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Characteristics, findings, and outcomes of palliative care inpatient consultations at a comprehensive cancer center.

Braiteh F, El Osta B, Palmer JL, Reddy SK, Bruera E

Department of Palliative Care and Rehabilitation Medicine, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas.

Purpose: There is limited information available about the role and effect of a palliative care consultation service (mobile team, MT) in patient care. The purpose of this retrospective chart review was to determine the characteristics, findings, and outcomes of patients referred to MT in a comprehensive cancer center and to thereby gain information about its role in this setting. Patients and Methods: The study group was 61 consecutive patients assessed by one MT during 2-month period. We reviewed their charts for information about demographic and disease features, reasons for consultation, findings, interventions, and outcomes. Results: Patients were mainly referred by thoracic (n = 21; 34%), genitourinary (n = 10; 16%), and gynecology (n = 9; 15%) services. The majority of patients had metastatic disease (n = 56; 92%). Evaluation of pain was the main reason for the consultation (n = 47; 77%) followed by delirium (n = 10; 16%). The MT found a total of 449 symptoms (median 8 per patient), whereas the referring team had mentioned only 86 (1 symptom per patient) in their requests. Twenty patients (38%) screened positive for a history of alcoholism. The MT diagnosed delirium in 34 patients (56%) and frequently found features of opioid-induced side effects, such as sedation (n = 46; 75%), constipation (n = 43; 70%), and confusion (n = 34; 56%). Frequent MT interventions were: administration of neuroleptics (n = 33; 54%), opioid rotation (n = 30; 49%), and enema (n = 33; 54%). Seventeen patients (28%) showed symptoms improvement within 24 hours and 23 patients within 72 hours (38%). Twenty-five patients (41%) required transfer to the palliative care unit. Conclusions: The MT had a positive impact on these patients' care in terms of clinical findings and outcomes. Further investigations are warranted.

Published 6 September 2007 in J Palliat Med, 10(4): 948-55.
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