Addressing palliative care barriers in the Orlando Health Cancer Institute.

311 Background: Palliative services remain underutilized across many health systems (Hu et al, Hui et al). Previous studies have encountered a variety of factors that contribute to the discrepancy between eligibility and provision of palliative services (Norman et al, Rocque et al, Adelson et al). In the current study, we aimed to analyze and categorize barriers to patients who had been deemed appropriate to receiving specialty PC and actual follow up within the Orlando Health Cancer Institute. Methods: Patients at the Orlando Health Cancer Institute treated for GI/Lung cancers at stage IV from 11/1/2023-12/31/2024 were surveyed. Patients were screened for the presence of a new palliative care referral and subsequent successful completion of palliative care visit. Finally, those with appropriate diagnoses and a palliative referral placed were further screened to see if patients successfully followed up with a palliative provider. The patients with PC referrals, but without PC visits were analyzed to determine potential barriers to PC usage. The reasons were grouped into four categories: 1) Financial/Insurance, 2) Moved care outside center, 3) Patient factors, and 4) System related process issues. Each chart was analyzed for multiple barriers; thus, individual patients could have more than one attributed factor. Results: In total, there were 657 records surveyed with stage IV GI/lung malignancies. Of those only 78 records had a PC referral. Twenty-seven records were referred but were not seen by a palliative provider. The majority of the counts for the reasons to not complete PC appointment was due to patient factors (89%, N=31). Reasons owing to financial/insurance and system related process issues had one instance each. There were two instances where patients moved care outside the center. Conclusions: This Orlando Health Cancer Center study identified multiple barriers to patients’ successful access to PC. With ~33% attrition rate, significant barriers exist to accessing PC for patients within the Orlando Health system. Of those lost to follow up, the majority (89%) were patient factors. Our study identified that a larger population of patients who were potentially appropriate to the palliative team (stage IV GI and lung malignancy) were never referred. In future research, we aim to assess and address barriers to access and explore avenues to support earlier palliative care referral. Barriers to PC Financial/Insurance Moved Care Outside Center Patient factors System-related process issues Uninsured In-state Being too ill Untimely appointment date Insurance not covering treatment Out of state Hospitalization Conflicting appointment dates Inadequate finances Death Enrolled into hospice Results N=1 N=2 N=31 N=1 3% 6% 89% 3%