Adelson Kerin, Paris Julia, Horton Jay R, Hernandez-Tellez Lorena, Ricks Doran, Morrison R Sean, Smith Cardinale B
Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
J Oncol Pract. 2017 May;13(5):e431-e440. doi: 10.1200/JOP.2016.016808. Epub 2017 Mar 17.
Hospitalized patients with advanced cancer have a high symptom burden and need for support. Integration of palliative care (PC) improves symptom control and decreases unwanted health care use, yet many patients are never offered these services. In 2016, ASCO called for incorporation of PC into oncologic care for all patients with metastatic cancer. To improve the quality of cancer care, we developed standardized criteria, or triggers, for PC consultation on the inpatient solid tumor service.
Patients were eligible for this prospective cohort study if they met at least one of the following eligibility criteria: had an advanced solid tumor; prior hospitalization within 30 days; hospitalization > 7 days; and active symptoms. During the intervention, patients who met the criteria received automatic PC consultation.
When we compared patients in the intervention group with control subjects, there were increases in PC consultations (19 of 48 [39%] to 52 of 65 [80%]; P ≤ .001) and hospice referrals (seven of 48 [14%] to 17 of 65 [26%]; P = .03), and there were declines in 30-day readmission rates (17 of 48 [35%] to 13 of 65 [18%]; P = .04) and receipt of chemotherapy after discharge (21 of 48 [44%] to 12 of 65 [18%]; P = .03). There was an overall increase in support measures following discharge ( P = .004). Length of stay was unaffected.
To our knowledge, this is the first study to demonstrate that among patients with advanced cancer admitted to an inpatient oncology service, the standardized use of triggers for PC consultation is associated with substantial impact on 30-day readmission rates, chemotherapy following discharge, hospice referrals, and use of support services following discharge. Expansion of this model to other hospitals and health systems should improve the value of cancer care.
晚期癌症住院患者症状负担重，需要支持。姑息治疗（PC）的整合可改善症状控制并减少不必要的医疗保健使用，但许多患者从未获得这些服务。2016年，美国临床肿瘤学会呼吁将PC纳入所有转移性癌症患者的肿瘤护理中。为提高癌症护理质量，我们制定了标准化标准或触发因素，用于住院实体瘤服务中的PC咨询。
如果患者符合以下至少一项资格标准，则有资格参加这项前瞻性队列研究：患有晚期实体瘤；30天内曾住院；住院时间>7天；以及有活跃症状。在干预期间，符合标准的患者接受自动PC咨询。
当我们将干预组患者与对照组进行比较时，PC咨询增加（48例中的19例[39%]增至65例中的52例[80%]；P≤.001），临终关怀转诊增加（48例中的7例[14%]增至65例中的17例[26%]；P =.03），30天再入院率下降（48例中的17例[35%]降至65例中的13例[18%]；P =.04），出院后接受化疗的比例下降（48例中的21例[44%]降至65例中的12例[18%]；P =.03）。出院后支持措施总体增加（P =.004）。住院时间未受影响。
据我们所知，这是第一项表明在住院肿瘤服务的晚期癌症患者中，标准化使用PC咨询触发因素对30天再入院率、出院后化疗、临终关怀转诊以及出院后支持服务的使用有重大影响的研究。将该模式扩展到其他医院和卫生系统应能提高癌症护理的价值。
