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Simple Summary: Metastatic breast cancer (MBC) frequently results in increased pain and distress for women affected by the disease. Management of these symptoms can be complicated and expensive, leading to undue stress for these patients and their families. Palliative care has demonstrated effectiveness in alleviating symptomology due to disease and improving quality of life for patients with MBC, yet utilization of palliative care remains low. The purpose of this study is to document the prevalence of palliative care consultations among inpatients with metastatic breast cancer and to examine the impact of palliative care on the length of hospital stay and total hospital charges. The results of this study demonstrate that only 5.7% of patients with metastatic breast cancer received a palliative care consultation during their inpatient stay. Palliative care consultation was associated with a longer length of stay but lower hospital charges. Introduction: Women with late-stage metastatic breast cancer are at an increased risk of pain and distress from symptoms and often struggle with associated emotional and financial burden of their disease. Palliative care is known to alleviate symptom burden in patients with end-stage, terminal diseases but is often underutilized in both inpatient and outpatient settings. The current study aims to investigate the prevalence of palliative care consultation on inpatients with metastatic breast cancer and examine the association between palliative care consultation and length of hospital stay and total hospital charges. Methods: Patients diagnosed with metastatic breast cancer between 1998–2017 were abstracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS). The primary outcome was the presence of a palliative care consultation (PCC) during the inpatient stay. Secondary outcomes were hospital length of stay and total hospital charges. Multivariable logistic regression was used to examine factors associated with the presence of a PCC. The relationship between PCC and hospital length of stay and total hospital charges were investigated using linear regression. Results: 513,509 cases of metastatic breast cancer were identified, 5.7% had a documented in-hospital palliative care encounter. Of those who received PCC, total hospital charges were about USD 5452 less than those who did not receive consultation. Women who received PCC had higher odds of a longer hospital stay. Predictors of PCC were older age, non-White race, and residing in a lower-income ZIP code. Conclusions: Palliative care remains to be an underutilized resource among patients with end-stage metastatic breast cancer. [ABSTRACT FROM AUTHOR]

1. Describe the characteristics associated with being offered a palliative care consultation in women with metastatic breast cancer. 2. Describe the association between palliative care consultation and hospital length of stay in women with metastatic breast cancer. The purpose of this study was to determine the incidence of inpatient palliative care consultations (PCC) in women with metastatic breast cancer and to examine the association between palliative care consultation and hospital length of stay (LOS) and in-hospital costs in a nationally representative sample. Women 18 years and older with a metastatic breast cancer related hospitalization in the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS) 1998-2017 were included in the study. Multivariable logistic and linear regression analyses were used to examine the effects of patient and hospital characteristics on the receipt of inpatient palliative care, length of stay, and total hospital charges. SAS software survey procedures (version 9.4, SAS Institute Inc, Cary, NC). The average age in the study population (N=513,509) was 63 years. Most women were white (73.2%) and received governmental types of insurance (58.4%). Older women were associated with higher odds of getting PCC [aOR 95% CI (60-69 yrs: 1.08 (1.01 1.16); ≥70 yrs: 1.25 (1.17 1.34)]. Women of races other than white [Black: 1.12 (1.07 1.16); other races 1.08 (1.04 1.13)] were more likely to receive PCC. Women receiving governmental insurance had slightly lower odds of receiving palliative care compared to commercially insured women [0.94 (0.91 0.98)]. Comorbid conditions increased odds of receiving a PCC. Hospitals were likely to charge patients receiving palliative care services less compared to patients who did not have a PCC encounter (Estimate: -5450; 95% CI: -5968, -4936 despite being associated with higher odds of a longer hospital stay (> 4 days) [1.17 (1.14 1.20)]. Our study found that inpatient PCC for women with metastatic breast cancer increased LOS. Inpatient PCC was provided to sicker patients; hence, targeted interventions must be implemented to increase PCC for metastatic breast cancer patients in the United States. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of early triggered palliative care consultation on the outcomes of high-risk ICU patients.Design: Single-center cluster randomized crossover trial.Setting: Two medical ICUs at Barnes Jewish Hospital.Patients: Patients (n = 199) admitted to the medical ICUs from August 2017 to May 2018 with a positive palliative care screen indicating high risk for morbidity or mortality.Interventions: The medical ICUs were randomized to intervention or usual care followed by washout and crossover, with independent assignment of patients to each ICU at admission. Intervention arm patients received a palliative care consultation from an interprofessional team led by board-certified palliative care providers within 48 hours of ICU admission.Measurements and Main Results: Ninety-seven patients (48.7%) were assigned to the intervention and 102 (51.3%) to usual care. Transition to do-not-resuscitate/do-not-intubate occurred earlier and significantly more often in the intervention group than the control group (50.5% vs 23.4%; p < 0.0001). The intervention group had significantly more transfers to hospice care (18.6% vs 4.9%; p < 0.01) with fewer ventilator days (median 4 vs 6 d; p < 0.05), tracheostomies performed (1% vs 7.8%; p < 0.05), and postdischarge emergency department visits and/or readmissions (17.3% vs 38.9%; p < 0.01). Although total operating cost was not significantly different, medical ICU (p < 0.01) and pharmacy (p < 0.05) operating costs were significantly lower in the intervention group. There was no significant difference in ICU length of stay (median 5 vs 5.5 d), hospital length of stay (median 10 vs 11 d), in-hospital mortality (22.6% vs 29.4%), or 30-day mortality between groups (35.1% vs 36.3%) (p > 0.05).Conclusions: Early triggered palliative care consultation was associated with greater transition to do-not-resuscitate/do-not-intubate and to hospice care, as well as decreased ICU and post-ICU healthcare resource utilization. Our study suggests that routine palliative care consultation may positively impact the care of high risk, critically ill patients. [ABSTRACT FROM AUTHOR]

B Learning Objectives: b While palliative care (PC) has an increasingly recognized role in the intensive care unit (ICU), prospective data to support routine PC consultation for the critically ill is lacking. This study examines the effect of early automatic PC consultation on patient outcomes and healthcare utilization in the medical ICU (MICU). [Extracted from the article]