BACKGROUND: Timely hospice care in oncology improves end-of-life care, decreases hospitalizations, improves quality of life and satisfaction. However, collaborative practice of palliative care and oncology remains inconsistent, resulting in absent or delayed hospice services. Short hospice length of service is a marker of poor quality of care and end-user dissatisfaction. Most Americans desire end-of-life care in their homes; however, most of them receive their end-of-life care in hospitals.
HYPOTHESIS: A collaborative oncology-palliative care clinic model improves access to hospice care.
INTERVENTION: In January 2015, we implemented an integrated oncology-palliative care clinic model with the following elements:
(1) Pre-clinic “huddle” among palliative care and oncology staff to identify palliative care needs for patients;
(2) Shared palliative care and oncology clinic appointments;
(3) Introduction of palliative care for every new oncology clinic patient, for advance care planning;
(4) Concurrent oncology and palliative care follow-up for all high-risk patients (aggressive histology, progressing disease, etc.) for goals of care discussions and symptom management;
(5) Palliative care and oncology staff co-managing oncology patients enrolled in hospice care.
MEASUREMENTS: In December 2019, we conducted a retrospective review of all Veterans seen in oncologypalliative care clinic during FY2018-FY2019 with specific attention to community hospice referrals, hospice length of stay, and location of Veterans’ death.
RESULTS: Of a total of 189 Veterans seen in this clinic in FY18-FY19, at the time of review.
(1) 68 (36%) Veterans accessed hospice care.
(2) Of 71 deceased Veterans, 59 (83%) died on hospice (Medicare data: 50%).
(3) Average length of stay on hospice was 64 days (other studies: 48 days).
(4) Compared to other studies, our longer hospice stay was consistent across various cancers: lung (75 vs. 40 days), prostate (69 vs. 48 days), pancreas (40 vs. 32 days), colorectal (140 vs. 46 days).
(5) Of Veterans who died on hospice care, 30 (51%) died at home (other studies: 25%).
CONCLUSION: Our intervention improved access to hospice care in cancer care.
FUTURE IMPLICATIONS: (1) Impact of this intervention of cost of end-of-life care.
(2) Future innovative clinic models for delivery of collaborative comprehensive care for complex nee