Outpatient Palliative Care for Noncancer Illnesses: One Program's Experience with Implementation, Impact, and Lessons Learned.

Abstract

<b><i>Background:</i></b> Despite substantial palliative care (PC) needs in people with serious illnesses other than cancer, outpatient PC is less available to these populations. <b><i>Objectives:</i></b> Describe the experience, impact, and lessons learned from implementing an outpatient PC service (OPCS) for people with noncancer illnesses. <b><i>Design:</i></b> Observational cohort study. <b><i>Setting/Subjects:</i></b> Patients seen by an OPCS at a United States academic medical center October 2, 2017-March 31, 2021. <b><i>Measurements:</i></b> Patient demographics and clinical characteristics, care processes, rates of advance care planning (ACP), and health care utilization. <b><i>Results:</i></b> During the study period, 736 patients were seen. Mean age was 66.7 years, 47.7% were women, and 61.4% were White. Nearly half (44.9%) had a neurologic diagnosis, 19.2% pulmonary, and 11.0% cardiovascular. Patients were most often referred for symptoms other than pain (62.2%), ACP (60.2%), and support for patient/family (48.2%). Three-quarters (74.1%) of visits occurred by video. A PC physician, nurse, social worker, and spiritual care provider addressed nonpain symptoms (for 79.2%), family caregiver needs (70.0%), psychosocial distress (69.9%), ACP (68.8%), care coordination (66.8%), pain (38.2%), and spiritual concerns (27.8%). Rates of advance directives increased from 24.6% to 31.8% (<i>p</i> < 0.001) and Physician Orders for Life-Sustaining Treatment forms from 15.6% to 27.3% (<i>p</i> < 0.001). Of 214 patients who died, 61.7% used hospice, with median hospice length-of-stay >30 days. Comparing the six months before initiating PC to the six months after, hospitalizations decreased by 31.3% (<i>p</i> = 0.001) and hospital days decreased by 29.8% (<i>p</i> = 0.02). <b><i>Conclusions:</i></b> Outpatient PC for people with noncancer illnesses is feasible, addresses needs in multiple domains, and is associated with increased rates of ACP and decreased health care utilization. Controlled studies are warranted.