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The impact of palliative care training for oncologists and integrative palliative service in a public-funded hospital cluster—a retrospective cohort study

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Abstract

Purpose

Oncological care of advanced cancer patients was provided by multiple departments in Hong Kong. One of these departments, the clinical oncology department (COD), introduced systematic palliative care training for its oncologists since 2002. The COD was recognized as a European Society for Medical Oncology (ESMO) Designated Centre of Integrated Oncology and Palliative Care since 2009. This retrospective cohort study aims to review the impact of integrative training and service on palliative care coverage and outcome.

Methods

Clinical information, palliative service provision, and end-of-life outcomes of patients who passed away from lung, colorectal, liver, stomach, or breast cancer in the Hong Kong West public hospital network during July 2015 to December 2015 were collected.

Results

A total of 307 patients were analyzed. Around half (49.2%) were attended primarily by COD, and 68.9% received palliative service. There are significantly fewer patients referred to palliative care from other departments (p < 0.001), with only 19.9% of this patient group receiving palliative referral. COD patients had longer palliative coverage before death (median 65 days versus 24 days, p < 0.001), higher chance of receiving end-of-life care at hospice units (36.4 versus 21.2%, p = 0.003), lower ICU admission (0.66 versus 5.1%, p = 0.02), and higher percentage of receiving strong opioid in the last 30 days of life (51.0 versus 28.9%, p < 0.001) compared to other departments. In multivariable analysis, COD being the primary care team (odds ratio 12.2, p < 0.001) was associated with higher palliative care coverage.

Conclusion

The study results suggested that systematic palliative care training of oncologists and integrative palliative service model was associated with higher palliative service coverage and improved palliative care outcomes.

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Authorship

All authors made significant contributions to the conception, data acquisition, interpretation, analysis, initial draft, and final approval of this study.

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Authors and Affiliations

  1. Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong

    Pak-Lun Lam

  2. Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 1/F, Professorial Block, Pokfulam, Hong Kong

    Tai-Chung Lam, Cheuk-Wai Choi & Anne Wing-Mui Lee

  3. Department of Clinical Oncology, Queen Mary Hospital, 1/F, Professorial Block, Pokfulam, Hong Kong

    Kwok-Keung Yuen & To-Wai Leung

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  1. Pak-Lun Lam
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  2. Tai-Chung Lam
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Correspondence to Tai-Chung Lam.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 17-043) on 9 February 2017. For this type of study, formal consent is not required.

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Lam, PL., Lam, TC., Choi, CW. et al. The impact of palliative care training for oncologists and integrative palliative service in a public-funded hospital cluster—a retrospective cohort study. Support Care Cancer 26, 1393–1399 (2018). https://doi.org/10.1007/s00520-017-3963-6

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  • DOI: https://doi.org/10.1007/s00520-017-3963-6

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