Oncology Rounds

The key to a successful oncology palliative care program

Hanna Kemeny, Oncology Roundtable

Many hospitals offer palliative care, but despite its benefits, cancer patients' use of palliative care remains low. A recent study at Mount Sinai Hospital found that a standardized palliative care referral system for cancer patients resulted in increased referrals and decreased hospital mortality rates and admissions.

Check out the results from Mount Sinai's study and learn more about the benefits of standardizing palliative care referrals and increasing palliative care consultations.

Trigger palliative care consults automatically

In 2012, the American Society of Clinical Oncology (ASCO) recommended that all metastatic cancer patients with uncontrolled symptoms receive adjuvant palliative care as part of their standard treatment. 

ASCO’s suggestion was prompted by a growing body of evidence showing that palliative care services improve decision-making, care coordination, symptom management, and patient satisfaction.

To make these recommendations actionable for clinicians, Mount Sinai developed standardized criteria to automatically trigger palliative care consults, including:

  • Late stage diagnosis
  • Metastatic solid tumors
  • Uncontrolled symptoms
  • Hospitalization within the past 30 days
  • Prolonged hospitalization (more than 7 days)

Care quality improvements

By increasing palliative care consultations, researchers measured several improvements in quality of care:

  • 100% increase in palliative care referrals from 41% to 82%
  • 79% increase in hospice use from 14% to 25%
  • Improvement in mortality index from 1.35 to 0.59, indicating a significant decrease in inpatient oncology related deaths

Health care cost reductions

A number of studies have shown that palliative care can reduce health care costs by decreasing unnecessary utilization of the ED and hospital. Mount Sinai researchers also found that readmissions to the hospital within 30 days of discharge decreased from 21.7% to 13.5%.

Formalize palliative care consult criteria

Given the results, Mount Sinai is establishing an additional palliative care team to ensure that all patients with late stage, metastatic solid tumors that also suffer from uncontrolled symptom management receive palliative care consultations.

The authors state that “formalizing criteria for palliative care consultation was easy to implement, highly effective, and led to improvements in multiple quality measures.” 

In other words, if your hospital or cancer program has a palliative care program, you can increase cancer patient use of palliative care through the development and implementation of systematic triggers.

More Palliative Care Resources

For more insights on how to successfully integrate palliative care into an oncology program, check out our recent blog post on Mass General's framework or our study, Integrating Palliative Care into Oncology Practice.