Assessment of Early, Standardized Palliative Care Referrals in Patients with Metastatic Gastrointestinal Cancer: A Quality Improvement Initiative

Background: Patients with advanced cancer often present with high symptom burden and decreased quality of life. Metastatic gastrointestinal cancers can be especially debilitating with 5-year relative survival rates ranging from 2%-15%. Early involvement of palliative care has shown to improve symptom management, quality of life, and quality of care in patients with advanced cancer. Criteria-based, or systematic palliative care referrals have emerged as a strategy to promote early involvement of palliative care in patients with advanced cancer but have not yet seen widespread uptake by the larger oncology community. Methods: The implementation site was a gastrointestinal oncology clinic within a nationally-recognized cancer hospital and research center in the urban Salt Lake region, which includes in-house palliative care specialty services. First, patients with gastrointestinal cancer who might benefit from systematic palliative care referrals were identified. New patient intake algorithms were then modified to include an automatic palliative care referral according to developed inclusion and exclusion criteria. Education was provided to the clinic staff regarding the intervention prior to the implementation date. Following a ten-week trial period, staff completed a post-intervention survey to assess feasibility, usability, and satisfaction of the early, systematic palliative care referrals. Results: Palliative care referrals increased from 19% (3/16) in the pre-intervention group to 62% (8/13) in the post-intervention group (p < .05). Clinic staff feedback was positive, with 92% of survey participants who checked "agree" or "strongly agree" that early palliative care intervention benefits patients, families, and caregivers. All survey participants (n=12) answered "yes" to the continuation of the intervention in the gastrointestinal oncology clinic. Conclusions: The implementation and evaluation of early, systematic palliative care referrals in patients with metastatic gastrointestinal cancers successfully increased referrals to palliative care and proved to be usable, feasible, and sustainable within the clinic. Further study is needed to directly measure patient outcomes and address identified barriers to early palliative care intervention.