Determinants of time to first palliative care consultation in hospitalized patients with advanced or terminal illness - A retrospective analysis.

Abstract

Diagnosis and sex-related biases can affect clinical decision-making in serious illness, including the recognition of palliative needs. Such biases may influence when and how patients receive palliative care (PC). This study aimed to investigate differences in timing and frequency of PC consultations by diagnosis, comorbidities, age, and sex among hospitalized patients. This study retrospectively analyzed 918 patients (50.5 % female) who received a PC consultation during hospitalization between 2016 and 2022. Time from admission to first PC consultation was analyzed using a Cox proportional hazards model adjusted for primary diagnosis, comorbidities, age, and sex. Further analysis included number of follow-up consultations, time from primary disease onset to first PC consultation, and from consultation to discharge or death. Inpatients with organ failure (HR: 0.7 [95 %-CI: 0.5-0.9]; p = 0.02) or neurological diseases (HR: 0.7 [95 %-CI: 0.5-1.0]; p = 0.03) received later PC consultations than those with solid organ tumors or hematologic malignancies. Higher comorbidity burden was associated with earlier PC consultation (HR: 1.04 [CI: 1.01-1.07]; p = 0.02), while age was not linked to consultation timing (HR: 0.997 [CI: 0.992-1.002]; p = 0.20). Women received earlier PC consultations than men (HR: 1.3 [95 %-CI: 1.1-1.4]; p < 0.001). Only 9.4 % of individuals received a follow-up consultation, with the lowest proportion in subjects with organ failure (4.7 %). This study highlights earlier PC consultation requests during hospitalization for individuals with malignant diseases and for women. The low rate of follow-up PC consultations indicates that the importance of regular PC involvement to improve patient's outcomes still did not permeate into clinical practice.