Heather Harris

Psychosocial distress screening in the health care safety net.

91 Background: Recognizing that psychosocial distress (PSD) is underestimated in patients with cancer, the Commission on Cancer mandated screening using a validated tool. Studies of PSD screening exist, but none to date in a diverse, multicultural safety net setting where patients face challenges such as homelessness, mental illness, and substance abuse, which may augment PSD. METHODS We performed a retrospective cohort study of patients with cancer offered PSD screening during 2015. Overall distress scores and problems in each domain were analyzed. Chart review identified potential predictors of distress including age, gender, race, language, housing, psychiatric illness, substance abuse, and cancer stage. RESULTS Of 177 eligible patients, 113 (64%) completed screening. The most common reasons patients were not screened were refusal, too symptomatic (physically or emotionally), or language barriers. Of screened patients, 40.7% were female, 57.5% male, and 1.7% transgender. 31% were Caucasian, 27% Asian/Pacific Islander, 25% Hispanic, and 17% African American. 35% were non-English speaking. 29% had history of mental illness and 34% of substance abuse. 23% were marginally housed or homeless. 63% reported moderate to severe levels of PSD as defined by the NCCN as ≥ 4. Patients with mental illness were nearly twice as likely to report PSD ≥ 4 (p = 0.012) and had higher mean PSD scores (5.78 vs. 4.03, p = 0.002). English speaking patients had a mean PSD score of 5.01 compared to 3.6 and 3.2 for Spanish and Chinese speaking patients, respectively (p = 0.02 for English v. Chinese) and more domains causing PSD (p = 0.028 for English v. Chinese). Lack of stable housing also correlated with more domains causing PSD (p = 0.05). CONCLUSIONS This proved to be an ethnically diverse cohort with high rates of mental illness, substance abuse, and homelessness, with the majority reporting moderate to severe distress. Even with a small cohort, English language and mental illness were significant predictors of PSD, and housing status correlated with more domains contributing to PSD. Several other variables trended toward significance, suggesting a larger cohort may be needed to determine if additional characteristics predict higher levels of PSD.

Making the Case: Is Outpatient Palliative Care for Oncology Patients Feasible Within the Safety Net? (S745)

identified student’s need to; 1) Ask more about the degree of knowledge family members want; 2) Ask religious beliefs; 3) Assess family member’s level of education (p<0.001). Conclusions. FM-OSCE provided students with a valuable learning experience providing direct feedback and identifying specific areas where MS require further communication expertise. Implications forResearch,Policy, orPractice. Future research is needed on how standardized communication teaching interventions with real time feedback such as FM-OSCEs could improve patient care, patient’s quality of life, and, subsequently, health systems.

Feasibility of outpatient palliative care for oncology patients within the safety net.

38 Background: Palliative care (PC) combined with standard oncology care has been shown to improve patient outcomes and reduce health care costs. In safety-net systems, where limited resources mandate containing costs across settings, outpatient PC (OP PC) could be an important tool for improving quality while lowering costs. Multiple studies have shown that oncology patients cared for in safety net systems often present very late in the course of illness, raising concerns about the proportion of patients who could be referred to an OP PC clinic. To address this question we analyzed utilization patterns among cancer patients cared for at our facility to examine the need for and expected net costs of an OP PC service. METHODS Retrospective cohort study of oncology patients cared for at an urban, safety-net hospital who died between July 2010 and June 2013. We used cancer registry data to identify decedents and claims data to evaluate utilization patterns and cost of care in the final 6 months of life. RESULTS Among the 403 cancer patients who died in the study period we found heavy, late utilization of inpatient (IP) services: 307 (76%) were admitted to the hospital in the 6 months preceding death, 45% in the final month of life. One third of patients died in the hospital and another 4% died within 3 days of hospital discharge. Direct costs per admission averaged

Making the case for outpatient palliative care for cancer patients at a safety-net hospital.

22,275. While late presentation was common, 133 (33%) patients had multiple health system encounters 91-180 days prior to death: early enough to be referred to an OP PC clinic. We modeled clinic costs assuming an annual volume of 50 patients, to be followed monthly for the last 4 months of life by a physician-nurse-social worker team. Annual staffing costs were estimated at

If We Build It, Will They Come? Estimating the Need for Community-Based Palliative Care in a Public Health System (S708)

88,290. Prior research has shown that utilization of IP services in the final month of life is 40% lower amongst patients who receive early OP PC. Using that value, we estimated that providing OP PC to 50 patients annually would avoid 38 hospitalizations, with resulting avoided direct costs of

Not Quite There Yet: Striving to Create a Diverse and Inclusive Palliative Care Workforce (FR459)

846,450. CONCLUSIONS This feasibility study reveals that OP PC in the safety net can provide substantial return on investment, even if such services are only used by a subset of oncology patients who present earlier in their disease course.

Oncology patients in the health care safety net: Is it too late for early palliative care?

310 Background: Prior research has shown that patients who receive earlier, outpatient palliative care (OP PC) have improved end-of-life care compared to patients who receive only inpatient palliative care (IP PC). We examined the need, expected impact and feasibility of providing OP PC to patients with cancer seen at our hospital, which offers IP PC but not OP PC. METHODS Retrospective cohort study of patients cared for at our urban, safety-net hospital who died of cancer between July 2010 and June 2013. We used cancer registry data to identify decedents and claims data to evaluate utilization patterns, contacts with our IP PC service, and cost of care in the final 6 months of life. RESULTS In the analysis period 403 patients died of cancer, 307 of whom were admitted to the hospital in the 6 months preceding death. On average patients were admitted 1.9 times, with 39% having multiple admissions. Average length of stay was 10.47 days. Nearly half of all patients were admitted to the hospital in the final month of life (181/403), and 21% of those (38/181) had multiple admissions. One third of patients died in the hospital and another 4% died within 3 days of hospital discharge. Direct costs per admission averaged

Psychosocial distress in vulnerable patient populations: What happens after screening?

22,275. The IP PC service had contact with 178 patients; 44% of the entire decedent population and 58% of those who were hospitalized. In 60% of cases the initial contact with the PC team took place in the final month of life. We determined that 33% of patients had multiple inpatient and or outpatient encounters 90-180 days prior to death, pointing to an expected annual clinic volume of about 50 patients. Annual costs for staffing a clinic that could follow 50 patients for an average of 4 months were estimated at

Early Referrals: An Ideal Goal for Both Patient and Hospital (S775)

88,290. We assumed that providing OP PC would reduce utilization of inpatient services by 40% (38 avoided admissions), with resulting avoided direct costs of

Bringing It to the Streets: A Novel Approach to Improve Palliative Care for Homeless Adults (FR468)

846,450. CONCLUSIONS At our facility cancer patients often receive aggressive EOL care. Our IP PC team sees many of these patients, but most contacts occur days-weeks prior to death. Though many patients present very late in the course of illness, a substantial number have multiple health system contacts >3 months prior to death, and could be referred to an OP PC clinic.