P0546 - Increasing Palliative Care Team Involvement in Pediatric Oncology Patients

Background: Palliative care involvement with pediatric oncology patients improves quality of life and the likelihood of receiving goal-concordant end-of-life care. However, barriers to involvement exist.
Between Jan 1, 2017 and Dec 31, 2018, the pediatric oncology department cared for 30 patients who died of refractory cancer with a 5-year event free survival (EFS) of 30 days prior to death occurred for 43%. This is less than the United States News and World Report benchmark of 75% for palliative care involvement >30 days prior to death in patients with refractory cancer.

Objectives: The global aim was to increase PaCT involvement with pediatric oncology patients. Due to rarity of events, we aimed to increase days between PaCT consult and death for target list patients from a median of 13.5 days to ≥30 days between March 6, 2019 to March 5, 2020.

Design/

Methods: Institutional Review Board approval was obtained. Days between PaCT involvement and death served as outcome measure. Days between target list cancer diagnosis and PaCT involvement served as process measure. The Plan-Do-Study-Act cycles were as follows:
Cycle 1: Components included a survey of oncology providers to identify barriers to PaCT involvement, agreement upon target diagnoses for which PaCT involvement was recommended at diagnosis (Table 1), development of template for documenting decisions about PaCT involvement, and information dissemination sessions regarding consult process.
Cycle 2: Monthly email reminders about template use and target diagnoses for PaCT involvement.
Cycle 3: Email reminders to primary teams within two weeks of new target list diagnoses.

Results: Our outcome measure improved from a median of 13.5 days to 159.5 days (Figure 1) resulting in an increase from baseline 43% to 100% of target list patients receiving PaCT involvement ≥30 days prior to death during study. Our process measure of time from target list diagnosis to PaCT consult reduced from a baseline median of 221.5 days to 14 days (Figure 1) resulting in an increase from baseline of 28% to 65% of patients receiving involvement ≤30 days after diagnosis. Of those without PaCT consult <30 days after diagnosis, 17% had template documentation of the rationale.

Conclusion: The global aim and the goal outcome and process measures were met. The use of QI methodology empowered more providers to involve PaCT. Poor template use was a barrier to identifying further drivers. Future plans involve expanding the target list to include children with relapses and children referred to experimental therapeutics or to hematopoietic stem cell transplant.