A standardized palliative care (PC) consultation system did not appear to lead to sustained PC follow-up throughout the duration of a patient’s illness among older individuals being treated for acute leukemia, according to research published in JCO Oncology Practice.

Although PC has been shown to improve quality of life as well as end-of-life care among these patients, this strategy is frequently under-utilized.

At the University of Pittsburgh Medical Center Shadyside Hospital, oncologists offer specialty care services for patients with acute leukemia, including PC. For this study, researchers at Shadyside evaluated whether a predefined consultation system — the Plan-Do-Study-Act (PDSA) method — improves PC uptake among elderly patients with newly-diagnosed acute leukemia.

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Researchers evaluated the effectiveness of the PDSA method for improving PC uptake rate from the 2019 baseline, which was 55%. All included patients were both at least 70 years old and had received an acute leukemia diagnosis within the preceding 8 weeks. PDSA cycles were conducted sequentially during 2021.

During PDSA cycle 1, PC consultation rates increased to 77%; during cycle 2, they increased to 80%. Furthermore, implementation of PDSA in 2021 decreased the time for first PC consultation from 49 to 7 days.

Data also showed that, after discharge, 43% of patients had no further PC consultation, whether as an in- or out-patient. “In conclusion, our institutional experience demonstrates that standardized consultation criteria can help overcome barriers to inpatient PC consultation and improve rates of early PC utilization in older patients with [acute leukemia],” the authors wrote. “Future PDSA cycles will focus on developing implementation strategies to increase and maintain outpatient PC use throughout the disease trajectory.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Rosenblum RE, Ormond E, Smith CW, et al. Institution of standardized consultation criteria to increase early palliative care utilization in older patients with acute leukemia. JCO Oncol Pract. Published online September 28, 2022. doi:10.1200/OP.22.00269