A Strong Case for Palliative Care Early Referrals

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
A Strong Case for Palliative Care Early Referrals

A new study from Stanford University shows that late referrals to palliative care have a negative impact on health outcomes, giving home care agencies the evidence they need to help convince hospital providers to refer cancer patients more quickly.

The study, conducted by Jessi Humphreys and Dr. Stephanie Harman, was published in the April edition of The Journal of Community and Supportive Oncology. The authors used data on 1,225 oncologic patients who received an inpatient palliative care referral and consultation at Stanford Hospital between July 2007 and May 2011.

The data showed a clear correlation between late referrals and worse hospital courses. Patients who were referred greater than one week after admission were more likely to stay in the hospital for longer periods following their referral and had higher rates of in-hospital mortality.

Specifically, waiting one week or longer to refer a patient was associated with an overall increased length of stay of 2.7 days. Being referred later than one week also was associated with an adjusted odds ratio of dying in the hospital that was more than three times higher than the odds of being discharged alive.

The study noted that part of the issue is there’s currently no standard definition of late referral. The authors said their findings argue strongly for education that emphasizes the importance of referring early to palliative care, with a focus on referring cancer patients in the first week following admission.

This approach certainly would benefit patients, who often are unable to leave the hospital to die despite a desire to do so (according to studies of patient preferences). It also could lead to health policies that would help improve patient care overall.

Humphreys and Harman say the data suggests a mechanism by which a late referral causes or increases the chance of poor outcomes. For example, it’s possible that patients who are referred late have started a treatment that extends their length of stay longer than patients referred early. It’s also possible that patients who were referred later deteriorated clinically during their hospital stay to the point where they could not safely or comfortably transition to an outpatient setting. The authors hope to explore these possibilities in future studies.

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