Frequency and Characteristics of First-Time Palliative Care Referrals During the Last Day of Life

Yvonne Heung, Ahsan Azhar, Syed Mujtaba Ali Akbar Naqvi, Janet Williams, Minjeong Park, David Hui, Seyedeh Dibaj, Diane Liu, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Context: Palliative care referrals (PCRs) improve symptom management, provide psychosocial and spiritual support, clarify goals of care, and facilitate discharge planning. However, very late PCR can result in increased clinician distress and prevent patients and families from benefiting from the full spectrum of interdisciplinary care. Objectives: To determine the frequency and predictors of PCR within 24 hours of death. Methods: Consecutive first-time inpatient PCR from September 1, 2013 to August 31, 2017 was identified to determine the frequency and predictors of referrals within 24 hours of death. We compared the clinical characteristics with a random sample of patients discharged alive or died more than 24 hours after first-time PCR as a control, stratified by year of consult in a 1:1 ratio. Results: Of 7322 first-time PCRs, 154 (2%) died within 24 hours of referral. These patients were older (P = 0.003) and had higher scores for depression (P = 0.0009), drowsiness (P = 0.02), and shortness of breath (P = 0.008) compared with a random sample of 153 patients discharged alive or died more than 24 hours after first-time PCR. Patients who received a PCR within 24 hours of death were more likely than the control group to have Eastern Cooperative Oncology Group 4 (95% vs. 25%, P < 0.0001), delirium (89% vs. 17%, P < 0.0001), do-not-resuscitate code status (81% vs. 18%, P < 0.0001), and hematologic malignancies (39% vs. 16%, P < 0.0001). In the multivariate analysis, depression (odds ratio [OR] 1.4; P = 0.005), do-not-resuscitate code status (OR 9.1; P = 0.003), and Eastern Cooperative Oncology Group 4 (OR 9.8; P = 0.003) were independently associated with first-time PCR within 24 hours of death. Conclusion: Although only a small proportion of first-time PCR occurred in the last 24 hours of life, the patients had a significant amount of distress, indicating a missed opportunity for timely palliative care intervention. These sentinel events call for specific guidelines to better support patients, families, and clinicians during this difficult time. Further research is needed to understand how to minimize very late PCR.

Original languageEnglish (US)
Pages (from-to)358-363
Number of pages6
JournalJournal of pain and symptom management
Volume61
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

  • Supportive care
  • advanced cancer
  • end-of-life care
  • palliative care

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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