Outpatient palliative care specialist referral patterns among patients with gynecological cancers

Background: Outpatient palliative care specialists remain underutilized in high-resource settings despite evidence demonstrating benefits in quality-of-life and symptom burden with early referral. The objective of this single institution retrospective cohort study was to develop a method to evaluate palliative care (PC) referral patterns to assess compliance with recently updated American Society of Clinical Oncology (ASCO) guidelines. Methods: Patients with gynecological cancers with advanced or recurrent disease seen in gynecologic oncology clinic from 2019–2022 were identified by Current Procedural Terminology (CPT) code and an institutional palliative care referral database. Demographics, referral source and utilization metrics were collected. Outcomes included rates of palliative care referral of eligible patients, referral completion and time from referral to first palliative care visit, hospice enrollment and/or death. Results: 434 patients with gynecological cancers met ASCO criteria for outpatient palliative care specialist referral. 192 of 434 (44%) were referred to palliative care and 147 of 192 (76.5%) saw a palliative care provider. 78% were referred by gynecologic oncology, 12% were referred by palliative care at hospital discharge and 8% were referred by medical or radiation oncology. Median time from referral to appointment was 20 days (interquartile range (IQR) 12–29 days). Patients did not utilize palliative care most commonly due to hospice enrollment (44%), patient preference (41%) and unable to be contacted (9%). Median time from referral to hospice enrollment was 112 days (IQR 30–329 days), and median time from hospice enrollment to death was 18 days (IQR 9–38 days). Conclusions: Fewer than half of patients with advanced or recurrent gynecological cancers were referred to outpatient palliative care specialists. Most referrals were completed within thirty days. Institutions can evaluate compliance with ASCO guidelines for palliative care uptake using a multi-pronged approach leveraging billing data and administrative databases to design strategic interventions for quality improvement.