Evaluating the effects of inpatient palliative care consultations on subsequent hospice use and place of death in patients with advanced GI cancers.
OBJECTIVE
Research has shown that patients with terminal illnesses prefer to die at home, yet more than 60% of patients with cancer are hospitalized in the last month of life. Less than half of these patients receive hospice care at the end of life. Inpatient palliative care consultations may serve as a bridge from hospitalization to receiving patient's preferred end-of-life care. GI tumors include some the deadliest cancers, and patients with these cancers may serve to benefit from palliative care services.


METHODS
The objective of this study was to evaluate the role of palliative care versus usual care on postdischarge outcomes and hospice use for patients with advanced GI cancers. Two hundred one adults, 82 of whom received a palliative care consult, were followed for 6 months after hospital discharge. Propensity scores were used to match palliative care patients to usual care patients. Outcome measures included hospice use, place of death, subsequent emergency department visits, hospital readmission, and survival.


RESULTS
Fifty-nine patients died in the 6 months postdischarge. Receiving a palliative care consult increased the odds of home death (odds ratio [OR] = 2.9; 95% CI, 1.02 to 8.44; P = .046) and decreased the odds of hospital death (OR = 0.159; 95% CI, 0.05 to 0.52; P = .002). At 2 and 4 months, more patients in the palliative care group were receiving hospice services at death, compared with the usual care group (75% v 18%, P = .001% and 93% v 30%, P = .000 respectively). There were no differences with respect to emergency department visits, hospital readmission, and survival.


CONCLUSIONS
Palliative care consultation was associated with increased hospice utilization, decreased likelihood of dying in a hospital, and increased likelihood of dying at home.
Icahn School of Medicine at Mount Sinai, New York, NY.
Julia
J
Paris
Icahn School of Medicine at Mount Sinai, New York, NY sean.morrison@mssm.edu.
R Sean
RS
Morrison
D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017051:Hospice Care / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012017:Referral and Consultation; D016896:Treatment Outcome