Throughout the United States, use of palliative care is expanding quickly due to several factors, most notably increasing evidence of its value in caring for the sickest and most vulnerable patients. Recent studies show that the prevalence of hospital-based palliative care services has increased by more than 25% over the past decade. Approximately two-thirds of all U.S. hospitals and more than 90% of U.S. hospitals with more than 300 beds currently offer palliative care services.
“Palliative care is a relatively new and rapidly evolving field,” explains Laura A. Schoenherr, MD. “Palliative care initially began with a focus on caring for people with cancer in their last days of life but has since expanded to help manage patients with a broader range of diagnoses and to see people earlier in their illness.” However, a lack of standardization of data in previously published studies has limited clinicians’ ability to characterize national practices and trends in a comprehensive way.
Seeking a Better Understanding
The Palliative Care Quality Network (PCQN), a multisite collaborative of palliative care teams from a diverse range of U.S. hospitals and healthcare organizations, was developed to provide palliative care teams with patient-level outcome data to guide and improve care. For a study published in JAMA Network Open, Dr. Schoenherr and colleagues analyzed the first 5 years of PCQN data to characterize current practices and trends among patients cared for and outcomes achieved by inpatient specialty palliative care services from 2013 to 2017.
“The PCQN database provides information on 135,197 patients seen by 88 palliative care member teams over 5 years,” Dr. Schoenherr says. “The database offers unique insights into where we came from, where the field currently stands, and how we might continue to improve in the future. Our analysis sought to provide a ‘State of the Union’ for the field of palliative care, and what we found was mostly reassuring.”
Highlighting Key Results
According to the study, cancer was the most common primary diagnosis (32%), though the percentage of patients with cancer decreased significantly over the 5-year study period. Pain and other symptoms were common in the study period and improved significantly during the consultation period. Most patients were discharged alive and were most commonly discharged home. The percentage of patients discharged alive increased from 75% in 2013 to 80% in 2017 (Figure). Rates of referral to clinic-based and home-based palliative care also increased significantly during the study, rising from 2% in 2013 to 4% in 2017 for clinic-based palliative care and from 2% in 2013 to 4% in 2017 for home-based services. However, referral rates to hospice dropped from 46% to 31%.
The findings suggest that that PC teams are reaching a broader group of patients with serious illness and seeing them earlier in their illness. “Given that studies continue to demonstrate the benefits of early palliative care for patients with all types of serious illness, it was encouraging to find that more patients are now able to experience the full benefits of this type of care,” says Dr. Schoenherr. “Our study also highlights areas where palliative care teams are highly effective, such as improving patients’ quality of life by quickly relieving distressing symptoms like pain and shortness of breath.”
Identifying Areas for Improvement
The wide variation in palliative care practices observed in the study also underscores opportunities to improve care, according to Dr. Schoenherr. “For example, only 25% of patients were seen by clinicians from at least 3 disciplines—such as nursing, social work, medicine, and/or chaplains—despite national guidelines recommending interdisciplinary care to ensure that all issues important to people with serious illness are addressed.”
Dr. Schoenherr notes that these data can empower researchers to study the structures and processes of care that make palliative care teams successful. “Identifying these factors may help us determine approaches that are associated with superior performance,” she says. “We hope these findings can help other palliative care teams adopt successful practices to enhance care for all patients with serious illness and their families.”
Schoenherr LA, Bischoff KE, Marks AK, O’Riordan DL, Pantilat SZ. Trends in hospital-based specialty palliative care in the United States from 2013 to 2017. JAMA Netw Open. 2019;2(12):e1917043. Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757255.
Bischoff K, O’Riordan DL, Marks AK, Sudore R, Pantilat SZ. Care planning for inpatients referred for palliative care consultation. JAMA Intern Med. 2018;178(1):48-54.
Dumanovsky T, Augustin R, Rogers M, Lettang K, Meier DE, Morrison RS. The growth of palliative care in U.S. hospitals: a status report. J Palliat Med. 2016;19(1):8-15.