Differences in patients accessing inpatient versus outpatient palliative care at time of referral at a cancer centre

Abstract

Outpatient palliative care clinics are a new and developing area of service delivery that can respond to increasing demand and facilitate earlier contact in the illness trajectory. Work is needed to standardise the criteria for referral to outpatient palliative care services and clarify which patients are likely to benefit the most from this mode of support. This study aimed to describe the demographic, clinical and symptom profile, and survival of patients referred to a newly established hospital-based integrated palliative care program. Comparisons were made between patients initially seen as outpatients versus those seen as inpatients. A retrospective population was identified from routinely collected hospital admitted inpatient and ambulatory databases comprising adult cancer patients receiving a new referral to the service during a 6-month period. Patients were grouped into two cohorts according to the setting of their first palliative care assessment and followed to death or study censor date. During the study period, 473 new referrals were made comprising 229 (48%) patients initially seen as outpatients and 244 (52%) initially seen as inpatients. The outpatient cohort had higher performance status, experienced higher symptom burden, lived longer, had fewer inpatient admissions, and received earlier referral to palliative care resulting in greater palliative care involvement up to their death (all p < .05). Early palliative care can be effectively delivered by an outpatient palliative care service for cancer patients who are experiencing symptom burden but are otherwise functional. These cases lived longer and had fewer subsequent inpatient visits, demonstrating the preliminary effectiveness of this integrated service.

Keywords:

• Palliative care
• Cancer
• Outpatients
• Symptom burden
• Healthcare utilization

Acknowledgments

The authors would like to thank Ms Martina Johnstone for her support in facilitating access to data informing this manuscript.

Additional information

Notes on contributors

David J. T. Marco

David J. T. Marco is a research fellow at the Centre for Palliative Care and an associate researcher with Palliative Nexus. He has a keen interest in bringing quantitative data to the clinical interface and collaborating with clinicians directly on evaluating service models for serious illness and finding evidence-based solutions for current gaps in care.

A. Collins

A. Collins is a senior research fellow at Palliative Nexus, leading the service models for serious illness and evolving communities programs of research. Her research aims to improve timely engagement with quality end of life care.

B. Le

Prof B. Le is the director of palliative care at the Victorian Comprehensive Cancer Centre and a specialist in both palliative medicine and medical oncology. He is a professor in the Department of Medicine at The University of Melbourne and is involved with research in the areas of palliative and supportive care, including clinical trials of novel therapies, and research into palliative care integration and benefits for patients and carers.

J. A. M. Philip

Prof J. A. M. is chair of palliative medicine at University of Melbourne, a palliative care clinician, researcher and teacher whose work aims to improve equity of access to high quality care underpinned by high quality evidence is available to all with needs. She leads the Palliative Nexus Group.