The purpose of this study is to evaluate the clinical outcomes of palliative care consultation teams on the care of hospitalized patients with advanced cancer. Repeated studies have demonstrated high rates of untreated symptom distress, poor doctor-patient communication about the goals of medical care and high levels of fragmentation and discontinuity of medical care between settings. Palliative care consultation teams have been shown in small preliminary studies to improve the identification and treatment of pain and symptoms;to increase the occurrence of goal setting discussions and appropriate discharge planning;and to improve family satisfaction with care. However, these studies have not explicated the structures and processes of care linked to the achievement of these outcomes. This proposal will assess the structure, processes, and clinical outcomes of care among hospitalized persons with advanced cancer that receive palliative care consultation team services as compared to similar patients receiving usual hospital care. We will accomplish this by studying an evidence-based standardized approach to palliative care consultation at five hospitals with well-established palliative care consultation teams, utilizing existing National Comprehensive Cancer Network-American Society of Clinical Oncology practice guidelines and protocols for pain and symptom management, patient-care team communication, and transition management. Employing validated and actionable assessment instruments, we will examine the effect of palliative care consultation teams on patient and family outcomes (pain and symptom intensity, satisfaction with care), process measures (analgesic prescribing, symptom assessment, goals of care discussions, care transition management, and advance care planning), and utilization (hospital and ICU lengths of stay, hospital readmission, and hospital costs) compared to usual care for adults hospitalized with advanced malignancies. We propose to accomplish these aims by conducting a multi-site observational controlled trial of palliative care consultation with adequate power to detect clinically meaningful differences using a novel application of the propensity score method to reduce selection bias. Reproducible structures and processes for the PCCTs will allow successful components of the program to be readily adopted and operationalized at a range of hospital types.
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