Impact of the change in service name from “palliative” to “supportive” care on patient referral at a comprehensive cancer center.

Abstract

9052 Background: Palliative care (PC) consultation services are available in major cancer (CA) hospitals, yet most referrals occur late. Early PC referral can relieve physical and psychosocial distress in CA patients (pts). The term “palliative care” has been considered a barrier to early pt referral. In 2007, we changed the name of the outpatient (OP) and inpatient (IP) PC consultation services to “Supportive Care.” The interdisciplinary PC team composition and function did not change. The study objectives were to determine if name change led to increased and earlier referral of pts. Methods: Records of 4,701 consecutive pts with first PC consultation (PC1), pre (Jan'06-Aug'07) and post (Jan'08-Aug'09) name change were analyzed, including demographics, and dates of first registration to hospital (R), advanced CA (aCA) diagnosis (locally recurrent/metastatic), PC1 and death (D). One sample proportions tests, median tests, chi-square tests, and log rank tests were used to identify group differences. Results: Median age was 59 years, 50% males, 90% had solid tumors. Post-name change, we found: a) A 41% increase in PC1 (1950 vs. 2,751 pts, p < 0.001), mainly accounted by increased PC referral (by 98%) in the IP setting (733 vs. 1,451 pts, p < 0.001). b) In OP (but not IP), there was shortened median time (months) from R to PC1 (9.2 vs. 13.2, HR = 0.85, p < 0.001) and from aCA diagnosis to PC1 (5.2 vs. 6.9, HR = 0.82, p < 0.001). c) In OP (but not IP), the overall survival (months) from date of PC1 significantly increased (median 6.2 vs. 4.7, HR = 1.21, p < 0.001). Conclusions: Name change to supportive care was associated with increased pt referrals, mainly in IP setting. In the OP (but not IP), referrals occurred earlier as compared to before name change. The OP setting allowed CA pts earlier access to palliative/supportive care and should be established in cancer centers Pt group Name change N of pts Median age Gender % Survival after PC1 N p yrs p M/F p mths HR (95% CI) p All Pre 1,950 < 0.001 60 0.14 52/48 0.064 2.9 0.99 (0.93-1.06) 0.886 Post 2,751 59 49/51 2.6 1 OP Pre 1,217 0.098 60 0.21 51/49 0.828 4.7 1.21 (1.10-1.33) < 0.001 Post 1,300 59 51/49 6.2 1 IP Pre 733 < 0.001 59 0.89 54/46 0.005 0.9 1.07 (0.97-1.18) 0.152 Post 1,451 58 47/53 1.1 1 No significant financial relationships to disclose.