Background We recently reported on an integrated palliative care and medical oncology co-rounding model that significantly reduced hospital bed days. We postulate that the co-rounding model may also have an effect on reducing care aggressiveness.
Objectives To compare the effect of a co-rounding model versus consult model (usual care) in reducing receipt of aggressive treatment at end-of-life.
Methods Secondary analysis of an open-label stepped-wedge cluster-randomized trial comparing two palliative care models within the inpatient oncology setting. The co-rounding model involved pooling specialist palliative care and oncology into one team for daily rounds, while the consult model constituted discretionary specialist palliative care referrals by the oncology team. We compared the odds of receiving aggressive care at end-of-life – acute healthcare utilization in last 30 days of life, death in hospital and cancer treatment in last 14 days of life between decedents within both arms.
Results A total of 2145 patients were included in the analysis, and 1803 patients died by 4th April 2021. There was no significant difference in survival between either model of care (p = 0.12). Compared to the consult model, the co-rounding model was not associated with significant differences in aggressive care at the end-of-life. The odds ratios and 95% confidence intervals were: 0.67 (0.26–1.51) for ICU admission, 0.91 (0.60–1.36) for 2 or more ED visits, 1.16 (0.87–1.53) for 2 or more hospitalizations in the last 30 days of life; 1.03 (0.83–1.28) for death in hospital; 1.27 (0.66–2.38) for chemotherapy in the last 14 days of life.
Conclusion The co-rounding model within an inpatient setting did not reduce aggressiveness of care at end-of-life. This could be due in part to the overall focus on resolving episodic admission issues.
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