Background: Patients with late stage metastatic cancer unresponsive to front line therapies have a poor prognosis and yet are often admitted to the ICU or other acute care settings without having had referral to palliative care/hospice service for goals-of-care discussion. In order to increase awareness of the need to consider palliative care/hospice services early in the course of patients with poor-prognosis cancer, we developed a template in the progress notes of CPRS. The template required response to two questions: is this patient appropriate for referral to palliative care and/or hospice service; if so, why and if not, why not? Completion of the template was required to continue the note.
Methods: We initiated the template in April 2018 and we evaluated numbers of patients referred to palliative care/hospice services in the 12-month period prior to, and 12-month period after initiating the template. Prior to initiating the template, there were 99 consults to palliative care/hospice and 2375 patients not referred.
Results: For the 12- month period after introduction of the template, there were 138 patients referred for palliative care/hospice and consults to palliative care/ hospice and 2314 patients not referred. The odds risk for referring after the template compared to prior to the template was 1.4 (95% CI: 1.098-1.864, P=0.004). Thus, patients were 1.43 times more likely to be referred to palliative care/hospice services after initiation of the template. Further research to know the reasons for referral and the precise diagnosis of patients who were referred is ongoing.
Conclusion: This study suggests that addition of a template to the CPRS chart can raise awareness of the need for palliative care/hospice consultations when appropriate.
