title: Palliative Care Specialist Consultation Is Associated With Supportive Care Quality in Advanced Cancer.
abstract: Although recent randomized controlled trials support early palliative care for patients with advanced cancer, the specific processes of care associated with these findings and whether these improvements can be replicated in the broader health care system are uncertain.
  
  
  
  The aim of this study was to evaluate the occurrence of palliative care consultation and its association with specific processes of supportive care in a national cohort of Veterans using the Cancer Quality ASSIST (Assessing Symptoms Side Effects and Indicators of Supportive Treatment) measures.
  
  
  
  We abstracted data from 719 patients' medical records diagnosed with advanced lung, colorectal, or pancreatic cancer in 2008 over a period of three years or until death who received care in the Veterans Affairs Health System to evaluate the association of palliative care specialty consultation with the quality of supportive care overall and by domain using a multivariate regression model.
  
  
  
  All but 54 of 719 patients died within three years and 293 received at least one palliative care consult. Patients evaluated by a palliative care specialist at diagnosis scored seven percentage points higher overall (P < 0.001) and 11 percentage points higher (P < 0.001) within the information and care planning domain compared with those without a consult.
  
  
  
  Early palliative care specialist consultation is associated with better quality of supportive care in three advanced cancers, predominantly driven by improvements in information and care planning. This study supports the effectiveness of early palliative care consultation in three common advanced cancers within the Veterans Affairs Health System and provides a greater understanding of what care processes palliative care teams influence.
authors.affiliation: Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA; RAND Health, Santa Monica, California, USA. Electronic address: awalling@mednet.ucla.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Walling
authors.affiliation: Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA; Department of Health Science, California State University, Fullerton, California, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Tisnado
authors.affiliation: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA; Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health at UCLA, Los Angeles, California, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.affiliation: VA Palo Alto Healthcare System, Palo Alto, California, USA; Stanford School of Medicine, Stanford, California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA.
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
authors.affiliation: RAND Population and Labor, Santa Monica.
authors.forename: Philip
authors.initials: P
authors.lastname: Pantoja
authors.affiliation: Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.affiliation: RAND Health, Santa Monica, California, USA; Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health at UCLA, Los Angeles, California, USA.
authors.forename: Sangeeta C
authors.initials: SC
authors.lastname: Ahluwalia
authors.affiliation: Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Schreibeis-Baum
authors.affiliation: Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.affiliation: Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA; Stanford School of Medicine, Stanford, California, USA.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D010166:Palliative Care; D011787:Quality of Health Care; D012017:Referral and Consultation; D012044:Regression Analysis; D012189:Retrospective Studies; D013038:Specialization; D013727:Terminal Care; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: Advanced cancer; palliative care; quality