the outpatient and inpatient setting. We plan to continue to collect data on long-term outcomes for our patients, and investigate future directions to improve sustainability and to expand to other cancer service line populations.