title: Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center.
abstract: OBJECTIVE
  Palliative care consultation services are now available in the majority of cancer centers, yet most referrals to palliative care occur late. We previously found that the term "palliative care" was perceived by oncology professionals as a barrier to early patient referral. We aimed to determine whether a service name change to supportive care was associated with earlier referrals.
  
  
  METHODS
  Records of 4,701 consecutive patients with a first palliative care consultation before (January 2006 to August 2007) and after (January 2008 to August 2009) the name change were analyzed, including demographics and dates of first registration to hospital, advanced cancer diagnosis, palliative care consultation, and death. One-sample proportions tests, median tests, χ(2) tests, and log-rank tests were used to identify group differences.
  
  
  RESULTS
  The median age was 59 years, 50% were male, and 90% had solid tumors. After the name change, we found: (a) a 41% greater number of palliative care consultations (1,950 versus 2,751 patients; p < .001), mainly as a result of a rise in inpatient referrals (733 versus 1,451 patients; p < .001), and (b) in the outpatient setting, a shorter duration from hospital registration to palliative care consultation (median, 9.2 months versus 13.2 months; hazard ratio [HR], 0.85; p < .001) and from advanced cancer diagnosis to palliative care consultation (5.2 months versus 6.9 months; HR, 0.82; p < .001), and a longer overall survival duration from palliative care consultation (median 6.2 months versus 4.7 months; HR, 1.21; p < .001).
  
  
  CONCLUSIONS
  The name change to supportive care was associated with more inpatient referrals and earlier referrals in the outpatient setting. The outpatient setting facilitates earlier access to supportive/palliative care and should be established in more centers.
authors.affiliation: University of Texas M.D. Anderson Cancer Center, Department of Palliative Care and Rehabilitation Medicine, 1515 Holcombe Boulevard, Unit 1414, Houston Texas 77030, USA. sdalal@mdanderson.org
authors.forename: Shalini
authors.initials: S
authors.lastname: Dalal
authors.forename: Shana
authors.initials: S
authors.lastname: Palla
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Linh
authors.initials: L
authors.lastname: Nguyen
authors.forename: Ray
authors.initials: R
authors.lastname: Chacko
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Li
authors.forename: Nada
authors.initials: N
authors.lastname: Fadul
authors.forename: Cheryl
authors.initials: C
authors.lastname: Scott
authors.forename: Veatra
authors.initials: V
authors.lastname: Thornton
authors.forename: Brenda
authors.initials: B
authors.lastname: Coldman
authors.forename: Yazan
authors.initials: Y
authors.lastname: Amin
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000523:psychology*; D011788:Quality of Life; D012017:Referral and Consultation; D012189:Retrospective Studies