Different Associations Between Inpatient or Outpatient Palliative Care and End-of-Life Outcomes for Hospitalized Patients With Cancer.

Abstract

Palliative care (PC) improves outcomes in advanced cancer, and guidelines recommend early outpatient referral. However, many PC teams see more inpatient than outpatient consults. We conducted a retrospective study of hospitalized patients with cancer to quantify exposure to inpatient and outpatient PC and describe associations between PC and end-of-life (EOL) quality measures. We identified all decedents admitted to an inpatient oncology unit in 1 year (October 1, 2017-September 30, 2018) and abstracted hospitalization statistics, inpatient and outpatient PC visits, and EOL outcomes. Descriptive statistics, univariate tests, and multivariate analysis evaluated associations between PC and patient outcomes. In total, 522 decedents were identified. 50% saw PC; only 21% had an outpatient PC visit. Decedents seen by PC were more likely to enroll in hospice (78% <i>v</i> 44%; <i>P</i> < .001), have do-not-resuscitate status (87% <i>v</i> 55%; <i>P</i> < .001), have advance care planning documents (53% <i>v</i> 31%; <i>P</i> < .001), and die at home or inpatient hospice instead of in hospital (67% <i>v</i> 40%; <i>P</i> < .01). Decedents seen by PC had longer hospital length-of-stay (LOS; 8.4 <i>v</i> 7.0 days; <i>P</i> = .03), but this association reversed for decedents seen by outpatient PC (6.3 <i>v</i> 8.3 days; <i>P</i> < .001), who also had longer hospice LOS (46.5 <i>v</i> 27.1 days; <i>P</i> < .01) and less EOL intensive care (6% <i>v</i> 15%; <i>P</i> < .05). PC was associated with significantly more hospice utilization and advance care planning. Patients seen specifically by outpatient PC had shorter hospital LOS and longer hospice LOS. These findings suggest different effects of inpatient and outpatient PC, underscoring the importance of robust outpatient PC.