Institution of Standardized Consultation Criteria to Increase Early Palliative Care Utilization in Older Patients With Acute Leukemia

Abstract

Older patients with acute leukemia (AL) have a high symptom burden and poor prognosis. Although integration of palliative care (PC) with oncologic care has been shown to improve quality-of-life and end-of-life care in patients with AL, the malignant hematologists at our tertiary care hospital make limited use of PC services and do so late in the disease course. Using the Plan-Do-Study-Act (PDSA) methodology, we aimed to increase early PC utilization by older patients with newly diagnosed AL.

We instituted the following standardized criteria to trigger inpatient PC consultation: (1) age 70 years and older and (2) new AL diagnosis within 8 weeks. PC consultations were tracked during sequential PDSA cycles in 2021 and compared with baseline rates in 2019. We also assessed the frequency of subsequent PC encounters in patients who received a triggered inpatient PC consult.

The baseline PC consultation rate before our intervention was 55%. This increased to 77% and 80% during PDSA cycles 1 and 2, respectively. The median time from diagnosis to first PC consult decreased from 49 days to 7 days. Among patients who received a triggered PC consult, 43% had no subsequent inpatient or outpatient PC encounter after discharge.

Although standardized PC consultation criteria led to earlier PC consultation in older patients with AL, it did not result in sustained PC follow-up throughout the disease trajectory. Future PDSA cycles will focus on identifying strategies to maintain the integration of PC with oncologic care over time, particularly in the ambulatory setting.

© 2022 by American Society of Clinical OncologyPRIOR PRESENTATION

Presented at the AAHPM Annual Assembly in Nashville, TN in February 2022.

Conception and design: Rachel E. Rosenblum, Ellen Ormond, James M. Rossetti, Mamta Bhatnagar

Provision of study materials or patients: James M. Rossetti

Collection and assembly of data: Rachel E. Rosenblum, Crystal W. Smith, Andrew L. Bilderback, Emily M. Geramita, Robert M. Arnold

Data analysis and interpretation: Rachel E. Rosenblum, Ellen Ormond, Andrew L. Bilderback, Stefanie C. Altieri Dunn, Dan Buchanan, Emily M. Geramita, Mamta Bhatnagar, Robert M. Arnold

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Andrew L. Bilderback

Employment: Evernorth

James M. Rossetti

Consulting or Advisory Role: AbbVie, CTI BioPharma Corp

Research Funding: AbbVie, CTI BioPharma Corp

Robert M. Arnold

Other Relationship: UpToDate, VitaTalk, AAHPM

No other potential conflicts of interest were reported.

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