Integrating Palliative Care in Outpatient Hematology Clinic Increases Patient Satisfaction, Adherence to Care and Decrease Hospital Admissions

Introduction:

Israel contains within it a unique variety of ethnic and religious groups with variable set of convictions and values. Integrating palliative care approach in routine care of patients with hematological malignancies is challenging although published data supports this approach that results in improved patient quality of life. In this study we tested the effect of this approach on adherence to the planned treatment plan and hospital admissions for symptoms management.

Methods:

Patients with hematological malignancies treated in Carmel Medical Center, Haifa, Israel were enrolled in our integrative palliative care program. All patients were diagnosed with hematological malignancy. Patients were in various stages of disease - during diagnosis, active treatment or follow-up.

Patients were evaluated by a multidisciplinary team including a palliative care physician, palliative care nurse, treating hematologist and a social worker. Evaluation included recognition of patient's unique characteristics and identifying needs and areas for intervention. A patient specific plan was formulated based on needs and social background. We measured patient's satisfaction using a specific questioner. Adherence to care was measured by the percentage of patients that had to change treatment plan due to side effects. We measured hospital admissions for symptoms management during treatment.

Results:

Fifty patients were enrolled in our integrated program. The mean age of our patients was 68, 46% were women, 62% were immigrants to Israel, 12% were Arab Israelis, and 64% were married. Most patients evaluated in the clinic were prior to initiating chemotherapy treatment for the underlying disease (70%). Most common patients main complain was depression and anxiety (42%) followed by pain (26%). Other complains included GI symptoms (12%), fatigue and malaise (10%), peripheral neuropathy (6%), none (4%). Most patients were treated with pharmacological interventions (66%).

Patient comprehension of their disease and treatment plan was significantly improved (81%) following palliative care intervention. The palliative care intervention significantly improved patient symptoms and 81% reported significant improvement. None of the patients had to stop or change treatment due to symptoms or side effects from therapy. A significant decrease in ED visits or inpatients admissions was noted. Over a period of 6 months there was 80% decrease in ED visits or inpatients admission for symptoms management (p=0.04).

Conclusions: Integrating palliative care in the outpatient hematology clinic significantly increase patients satisfaction, adherence to care and decrease hospital admissions for symptoms management. Depression and anxiety are very significant symptoms in patients prior to chemotherapy initiation and should be addressed to improve patient care. This approach has tremendous value in treating newly diagnosed patients with hematological malignancies.