Improving Early Palliative Care Consultation in Solid Tumor Patients

Purpose/Objectives: Early integration of palliative care for pediatric oncology patients has been shown to improve symptomatology and quality of life (QOL) of both patients and their parents, and is therefore becoming more standard of care. While early involvement of palliative care for oncology patients is preferred at our institution, timing of palliative care consultation is highly variable. This quality improvement project aimed to develop a reliable process to establish a palliative care consultation within 6 weeks of diagnosis for the solid tumor population.

Design/Methods: This quality improvement project utilized PDSA ramps to find reliable processes to identify new eligible solid tumor patients and schedule palliative care consultations within 6 weeks of diagnosis or presentation to Cincinnati Children's Medical Center (CCHMC). We included solid tumor patients (excluding patients with neurofibromatosis and retinoblastoma) who were actively getting therapy at CCHMC with either chemotherapy or bone marrow transplant. Time of palliative care consultation was determined using date of diagnosis or presentation to CCHMC (whichever is later) and date of initial consultation note from a palliative care provider.

Results: We increased palliative care consultations in solid tumor patients from 20% to 80% using the new process developed from this quality improvement project. New solid tumor patients were reliably identified using a report of new oncology treatment plans which was generated daily. Most failures were due to scheduling rather than identification.

Conclusion/Discussion: This quality improvement project demonstrates a reliable process for which to establish early palliative care consultations in solid tumor patients at a children's hospital. While the process for identifying new eligible patients is reliable and efficient, scheduling consultation was challenging at times as due to provider availability and patient location. One unanticipated barrier was rooted in the psychology of change and discomfort with palliative care. With the overall success of this project, we aim to broaden the target population to include neuro-oncology patients in our next phase.