J Pain Symptom Manage. 2016 Apr 1. pii: S0885-3924(16)30012-4. doi: 10.1016/j.jpainsymman.2015.12.338. [Epub ahead of print]

Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations.

Hochman MJ, Wolf S, Zafar SY et al

A cross-sectional descriptive secondary database analysis of a 10 organization registry of initial palliative care patient consultations was used to compare the unmet symptom, advance care planning and functional needs of 633 patients receiving hospital (n=216) and outpatient (n=417) palliative care. Inpatients were older than outpatients (73 vs. 64 years), were twice as likely to have a primary diagnosis of cancer (81% vs. 43%) and had a with a lower performance status (38% of inpatients and no outpatients had a Palliative Performance Score ≤30%), with twice as many inpatients thought to be in the last 6 months of life (88% vs. 46%). The vast majority of both groups indicated they were ‘at peace’, but 39% of inpatients and 21% of outpatients rated their quality of life as poor. At their first palliative care encounter 4% of inpatients and 59% of outpatients had pain, however more inpatients had anorexia and dysphagia compared to outpatients. In view of the differences in these population, the authors conclude that different clinician skillsets and assessments are needed depending on the setting of palliative care consultation.

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