J Palliat Med. 2015 Dec 1. [Epub ahead of print]
Blackhall LJ, Read P, Stukenborg G, et al
The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care in the first year of the Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program. This is a phased intervention integrating outpatient palliative care into cancer care along with standard oncology care in collaboration with oncologists. In this phase patients were referred at the discretion of their oncologist.
207 patients with advanced cancer were referred to palliative care in the first year of this intervention, a median of 72.5 days prior to death. The control group included 198 deceased patients with similar diagnoses but not referred to CARE Track. CARE Track patients were younger, had more women, and more patients with gynaecological, head and neck, and breast cancer. CARE Track patients were less likely to be admitted to the hospital in the last month of life (38 vs. 58%), had a lower odds of hospitalization within 30 days of death (odds ratio = 0.29), were less likely to die in hospital (8 vs. 34%), had increased hospice utilization (68 vs. 47%), and decreased cost of care; these results remained significant after controlling for group differences. Inpatient palliative consultation alone led to increased hospitalization in the last month of life (81%) and increased hospital death (44%). Only half of patients with incurable cancers were referred to this program and methods of systematically identifying appropriate patients are needed.
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