Does a Palliative Care Clinic Have a Role in Improving End-of-Life Care? Results of a Pilot Program

Abstract

Objective: To assess the efficacy of a palliative care clinic (PCC), which provided some of the interdisciplinary services and expertise of an inpatient consult service to outpatients, in traditional clinic sessions. Design: Chart review. Setting: A large urban Veterans Administration Medical Center. Patients: One hundred patients referred to clinic. Interventions: Palliative care clinic. Outcome Measures: Patients' reported needs, Global Distress Index (GDI) subscale, hospice eligibility, and time to death. Results: The most common diagnosis was cancer (n = 85). Most patients (n = 89) had at least one need for services that the team provided (median, 2; range, 0-4), the most common of which was a desire for information about prognosis (n = 84). In a Cox proportional hazards model, predictors of enrollment in hospice included white ethnicity (hazard ratio, 3.42; p < 0.001), a need for help around the home (hazard ratio, 3.26; p = 0.002), and insufficient money left at the end of the month (hazard ratio, 2.39; p = 0.014). Conclusions: The experience of the PCC described here offers a unique approach to improving end-of-life care for those outpatients who may not be well served by existing structures of care such as palliative care consult services and who have not yet enrolled in hospice.