Ordering a palliative care consultation by “default”—via an automatic order programmed into the electronic medical record that doctors may cancel if they choose—is an effective strategy to give more hospitalized patients the opportunity to benefit from palliative care, and sooner, according to a new study led by researchers from the Perelman School of Medicine.
Palliative care is specialized medical care focused on relieving the symptoms and stress of a serious illness and improving quality of life, in alignment with a patient’s individual goals, values, and priorities. By changing the process for ordering palliative care consultation from doctors opting in and actively placing an order to having the opportunity to opt out and cancel an automatic order, the investigators increased palliative care consultation rates from 16.6% to 43.9% and decreased the time to consultation by 1.2 days in the largest-ever study of inpatient palliative care, published in JAMA.
“While early palliative care consultation could help many patients with chronic serious illnesses better understand their diagnosis and align their treatment choices to their individual care goals, there's never been an established approach to realizing that goal at scale. We found that a simple, pre-programmed order within the electronic medical record can get more palliative care to more people more quickly,” says lead author Kate Courtright, an assistant professor of critical care and palliative medicine. “This strategy was low-cost and easily implemented in community hospitals, which is where most Americans receive their health care.”
The study included more than 34,000 patients with chronic obstructive pulmonary disease (COPD), dementia, or kidney failure at 11 hospitals in eight states, all part of one of the nation’s largest nonprofit health systems. Although palliative care consultation is recommended for millions of Americans with serious illnesses, many patients aren’t referred to palliative care or only receive a consultation at the end of life.
Patients with COPD, dementia, and kidney failure have been underrepresented in past studies of palliative care delivery, which have largely focused on patients with cancer or heart failure in academic health centers. But these patients often experience challenges with coping, as well as breathlessness, anxiety, pain, and other symptoms that palliative care can help address through medications, other treatments, and/or referrals to other specialists. Palliative care can be given at any stage of treatment, including along with therapy intended to cure the condition.
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