Does a Palliative Care Clinic Have a Role in Improving End-of-Life Care? Results of a Pilot Program

Abstract

Objective

: To assess the efficacy of a palliative care clinic (PCC), which provided some of the interdisciplinary services and expertise of an inpatient consult service to outpatients, in traditional clinic sessions.

Design:

Chart review.

Setting:

A large urban Veterans Administration Medical Center.

Patients:

One hundred patients referred to clinic.

Interventions:

Palliative care clinic.

Outcome Measures:

Patients' reported needs, Global Distress Index (GDI) subscale, hospice eligibility, and time to death.

Results:

The most common diagnosis was cancer (n = 85). Most patients (n = 89) had at least one need for services that the team provided (median, 2; range, 0-4), the most common of which was a desire for information about prognosis (n = 84). In a Cox proportional hazards model, predictors of enrollment in hospice included white ethnicity (hazard ratio, 3.42; p < 0.001), a need for help around the home (hazard ratio, 3.26; p = 0.002), and insufficient money left at the end of the month (hazard ratio, 2.39; p = 0.014).

Conclusions:

The experience of the PCC described here offers a unique approach to improving end-of-life care for those outpatients who may not be well served by existing structures of care such as palliative care consult services and who have not yet enrolled in hospice.