Post-Acute Transition to Home With Supportive Care (PATHS): A Novel Nurse Practitioner-Led Telehealth Intervention to Improve End-of-Life Oncology Care.

Abstract

Patients with advanced cancer discharged from the hospital with no plan for further disease-directed treatment (on 'best supportive care'; BSC) and without specialized palliative care at home are extremely vulnerable to end-of-life suffering and hospital readmission. To assess preliminary outcomes of PATHS (Post-Acute Transition to Home with Supportive Care), a nurse practitioner-led telehealth intervention delivering proactive, intensive, specialized palliative care in the immediate two-week post-discharge period. We conducted a single-arm prospective quality improvement evaluation of PATHS with patients ≥21 years with advanced solid tumor malignancies discharged from the hospital on BSC having initially declined hospice. Sociodemographic and illness characteristics, index hospital admission (IHA) and discharge data, and PATHS outcomes were descriptively analyzed. Competing-risks analysis provided cumulative incidence of hospital readmission following IHA discharge (primary outcome). Patients (n = 30) had a median age of 67 years and were predominantly female (53%) and white (63%). Colorectal cancer was the most common diagnosis (30%) and pain the most common IHA reason (33%). The 30-day cumulative incidence of hospital readmission was 33% (95% CI: 16, 51) compared to a historical control rate of 43% (95% CI: 26, 59). No patient receiving timely hospice care at home was readmitted to the hospital. At PATHS completion, 11 patients (36%) had transitioned to hospice, nine of whom accepted a hospice referral during their first PATHS visit. PATHS fills a substantive practice gap, potentially reducing end-of-life hospital readmissions while increasing home-based, specialized palliative care access for BSC patients with cancer approaching death after hospitalization.