Abstract 182: The Incidence And Indication For Palliative Care Consultation In A Cohort Of Out Of Hospital Cardiac Arrest Patients

Abstract

Introduction: The indications for palliative care consultation are varied and integration of palliative care is often left to physician discretion. We sought to describe the population of post-arrest patients who receive a palliative care consultation and identify common indications for the consultation. Methods: Our study is a single center retrospective chart review from the Colorado Cardiac Arrest Registry (CCAR) including 541 patients admitted to the ICU after OHCA. Data abstracted included race, sex, preferred language, age, placement of a palliative care consult and number of palliative care meetings. A chi-squared test was used to determine statistical significance with a cutoff p value <0.05. Each palliative care consultation was reviewed and the indication for palliative care consultation was coded using thematic analysis. Results: Of the 541 patients in the study sample, a palliative care consult order was placed for 73 (13.5%) patients and 55 (10.2%) patients had at least one documented palliative care meeting. Code status changed after the first palliative care meeting in 4 patients. When comparing men to women, 15% of men and 11% of women received a consult. A consult was placed in 18.7% of patients identifying as Hispanic, compared to 13.9% in white patients and 12.6% in black patients. In patients whose preferred language was not English or Spanish, 28.6% received a consult compared to 13.5% of patients preferring English or Spanish. None of these differences were statistically significant. The most common themes identified as the indication for the palliative care consultation were 1.) conflict between the physician and family; 2.) low health literacy; 3.) within family discordance on goals of care and; 4.) the need for specialty social work such as assistance with hospice planning. Conclusions: Our study found a low incidence of palliative care consultation and more frequent consultation for non-English or Spanish speaking patients, with four major prevailing themes. Further study is needed to better understand and optimize the utilization of palliative care consultation in post-cardiac arrest patients.