Pre-Post Evaluation of Collaborative Oncology Palliative Care for Patients With Stage IV Cancer

CONTEXT: The Collaborative Care Model improves care processes and outcomes but has never been tested for palliative care. OBJECTIVE: To develop and evaluate a model of collaborative oncology palliative care for Stage IV cancer. METHODS: We conducted a pre-post evaluation of Collaborative Oncology Palliative Care (CO-Pal), enrolling patients with Stage IV lung, breast or genitourinary cancers and acute illness hospitalization. CO-Pal has 4 components: 1) oncologist communication skills training; 2) patient tracking; 3) palliative care needs assessment; and 4) care coordination stratified by high vs. low palliative care need. Health record reviews from hospital admission through 60 days provided data on outcomes - goals-of-care discussions (primary outcome), advance care planning, symptom treatment, specialty palliative care and hospice use, and hospital transfers. RESULTS: We enrolled 256 patients (n=114 pre and n=142 post-intervention); 60-day mortality was 32%. Comparing patients pre vs post-intervention, CO-Pal did not increase overall goals-of-care discussions, but did increase advance care planning (48% vs 63%, p=0.021) and hospice use (19% vs 31%, p=0.034). CO-Pal did not impact symptom treatment, overall treatment plans, or 60-day hospital transfers. During the intervention phase, high-need vs low-need patients had more goals-of-care discussions (60% vs. 15%, p