Electronically Triggered Hospital-Based Palliative Care: Patient and Clinician Perspectives (RP509)

• Published in: Journal of pain and symptom management Vol. 60; no. 1; pp. 233 - 234
• Main Authors: Courtright, Kate, Szymanski, Stephanie, Hyder, Sydney, Weissman, Gary, Eriksen, Whitney, Bocage, Claire, Shah, Arnav, Draugelis, Michael, Regli, Susan, O'Connor, Nina, Halpern, Scott
• Format: Journal Article
• Language: English
• Published: Madison Elsevier Inc 01.07.2020; Elsevier Limited
• Subjects: Age; Autonomy; Collaboration; Continuity of care; Coordination; Females; Foster care; Hospitalists; Hospitals; Integrated care; Palliative care; Patients; Professional attitudes; Quality of care; Treatment preferences
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.04.101

Objectives Describe patient and clinician attitudes and preferences regarding triggered palliative care consultation. Evaluate a conceptual framework of patient and clinician preferences for triggered palliative care delivery using the electronic health record. Importance. Hospitals are increasingly using triggers for palliative care to identify patients most likely to benefit, yet perspectives of key stakeholders on this practice are unknown. Objective(s). Describe patient and clinician attitudes and preferences regarding electronically triggered palliative care. Method(s). A descriptive qualitative study across two urban hospitals from June 2018 to January 2019. We conducted semi-structured interviews with seriously ill hospitalized patients (predicted 6-mo mortality risk $0.5) who received a triggered consult, hospitalists, and palliative care clinicians. Transcripts were independently dual-coded among three trained coders and every third transcript from each group was doublecoded to assess agreement. We used an inductive thematic approach to identify emergent themes. Results. We interviewed 12 patients (mean age 67 years, 50% female, 58% married); 14 hospitalists (mean age 39 years, 43% female, 72% in practice <10 years); and 15 palliative care clinicians, including 9 MDs, 5 CRNPs, and 1 MSW (mean age 40 years, 67% female, 60% in practice <10 years). Five emergent themes were grouped into two processes of care: (1) the trigger strategy: patient identification and consult delivery and (2) the patient and clinician experience of care: quality of care, resource use, and education. The majority of participants were receptive to electronically triggered palliative care for its potential to foster care coordination and collaboration, promote awareness and education, and increase consultation among appropriate patients. Some patients and hospitalists expressed concern with automated care decisions, while palliative care clinicians were concerned about the potential impact on consult volume. Conclusion(s). Seriously ill patients and clinicians were generally amenable to electronically triggered palliative care to increase opportunity, education, and improve efficiency, favoring consult delivery approaches that retained clinicians' decision autonomy. Impact. Future trigger designs should strive to balance efficiency and equity of palliative care resource use, and to promote coordinated and collaborative care.