Early Integration of Palliative Care in Patients with Advanced Gastrointestinal Cancer

Abstract

Problem & Purpose: The literature shows the use of palliative care (PC) improves patients’ health related quality of life and overall survival and reduces symptom burden and depression. The literature also recommends patients be referred to PC within eight weeks of diagnosis or when starting treatment for advanced cancer. A National Cancer Institute designated outpatient comprehensive cancer center (CCC) does not implement PC within eight weeks of diagnosis. Internal data was collected between September 2021 and February 2022. This internal data demonstrated that out of 185 patients receiving active treatment, only 12% (n=23) were enrolled in PC and only three (1%) were referred at the start of treatment, proving this facility would benefit from initiating PC according to guidelines. The purpose of this quality improvement project is to initiate referrals to PC at the start of treatment for individuals with newly diagnosed advanced GI cancer. Methods: Eligible patients were identified during the initial provider visit for treatment consent, during which the physician endorses the use of PC. After the provider discussion, the nurse coordinator places the referral. Following the referral, the PC team meets with the patient within three weeks of referral and the patient has an option to enroll or decline PC services. Data collection occurred through chart audits of the EHR for referral placement and PC consultation date. Data was recorded on REDCap, a HIPAA and VPN password protected server. Results: 37 new patients were seen in the CCC during implementation; 45% (n=17) were eligible for a PC referral. Of the eligible patients, 29% (n=5) were referred to PC, of those referred, 100% (n=5) were seen within the expected timeframe and 100% (n=5) of referred patients chose to utilize PC during treatment. Conclusions: Having a workflow that allows patients to be identified early after diagnosis of an incurable disease allows for early utilization of PC.