A population health approach to assessing for and addressing palliative care needs in outpatients with advanced gynecologic malignancies.

OBJECTIVE

Describe a pilot system that 1) proactively identifies palliative care (PC) needs in a gynecology oncology population and 2) efficiently connects patients with targeted primary and specialty PC services.

METHODS

Outpatients with stage 3 or 4 gynecologic malignancies received electronic surveys assessing PC needs in domains of physical symptoms, emotional or spiritual distress, care coordination, practical concerns, and advance care planning (ACP). Referrals to support groups, social work (SW), ACP websites/workshops, and specialty PC consultation were offered accordingly.

RESULTS

Overall, 129 (45 %) of 287 patients participated. Sixty-three (49 %) reported significant physical symptoms, 58 (45 %) significant emotional symptoms, 9 (7 %) spiritual distress, 19 (14.7 %) a care coordination challenge, 30 (23 %) a practical issue, and 86 (67 %) no ACP documentation. Thirty-seven (59 %) patients with physical symptoms not already followed by PC were offered a PC consultation; 18 (49 %) accepted. Of 58 patients with emotional symptoms 18 (31 %) accepted a SW consultation, 19 (32 %) a support group and 21 (36 %) a resiliency class. Fifteen (50 %) patients with practical concerns were not already connected with SW and offered SW consultation; 10 (33 %) accepted. Forty (47 %) patients with ACP needs accepted an interactive ACP website, 23 (27 %) an ACP workshop, and 31 (36 %) an advance directive worksheet via mail.

CONCLUSIONS

We describe how to routinely screen and proactively connect patients to a wide range of PC services. PC needs were common and many could be addressed through non-specialty PC services. Acceptance of the services offered was incomplete, however, and warrants further investigation.