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. 2011;16(1):105-11.
doi: 10.1634/theoncologist.2010-0161. Epub 2011 Jan 6.

Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center

Shalini Dalal  1 , Shana Palla, David Hui, Linh Nguyen, Ray Chacko, Zhijun Li, Nada Fadul, Cheryl Scott, Veatra Thornton, Brenda Coldman, Yazan Amin, Eduardo Bruera
Affiliations

Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center

Shalini Dalal et al. Oncologist. 2011.

Abstract

Purpose: Palliative care consultation services are now available in the majority of cancer centers, yet most referrals to palliative care occur late. We previously found that the term "palliative care" was perceived by oncology professionals as a barrier to early patient referral. We aimed to determine whether a service name change to supportive care was associated with earlier referrals.

Patients and methods: Records of 4,701 consecutive patients with a first palliative care consultation before (January 2006 to August 2007) and after (January 2008 to August 2009) the name change were analyzed, including demographics and dates of first registration to hospital, advanced cancer diagnosis, palliative care consultation, and death. One-sample proportions tests, median tests, χ(2) tests, and log-rank tests were used to identify group differences.

Results: The median age was 59 years, 50% were male, and 90% had solid tumors. After the name change, we found: (a) a 41% greater number of palliative care consultations (1,950 versus 2,751 patients; p < .001), mainly as a result of a rise in inpatient referrals (733 versus 1,451 patients; p < .001), and (b) in the outpatient setting, a shorter duration from hospital registration to palliative care consultation (median, 9.2 months versus 13.2 months; hazard ratio [HR], 0.85; p < .001) and from advanced cancer diagnosis to palliative care consultation (5.2 months versus 6.9 months; HR, 0.82; p < .001), and a longer overall survival duration from palliative care consultation (median 6.2 months versus 4.7 months; HR, 1.21; p < .001).

Conclusion: The name change to supportive care was associated with more inpatient referrals and earlier referrals in the outpatient setting. The outpatient setting facilitates earlier access to supportive/palliative care and should be established in more centers.

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Conflict of interest statement

Disclosures: Shalini Dalal: None; Shana Palla: None; David Hui: None; Linh Nguyen: None; Ray Chacko: None; Zhijun Li: None; Nada Fadul: None; Cheryl Scott: None; Veatra Thornton: None; Brenda Coldman: None; Yazan Amin: None; Eduardo Bruera: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

Figures

Figure 1.
Figure 1.
Number of new palliative care consultations before and after the name change from palliative care to supportive care in the outpatient and inpatient settings. n of patients = 4,701.
Figure 2.
Figure 2.
Kaplan–Meier estimates for overall survival from first palliative care consultation. Comparison was conducted based on whether patients were first referred as outpatients or inpatients, and before or after the name change.
Figure 3.
Figure 3.
Percentage growth in new patient activity for palliative/supportive care, the Division of Cancer Medicine, and the hospital overall in the period after the name change compared with the period before the name change.
See this image and copyright information in PMC

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