Characteristics of Inpatient Deaths During the COVID-19 Pandemic at a Comprehensive Cancer Center (Sci214)

OUTCOMES: 1. Apply the knowledge about how the COVID-19 pandemic has impacted the care of patients with serious illness into daily practice. 2. Summarize current research findings in hospice and palliative care and describe its relevance to the care and treatment of patients with serious illness. CONTEXT: The urgency of the COVID-19 pandemic has brought forth an increased focus on palliative care involvement and advance care planning discussions around end-of-life preferences; however, few outcomes have been reported to date. The objective of this study was to compare characteristics of patients with advanced cancer during their terminal admission at a tertiary care comprehensive cancer center before and after the onset of the COVID-19 pandemic. METHODS: A random sample of 250 inpatient deaths from April 1, 2019 to July 31, 2019 was compared to a random sample of 250 inpatient deaths from April 1, 2020 to July 31. Sociodemographic and clinical characteristics, timing of palliative care referral, timing of DNR order, location of death, and pre-admission Out-of-Hospital DNR documentation were included. RESULTS: Timing of DNR orders occurred earlier (2.9 days vs. 1.7 days prior to death, p=0.024), while the frequency of DNR orders before death did not change (94% vs. 90%, p=0.25). Palliative care referrals increased (68% vs. 60%, p=0.062) and occurred earlier (3.5 days vs. 2.5 days prior to death, p=0.037). Overall length of stay increased (9.4 days vs. 7 days, p=0.048). 36% of inpatient deaths occurred in ICU and 36% in the PCU, compared to 48% and 29% prior to the COVID-19 pandemic, respectively (p=0.01). CONCLUSION: DNR orders occurred significantly earlier after the onset of the COVID-19 pandemic, indicating a shift in early and intentional conversations with patients with advanced cancer at the time of their terminal admission. Earlier palliative care referrals and significantly fewer ICU deaths also suggest an improvement in quality end-of-life care. These findings highlight encouraging changes that have occurred as a response to the COVID-19 pandemic and may have future implications for timely integration of palliative care. Further research is needed to understand how to maintain and expand on such progress.