title: Predictors of palliative care consultation on an inpatient gynecologic oncology service: are we following ASCO recommendations?
abstract: OBJECTIVE
  Determine predictors of inpatient palliative care (PC) consultation and characterize PC referral patterns with respect to recommendations from the American Society of Clinical Oncology (ASCO).
  
  
  METHODS
  Women with a gynecologic malignancy admitted to the gynecologic oncology service 3/2012-8/2012 were identified. Demographic information, disease and treatment details and date of death were abstracted from medical records. Student's t-test, Fischer's exact test or χ(2)-test was used for univariate analysis. Binomial logistic regression was used for multivariate analysis.
  
  
  RESULTS
  Of 340 patients analyzed, 82 (24%) had PC consultation. Univariate predictors of PC consultation included race, cancer type and stage, recurrent disease, admission frequency, admission for symptom management or malignant bowel obstruction (MBO), discharge to skilled nursing facility (SNF) and number of lines of chemotherapy. On multivariate analysis, significant predictors of PC consultation were recurrent disease (OR 2.4, 95% CI 1.1-5.3), number of admissions (≥ 3, OR 10.9, 95% CI 3.4-34.9), admission for symptom management (OR 19.4, 95% CI 7.5-50.1), discharge to SNF (OR 5, 95% CI 1.9-13.5) and death within 6 months (OR 16.5, 95% CI 6.9-39.5). Of patients considered to meet ASCO guidelines, 53% (63/118) had PC referral. Of patients referred to PC, 51.2% (42/82) died within 6 months of last admission.
  
  
  CONCLUSIONS
  Patients referred to inpatient PC have high disease and symptom burden and poor prognosis. High-risk patients, including those meeting ASCO recommendations, are not captured comprehensively. We continue to use PC referrals primarily for patients near the end of life, rather than utilizing early integration as recommended by ASCO.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. Electronic address: caseylefkowitscj@upmc.edu.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lefkowits
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Anna B
authors.initials: AB
authors.lastname: Binstock
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Courtney-Brooks
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Section of Palliative Care & Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Winifred G
authors.initials: WG
authors.lastname: Teuteberg
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Section of Palliative Care & Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Leahy
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data*; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Early palliative care integration; Gynecologic cancer; Inpatient palliative care; Palliative care referral patterns