An Exploratory Study of Demographics and Outcomes for Patients Seen by Specialist Palliative Care Social Work in the Inpatient Setting at an Academic Medical Center.

CONTEXT: Specialist palliative care social work (PCSW) across a four-team palliative care (PC) service in the inpatient setting at a tertiary academic medical center. OBJECTIVES: to describe the population of patients seen by inpatient PCSW, quantification of the involvement of PCSW in PC consultations, as well as comparisons of patient characteristics for those seen by PCSW and the overall population seen by the PC team. METHODS: Retrospective chart review of patients admitted to a tertiary academic medical center between January, 1 2015 and October 31, 2019 who received a PC consult. RESULTS: Over the study period, PCSW saw 2,381 out of the 4907 patients seen by the palliative care teams for a PCSW penetration rate of 52% with an 83% increase in the percent of consults seen by PCSW and a 133% increase in PCSW staffing over the study period. Compared to all PC consults, when PCSW was involved in the case, the LOS is longer (average 15.6d vs. 14.4d; P = 0.0062); goals of care are more likely to be addressed (90.7% vs. 87.4%, P = 0.004); dyspnea was more likely to improve (43.3% vs. 31.9%, P = 0.018) and pain was less likely to improve (28.2% vs. 49.4%, P < 0.001). CONCLUSION: Involvement of PCSW increased dramatically over the study period. Compared to the rest of the PC team, when PCSW was involved, length of stay was longer, whole-person care components were more likely to be addressed, dyspnea was significantly improved, and pain was significantly worse when compared to those consults not seen by PCSW. Other symptoms such as nausea and anxiety as well as discharge characteristics such as death or hospice discharge were not significantly different with involvement of PCSW.

Evidence-based Palliative Care Approaches to Non-pain Physical Symptom Management in Cancer Patients.

OBJECTIVE: To review effective approaches for non-pain symptom management for cancer patients focusing on treatment of nausea and vomiting, constipation, diarrhea, anorexia/cachexia, fatigue, and dyspnea. DATA SOURCES: Peer-reviewed articles, clinical practice guidelines, professional organization position statements. CONCLUSION: Oncology nurses are key advocates for optimal symptom management. Maximizing palliation of symptoms improves quality of life and prolongs survival. IMPLICATIONS FOR NURSING PRACTICE: To provide an evidence-based approach to symptom management, oncology nurses require a deep understanding of symptom pathophysiology while anticipating side effects, educating patients and caregivers, considering psychosocial/spiritual factors, exploring treatment expectations, and clarifying goals of treatment.