Effect of a Symptom Surveillance and Collaborative Care Intervention on Palliative Care Utilization

Outpatient palliative care (PC) improves symptom management and quality of life for patients with advanced cancer, yet most do not receive PC services. Remote symptom surveillance and collaborative care (CC) interventions may increase appropriate and timely PC.

To assess whether an electronic health record (EHR)-facilitated CC intervention to monitor and manage SPPADE symptoms (Sleep interference, Pain, impaired Physical function, Anxiety, Depression, and Energy deficit/fatigue) increases outpatient PC use in advanced cancer patients.

This is a secondary analysis of data from the Enhanced, EHR-facilitated Cancer Symptom Control (E2C2) cluster-randomized pragmatic trial. Oncology patients in a multistate health system completed visit-linked questionnaires that included numeric rating scales for SPPADE symptoms during usual care and intervention periods. Intervention periods added monthly surveys, automated delivery of symptom self-management, and access to symptom care managers for severe symptoms. Our analysis was restricted to patients with metastatic disease. Outpatient PC encounters were identified from the EHR. Mixed effects Poisson regression with offset for exposure time was used to compare the rates of initial PC consults between study groups.

From March 2019 to January 2023, 16,406 patients with metastatic cancers were assigned a symptom questionnaire. At first assessment, mean age was 65; 49% were female, and 26.7% lived in rural areas. After adjustment, there was a 50% higher rate of PC consultation during the intervention period compared with the usual care period (incidence rate ratio = 1.50, P < 0.001).

EHR-facilitated symptom surveillance and CC management significantly increased outpatient PC utilization in a large metastatic cancer population.