title: Lack of documentation of evidence-based prognostication in cancer patients by inpatient palliative care consultants.
abstract: BACKGROUND
  Prognostication plays a key role in palliative care (PC). It is critical for advance care planning, determining hospice eligibility, and communication. In contrast to subjective clinical prognostication, evidence-based prognostication (EBP) uses existing validated data to quantify prognosis; however, the extent to which PC providers use EBP is limited.
  
  
  OBJECTIVE
  The objective was to analyze documentation of EBP by PC providers in the absence of an inpatient consultation note template at a single academic medical center.
  
  
  METHODS
  We retrospectively evaluated prognostic documentation of inpatient PC consultations on oncology patients at a single academic hospital. Ratings of Eastern Cooperative Oncology Group (ECOG) Scale, Karnofsky Performance Scale (KPS), Palliative Performance Scale, and/or activities of daily living (ADLs) were considered documentation of functional status. PC-specific documentation of EBP included the Palliative Prognostic Index and/or Palliative Prognostic Score.
  
  
  RESULTS
  There were 412 inpatient PC consultations for oncology patients (2012-2013). Reasons for consultation included goals of care (n=108), symptom management (n=181), or both (n=123). In the absence of a note template, functional status was documented in 6% (n=24) of consultation notes, while no consultation notes contained EBP documentation of the Palliative Prognostic Index and Palliative Prognostic Score.
  
  
  CONCLUSIONS
  This retrospective analysis conducted at a single academic medical center suggests poor documentation by PC providers of EBP in the absence of a consultation note template. Research and educational opportunities exist to evaluate barriers to EBP utilization and documentation by PC providers.
authors.affiliation: 1 Department of Medicine, UC San Diego Moores Cancer Center , La Jolla, California.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Bruggeman
authors.forename: Sean F
authors.initials: SF
authors.lastname: Heavey
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Ma
authors.forename: Carolyn
authors.initials: C
authors.lastname: Revta
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Roeland
mesh_terms: D000046:Academic Medical Centers; D032722:Advance Care Planning / Q000592:standards*; D002140:California; D004282:Documentation / Q000592:standards*; D004608:Eligibility Determination / Q000592:standards; D055317:Evidence-Based Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D017051:Hospice Care / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000473:pathology*; D010166:Palliative Care / Q000592:standards*; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards; D012189:Retrospective Studies; D012720:Severity of Illness Index