Petrey Luca, Ratnaparkhi Rubina, Pope Elaine, Wolff Sharon Fitzgerald, Cook Ian, Javellana Melissa, Jewell Andrea, Sinclair Christian, Spoozak Lori
Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, USA.
Ann Palliat Med. 2025 Jul;14(4):332-344. doi: 10.21037/apm-25-39.
Late-stage and recurrent disease patients with a prognosis of 6-24 months should receive specialty palliative care, yet only 30% of eligible patients are referred. We aimed to characterize outpatient palliative care referral sources, timeliness, and completion rates across our cancer center at The University of Kansas Medical Center.
We conducted a single institution retrospective quality improvement study of patients in oncology subspecialties with the most palliative care referrals from 2019-2022 at our institution. Data collected included demographics, referral sources, and utilization metrics. The primary outcome was referral completion rates, and secondary outcomes included time from referral to first palliative care visit, hospice enrollment, and/or death. We performed descriptive statistics using chi-square and one-way analysis of variance (ANOVA) tests to compare oncologic subspecialty cohorts regarding these outcomes.
There were 1,674 outpatient specialty palliative care referrals. Medical oncologists initiated 57%, whereas surgical oncologists initiated only 14%. Seventy-four percent of patients referred were ultimately seen by outpatient palliative care. Gynecologic and breast cancer patients had the highest rates of being scheduled. The median time from referral to appointment was 20 days, ranging from 19-23 days. The most common reason patients did not utilize palliative care was patient choice (41%). Eighty-five percent of patients were enrolled in hospice at the time of death; gynecologic cancer patients had the highest rate of enrollment. The median time from referral to hospice was 66 days and the median time from palliative care referral to death was 92 days. Gynecologic cancer patients had the longest median times for both metrics.
At our cancer center, most patients referred to outpatient specialty palliative care were seen within 30 days, which represents timely initiation of palliative care after referral placement. However, the uptake of outpatient specialty palliative care and the timing of outpatient specialty palliative care referral relative to end-of-life transitions varied across oncologic subspecialties. Relevant goals for quality improvement interventions include increasing palliative care referrals among surgical oncologists, referring patients earlier in the disease process, and reframing palliative care as a beneficial resource for all patients.
预期生存期为6至24个月的晚期和复发疾病患者应接受专科姑息治疗，但只有30%的符合条件的患者得到转诊。我们旨在描述堪萨斯大学医学中心癌症中心门诊姑息治疗的转诊来源、及时性和完成率。
我们对2019年至2022年在本机构接受姑息治疗转诊最多的肿瘤亚专科患者进行了一项单机构回顾性质量改进研究。收集的数据包括人口统计学、转诊来源和利用指标。主要结果是转诊完成率，次要结果包括从转诊到首次姑息治疗就诊的时间、临终关怀登记和/或死亡时间。我们使用卡方检验和单因素方差分析（ANOVA）进行描述性统计，以比较这些结果的肿瘤亚专科队列。
共有1674例门诊专科姑息治疗转诊。肿瘤内科医生发起了57%的转诊，而外科肿瘤医生仅发起了14%。转诊患者中有74%最终接受了门诊姑息治疗。妇科和乳腺癌患者的预约率最高。从转诊到预约的中位时间为20天，范围为19至23天。患者未接受姑息治疗的最常见原因是患者选择（41%）。85%的患者在死亡时登记了临终关怀；妇科癌症患者的登记率最高。从转诊到临终关怀的中位时间为66天，从姑息治疗转诊到死亡的中位时间为92天。妇科癌症患者在这两个指标上的中位时间最长。
在我们的癌症中心，大多数转诊至门诊专科姑息治疗的患者在30天内得到诊治，这表明在转诊后及时启动了姑息治疗。然而，门诊专科姑息治疗的接受情况以及门诊专科姑息治疗转诊相对于临终转变的时间在不同肿瘤亚专科中有所不同。质量改进干预的相关目标包括增加外科肿瘤医生的姑息治疗转诊、在疾病过程中更早地转诊患者，以及将姑息治疗重新定位为对所有患者都有益的资源。
