Clinician engagement strategies to increase palliative care access in a multi-site community oncology practice.

Abstract

196 Background: Despite nearly 20 years since PC was recognized as a medical subspecialty, and ACS, ASCO and NCCN’s recommendations for early involvement, many oncologists continue to categorize PC synonymously with hospice and therefore refer to palliative medicine specialists very late in the disease trajectory, if at all. Each year, more oncology and PC researchers study and report the life changing impact of early PC for patients living with stage III and IV “advanced cancer” (AC). While mandating PC would have its challenges, creating workflows to encourage providers to change their behavior and attitude regarding PC, while empowering other clinical team members to directly refer, should result in patients and families receiving earlier PC services. Methods: The study included a pre-intervention period (9/1/2023 - 12/31/2023), and an intervention period (1/1/2024 - 4/30/2024). Pre-intervention referral data was collected from OncoEMR, OneAnalytics and Social Work reports. PC referrals were requested for both oncology and hematology patients, regardless of diagnosis date or stage. During the intervention period, 6 strategies were designed to increase PC referrals and were deployed equally in all 8 oncology/hematology offices. Strategies included 1) weekly MD/APP huddles with one of the goals to discuss the palliative care needs of all patients, 2) self-directed referrals from nursing, 3) self-directed referrals from social work, 4) APP referrals for advance care planning, 5) proactive chart reviews by PC APNs and direct PC referral suggestions to MD/APPs for AC patients, and 6) hardwiring timely scheduling of PC referrals. The primary end point is the percent of unique cancer (UC) patients who had a PC referral; the secondary end point is the percent of referred AC patients with early PC referral as defined by referral within 8 weeks of diagnosis. Results: During the pre-intervention period, of the 8,551 UC patients, 154 (1.8%) received PC referrals as compared to 227 (2.8%) of the 8,055 UC patients during the intervention period, yielding a 56% increase in the intervention period. In the pre-intervention period, 24 (14%) of the 177 newly diagnosed AC patients received early PC referrals compared to 32 (21%) of the 153 newly diagnosed AC patients in the intervention period, giving rise to a 50% increase. Conclusions: Strategies to increase PC referrals in a community oncology practice increased overall referrals as well as earlier referrals in newly diagnosed AC patients. As the interventions mature, the total number of PC referrals and a shift toward earlier referrals will likely be seen. Future goals will include assessing patient and family comfort with their treatment plan with PC versus without PC, as well as assessing providers' perceived value of PC over time. With attitude and behavior change, practice culture change is anticipated amid PC becoming the standard of care for all AC patients.