Abstract

Background: Palliative care is a holistic patient-centered approach that aims to address the physical, emotional, social, and spiritual needs of patients with serious illnesses. Advanced Breast Cancer (ABC) poses significant challenges to patients and their families requiring comprehensive supportive and palliative care interventions to improve patient's quality of life. When the patients' needs are not addressed, it can culminate in profound distress compromising their quality of life.

Objectives: This performance indicators study aims to review and assess the impact of inpatient palliative care consultation on code status and patients' length of stay (LOS) for patients with ABC.

Methods: A retrospective quantitative evaluation of data on the total number of ABC patients seen by the palliative care team between 2014 and 2022 at the American University of Beirut Medical Center in Lebanon was done. The average LOS for each patient before and after palliative care consultation was calculated as well as the percentage of patients who chose to de-escalate their care from full code to "Do Not Resuscitate, Do Not Intubate" (DNR/DNI). Data were analyzed using descriptive statistics to identify trends in the data.

Results: A total of 263 patients were included in the analysis. The average LOS before palliative care consultation was 8.02 days (min: 4 days in 2019; max: 13 days in 2022) compared to 6.85 days post palliative care consultation (min: 5 days in 2017; max: 10 days in 2014) showing a significant reduction in the average LOS post consultation.

When it comes to code status and serious illness conversation, 30% of patients with ABC chose to change their care status from full code to DNR/DNI in 2014 compared to 84% of patients in 2022.

Conclusion: ABC illness imposes immense hardships on all stakeholders, encompassing patients and healthcare professionals, especially when the needs of these patients are left unhinged. A palliative care consultation for patients with ABC has demonstrated significant benefits. The findings of this study indicate a notable reduction in the average LOS post-consultation and a substantial decrease in aggressive and futile care at end of life, shedding light on the positive impact of palliative care team involvement. These results underscore the dire need to incorporate palliative care into primary care for all patients with advanced breast cancer.