Outpatient Palliative Care Service Involvement: A Five-Year Experience from a Tertiary Hospital in Switzerland

Dorothea Rebekka Birkner; Markus Schettle; Markus Feuz; David Blum; Caroline Hertler

doi:10.1089/pmr.2023.0052

Outpatient Palliative Care Service Involvement: A Five-Year Experience from a Tertiary Hospital in Switzerland

Palliat Med Rep. 2024 Jan 5;5(1):10-19. doi: 10.1089/pmr.2023.0052. eCollection 2024.

Authors

Dorothea Rebekka Birkner¹, Markus Schettle², Markus Feuz², David Blum^{1

2}, Caroline Hertler^{1

2}

Affiliations

¹ University of Zurich, Zurich, Switzerland.
² Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland.

Abstract

Background: The value of early integration of palliative care has been demonstrated increasingly for the past years in both oncological and nononcological diseases. Outpatient palliative care services might represent a feasible approach to implement supportive care in early disease. In this study, we aimed at evaluating which patients use and benefit from outpatient palliative care services, which symptoms are addressed most, and which support services are installed in this early phase of disease.

Methods: We retrospectively analyzed the entire patient collective of a recently developed palliative care outpatient clinic within the leading university hospital in Switzerland for a period of five years. Sociodemographics, symptoms, and information on disease as well as patient-reported outcomes were retrieved from the electronic patient files. Demographic and clinical data were analyzed by descriptive statistics between groups and survival was analyzed by means of Kaplan-Meier estimates and log-rank test.

Results: We report on 642 consultations of 363 patients between 2016 and 2020. Patients had a mean of 1.8 visits (range 1-10), with n = 340 patients (93.7%) of patients suffering from an oncological disease. Overall symptom load was high, with n = 401 (73.7%) of patient-reported outcomes reporting two or more symptoms. Distress levels of 5 or higher were reported in n = 78 (30.4%) of available patient-reported outcomes. Independent of the origin of primary disease and the length of the disease trajectory, patients were referred to the palliative care service in median only four months before death.

Conclusion: We identify high symptom load and distress in the outpatient palliative patient population. Patients benefitted from supportive medication, improvement of ambulatory support systems and advance care planning, and more than one-third of patients remained in follow-up, indicating a good acceptance of the service. Overcoming the overall late referral could, however, further increase the quality of life at earlier stages of disease.

Keywords: caregiver; early implementation; outpatient needs; palliative care; quality of life.