Prospective and Comprehensive Characterization of an Inpatient Radiation Oncology Consult Service: Examining Interdisciplinary Coordination of Palliative Radiation Access and Receipt

Abstract

Studies have increasingly demonstrated the benefit of dedicated palliative radiation therapy (PRT) models on care quality, coordination and cost-effectiveness. However, these studies are primarily retrospective and volume-based, limiting broad application of findings. Through prospective, comprehensive characterization of inpatient consults, we investigated trends in interdisciplinary coordination and PRT delivery. Inpatient consult pages at a single institution from 11/1/21-5/31/22 were prospectively tracked and characterized. Consult type, temporality and decision-making, and patient demographics, disease and treatment details, and mortality outcomes were recorded. Chi-square and logistic and linear regressions evaluated associations between consult and patient-specific features. Of 460 pages received, 131 (28.5%) were requests for further communication following initial consultation. For the 329 original consults, 20.1% related to care coordination for established on-treatment or recently treated patients who were hospitalized. RT was recommended for 57% of patients-81.3% with palliative intent. With a mean 1.85 vs. 0.8 consults per day for weekday vs. weekend, 52.6% and 34.0% of pages occurred from 7am-noon or noon-5pm respectively, with 13.4% received overnight. This distribution did not significantly differ between weekday vs. weekend. Consult type (RT consideration vs. care coordination) was not associated with day or time period. Concern regarding benefit and/or safety of radiation was the main reason for treatment deferral (31.3%). Neurologic compromise (38.7%), pain (33.8%) and obstruction (ex. airway, luminal; 11.6%) were the most frequent non-post-operative palliative indications. Median time from admission to consult was 2 days (range 0-70), with a median of 1 day for neurologic compromise, 2 days for pain and 4 days for obstruction. For PRT scenarios, patients treated or untreated with RT had no significant difference in 30 days (25.2% vs. 28.2%, respectively) or 60 days (39.6% vs. 46.3%, respectively) mortality. 53.5% of patients had either a palliative medicine consultation while an inpatient or one scheduled at the time of discharge. Prospective characterization at a tertiary-care institution reveals high-volume care coordination- and communication-related consults with temporal distribution similar to consults for RT consideration for new patients. Association of timing with palliative indication and the observed rate of palliative medicine involvement highlight opportunities for interdisciplinary education regarding early multidisciplinary engagement to ensure provision of comprehensive palliative oncologic care.