A Quantitative Study to Examine the Comprehensiveness of Palliative Care Consultations During COVID-19 (Sch406)

ABSTRACT

Outcomes: 1. Evaluate the comprehensiveness of palliative care consultations in different clinical settings and time periods quantitatively by utilizing national consensus project guidelines. 2. Analyze patient sociodemographic and administrative data and palliative care consultation charts to infer variables that predict the comprehensiveness of consultations. Background(s) COVID-19 has caused unprecedented suffering, strained healthcare systems, and jeopardized the well-being of healthcare providers. Few studies exist to characterize how inpatient specialist palliative care (PC) teams managed an increase in demand for consultations while maintaining the quality of their service. Objective(s) This quantitative study aims to (1) examine the comprehensiveness of inpatient PC consultations conducted from 2019 through 2022 at a tertiary academic hospital in Toronto, Canada, and (2) assess the predictors of comprehensiveness of PC consultations. Method(s) We are conducting a retrospective cohort study examining a 33% random sample of inpatient palliative care consultation notes (n=600) completed for adult (>18 years old) inpatients at Mount Sinai Hospital between January 1, 2019, and July 1, 2022. Our definition of comprehensiveness is informed by a recent publication addressing necessary clinical domains (eg, performing a spiritual history, code status discussion) in a palliative care assessment. We will code each inpatient palliative care consult note for the completion of individual clinical domains using template analysis. We will dual code a random selection of 10% of the transcripts to evaluate interrater reliability. Informed by Andersen's behavioral model for health services utilization, we will sociodemographic (age, gender, rurality, English language proficiency) and clinical pathophysiological variables (primary diagnosis, referral service, reason for referral, disposition, etc.) from the consult notes and linked administrative data. We will calculate frequencies and distributions of all study variables and use multiple linear regressions to examine predictors of comprehensiveness of PC consultations. Conclusion(s) This study will provide novel data on the clinical work completed by inpatient palliative care clinicians during the COVID-19 pandemic. The data will offer critical insights into how palliative care clinicians prioritize clinical domains during initial assessments of inpatients with varying sociodemographic and clinical backgrounds.Copyright © 2023