Hospital‐based palliative medicine (PM) is becoming increasingly available. However, inpatient medical providers may underrecognize the value of PM interventions in their patients who do not have cancer, leading to delays in referral and decreased access to beneficial services for these patients.
We evaluated data collected prospectively by the Palliative Medicine Program on all non‐ICU patients referred for inpatient PM consultation at our large urban teaching hospital between June 2000 and August 2007. Information included history of cancer, purpose of the consult, code status, treatments discontinued, whether patient was hospice appropriate, and discharge disposition. In addition, we linked to patient data fields from hospital administrative records including age, sex, race/ethnicity, length of stay (LOS), whether admitted via emergency room (ER), and principle diagnosis. We performed chi‐square tests, logistic regression, and nonparametric statistics to compare patients with and without cancer.
Of the 1096 inpatients in our study population, 364 (33%) had no history of cancer. The top 3 categories of discharge diagnoses of these 364 noncancer patients were cardiac (21%), septicemia (12%), and respiratory (11%). Compared with the patients with cancer, the noncancer patients were older (70 vs. 64 years, P < .001), less likely to be white (35% vs. 47%, P < .001), more often admitted from the ER (77% vs. 59%, P < .001), and less likely to need pain management (25% vs. 41%, P < .001). The median LOS prior to PM consult was greater in the noncancer patients (7 vs. 4 days, P < .001). Despite these differences, the noncancer patients derived comparable benefits from PM intervention, as shown in Table 1. Similar proportions of patients in both groups were hospice appropriate and chose to enroll in hospice, changed their code status from full code to DNR, and chose to discontinue medical treatments following PM intervention. Patients in both groups had a similar median LOS from the time of PM consult to discharge.
Table 1. Impact of Palliative Medicine Intervention on Participants (n = 1096) by Presence or Absence of Cancer
Although noncancer patients received PM intervention later than cancer patients, they experienced similar rates of hospice enrollment, treatment discontinuation, and code status conversion to DNR. Although more research is needed, our experience suggests that noncancer patients have as much to gain from timely PM intervention as cancer patients.
E. Hummel, none; G. Buran, none; L. Bricker, none.
To cite this abstract:Hummel E, Buran G, Bricker L. Impact of Palliative Medicine Intervention in Hospitalized Patients without Cancer. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 31. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/impact-of-palliative-medicine-intervention-in-hospitalized-patients-without-cancer/. Accessed November 13, 2019.