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Outpatient palliative medicine consultations: urgent or routine?
  1. Sorayya Alam1,
  2. Ashley Pope2,
  3. Lisa Le3,
  4. Ahmed Al-Awamer2,
  5. Subrata Banerjee2,
  6. Jenny Lau2,
  7. Ernie Mak2,
  8. Camilla Zimmermann2 and
  9. Breffni Hannon2
  1. 1 Palliative Medicine, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
  2. 2 Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  3. 3 Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Breffni Hannon, Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; breffni.hannon{at}uhn.ca

Abstract

Background Although outpatient palliative care clinics (OPCCs) provide a venue for early, pre-emptive referral to palliative care on a routine basis, some patients will continue to require urgent referrals. The purpose of this study was to characterise these urgent referrals to determine whether they reflect clinical need or convenience.

Methods We retrospectively compared new patients in an OPCC who were seen urgently versus those seen at routine appointments. Descriptive statistics compared the two groups in terms of clinical characteristics, referring teams, symptoms, performance status and outcomes. Logistic regression was used to identify factors associated with urgent referral to the OPCC. Overall survival was compared using the log-rank test.

Results Between January 2016 and December 2017, a total of 113 urgent referrals were reviewed in the OPCC; these were compared with a random sample of 217 routine referrals. Patients seen urgently were more likely to be referred by surgical oncology, and to report worse symptom scores for pain (p=0.0007), tiredness (p=0.02), well-being (p=0.001), constipation (p=0.02) and sleep (p=0.01). More patients seen urgently required direct admission to hospital following the visit (17.7% vs 0.9%, p<0.001). Median survival was shorter for patients seen urgently (4.3 months, 95% CI 3.4 to 7.8) versus routinely (8.1 months, 95% CI 7.2 to 9.5).

Conclusions Compared with routine referrals, new patients seen urgently in the OPCC had higher symptom burden, shorter median survival and a greater chance of direct admission to hospital. Palliative care clinics should consider how best to accommodate urgent referrals.

  • cancer
  • supportive care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data are held by the senior author.

Statistics from Altmetric.com

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data are held by the senior author.

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Footnotes

  • Twitter @JelauPC

  • Contributors BH designed the study, assisted with data collection and wrote the manuscript. SA assisted with data collection and manuscript writing. AP assisted with data collection and manuscript writing. LL performed the statistical analyses. AA-A, SB, JL and EM conducted the assessments on which the data was collected and contributed to the manuscript. CZ assisted with manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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