EOLP-06. Early experiences in a palliative medicine and neuro-oncology multidisciplinary clinic pilot program

Abstract Given substantial evidence supporting benefits of early palliative medicine specialist referral in advanced cancers, as well as limited utilization of early palliative referrals in neuro-oncology, we integrated palliative medicine into our multidisciplinary brain tumor clinic (MDC), alongside neuro-oncology, neurosurgery, and radiation oncology. In our first 5 integrated clinics, there were 10 referrals to palliative care seen in MDC with malignant primary brain tumors, predominantly seen in their first hospital discharge follow-up encounter following initial resection. No patients refused referral or initial goals of care discussion. All 10 patients had documented advanced care planning discussion, with 1 patient declining to discuss advanced directive paperwork (ADP), 1 patient who did not complete it, and 8 who completed ADP. During their MDC visits, 8 patients reviewed and/or updated code status, of those 5 remained full code and 3 chose Do Not Resuscitate orders. 9 patients elected to pursue tumor directed therapy while 1 was referred directly to hospice. There were 2 total hospitalizations among the 10 patients after establishing in MDC, one for progression of disease and re-resection, and one for elective atrial fibrillation ablation. Patients seen in MDC all had ACP discussions, as well as very high rates of updating ADP and code status, early on in their disease course without negatively affecting care. Routine, rather than elective, referral to specialist palliative care was successful in facilitating early conversations about goals of care and complex decision-making which otherwise may have been deferred. These data support expansion of our MDC to better assess effects on ACP, health care utilization, perceived quality of care, and end-of-life care.