What’s in the ‘special sauce’ of protocol-driven outpatient palliative care consultations?

Academic Article

Abstract

  • 139 Background: Initial outpatient palliative care consultations (OPCC) in clinics are usually requested for uncontrolled symptoms. The purpose of this substudy was to determine the nature of recommendations made in early PC (EPC) protocol-driven OPCC. Methods: Using a standardized tool, we conducted a content analysis on the assessment and plan components of protocol-driven OPCCs. OPCCs were conducted as a component of the ENABLE [Educate, Nurture, Advise, Before Life Ends] RCT (10/2010-9/2013) consisting of an OPCC and 6 structured weekly telephone coaching sessions and monthly follow up either at study entry (early) or 12 weeks later (delayed). We coded OPCCS for 37 specific recommendations, grouped into 3 categories: general, symptom-specific or advance care planning (ACP). Results: Of 207 study participants, 142 (early = 71; delayed=71) had an OPCC; 65 (31%) did not receive OPCC due to unable (n=35), unknown (n=17), and declined (n = 13). OPCC patients were mostly female (51%), married or living with partner (65%), rural-dwelling (66%), high school graduates (54%), white (99%), Catholic (30%), retired (46%), and had GI cancers (44%). Patients who had OPCCs had statistically ↓ CAGE (p = 0.03), ↑rural-dwelling (p = 0.03), and ↓hospice referral (p = 0.03) at baseline. Median OPCC length was 60 minutes (range 15-105). The most frequent general recommendations were for counselling (34%, n = 48) and medication review (30%, n = 43); symptom-specific recommendations were for pain (16%, n = 23), depression (11%, n = 16), and constipation (8%, n = 11); and ACP were for AD completion (20%, n = 29), identifying surrogate (18%, n = 25), and discussion of illness trajectory (17%, n = 24). There were no significant differences in recommendations between early and delayed group (p > 0.05) except hospice discussion was ↑ in delayed patients (p = 0.02). Conclusions: Protocol driven OPCCs for newly diagnosed advanced cancer patients can prospectively address patients’ needs for additional counseling, symptom control and ACP. Future analyses will focus on relationships regarding overall EPC ‘dose’ and longitudinal patient outcomes.
  • Published In

    Digital Object Identifier (doi)

    Author List

  • Bagcivan G; Bakitas M; Dionne-Odom JN; Frost J; Plunkett M; Lisa A Stephens LA; Bishop P
  • Start Page

  • 139
  • End Page

  • 139
  • Volume

  • 34
  • Issue

  • 26_suppl