Palliative care, which focuses on providing specialized medical care to relieve symptoms and improve the quality of life for patients with serious illnesses, can now be provided to more hospitalized patients through a new strategy. The strategy involves changing the process for ordering palliative care consultations, from doctors actively placing an order to having the opportunity to cancel an automatic order. This simple change led to a significant increase in palliative care consultation rates and decreased the time to consultation by 1.2 days, according to a study led by researchers from the Perelman School of Medicine at the University of Pennsylvania.
Published in JAMA, this study is the largest-ever study of inpatient palliative care and demonstrates a scalable approach to increasing support for seriously ill patients. The researchers implemented the strategy in 11 hospitals across eight states, involving over 34,000 patients with chronic obstructive pulmonary disease (COPD), dementia, or kidney failure. These patient groups, which have been underrepresented in previous studies, often experience challenges and symptoms that can be addressed through palliative care.
Traditionally, palliative care consultation has been recommended for millions of Americans with serious illnesses but is often underutilized or only received at the end of life. By implementing a default order system through the electronic medical records, more patients were given the opportunity to benefit from palliative care. During the study, the default order was cancelled for less than 10% of patients, indicating that the strategy was generally acceptable to clinicians. This is important as the goal is to reach as many eligible patients as possible in real-world healthcare settings.
The implementation of default orders did not affect the length of hospital stays compared to usual care. However, for those patients who received a palliative care consultation through the default order, their median length of stay was reduced by 9.6%. Additionally, more patients were discharged to hospice care without affecting mortality rates, indicating an improvement in the quality and patient-centeredness of end-of-life care.
To further build on these findings, the researchers at the Penn’s Palliative and Advanced Illness Research (PAIR) Center are planning another randomized clinical trial. This upcoming study will focus on training and prompting generalists, including nurses, physicians, social workers, and advanced practice providers, who make up a patient’s primary hospital team, to provide palliative care themselves.
The ultimate goal of this research is to continuously improve inpatient palliative care so that all patients and families facing serious illnesses have access to the support they need throughout their treatment journey. By implementing scalable strategies such as default orders, healthcare systems can effectively increase the delivery of palliative care, improving the overall well-being and quality of life for seriously ill patients.
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it