Table 4.
Structure and Processes of Palliative Care Clinical Services, Education and Research in Cancer Centers According to Palliative Care Program Leaders
| NCI Cancer Centers (N=61)a |
Non-NCI Cancer Centers (N=35)a |
P- valueb |
|||||
|---|---|---|---|---|---|---|---|
| N | % | 95% CI (%)c | N | % | 95% CI (%)c |
||
| Consultation Service (N=83)d | 54 | 89 | 78–95 | 29 | 83 | 66–93 | 0.54 |
| Availability | |||||||
| 24 hours/7 days per week | 23 | 45 | 31–60 | 11 | 38 | 21–58 | |
| 24 hours/weekdays only | 4 | 8 | 2–19 | 3 | 10 | 2–27 | 0.68 |
| Business hours/weekdays only | 23 | 45 | 31–60 | 13 | 45 | 26–64 | |
| Other | 1 | 2 | 0–10 | 2 | 7 | 1–23 | |
| Unknown or not answered | 3 | 0 | |||||
| Number of referrals/month, median (Q1–Q3) |
47.5 | (30–75) | 30 | (19–50) | 0.03 | ||
| Unknown or not answered | 2 | 0 | |||||
| Number of days from referral to death, median (Q1–Q3) |
6 | (4–16.25) | 7 | (4–10) | 0.76 | ||
| Unknown or not answered | 26 | 8 | |||||
| Palliative Care Units/Beds (N=27)d | 16 | 26 | 16–39 | 11 | 31 | 17–49 | 0.64 |
| Physical unit present | 9 | 69 | 39–91 | 4 | 40 | 12–74 | |
| Unknown or not answered | 3 | 1 | |||||
| Duration ≥3 years | 11 | 92 | 62–100 | 7 | 70 | 35–93 | - |
| Unknown or not answered | 4 | 1 | |||||
| Number of beds, median (Q1–Q3) | 10.5 | (4–12) | 4 | (4–6) | - | ||
| Unknown or not answered | 4 | 6 | |||||
| Number of discharges/month, median (Q1–Q3) |
45 | (30–50) | 15 | (11.5–26.5) | - | ||
| Unknown or not answered | 7 | 3 | |||||
| Median days from admission to death, median (Q1–Q3) | 6 | (3–21) | 7 | (6.3–7) | |||
| Unknown or not answered | 13 | 6 | |||||
| Mortality rate, median (Q1–Q3) | 40 | (28–65) | 43 | (25–70) | |||
| Unknown or not answered | 5 | 2 | |||||
| Outpatient Clinic (N=50)d | 40 | 66 | 52–77 | 10 | 29 | 15–46 | 0.001 |
| Dedicated palliative care outpatient clinic |
33 | 54 | 41–67 | 7 | 20 | 8–37 | 0.001 |
| Unknown or not answered | 0 | 0 | |||||
| Patients seen in oncology clinics | 14 | 23 | 13–35 | 4 | 11 | 3–27 | 0.19 |
| Unknown or not answered | 0 | 0 | |||||
| Number of clinic days/week, median (Q1–Q3) |
2 | (1–4.5) | 1 | (.5–3.5) | 0.46 | ||
| Unknown or not answered | 2 | 1 | |||||
| Number of referrals/month, median (Q1–Q3) |
14 | (6–22.5) | 7.5 | (2–18) | 0.08 | ||
| Unknown or not answered | 4 | 0 | |||||
| Number of days from referral to death, median (Q1–Q3) |
90 | (84–120) | 41 | (28–54) | - | ||
| Unknown or not answered | 31 | 8 | |||||
| Hospice (N=43)d | 19 | 31 | 20–44 | 24 | 69 | 51–83 | 0.001 |
| Daily census, median (interquartile range) |
20 | (7–50) | 85 | (19.5–268) | 0.03 | ||
| Unknown or not answered | 5 | 4 | |||||
| Palliative Care Education | |||||||
| Palliative care fellowship program | 23 | 38 | 26–51 | 6 | 17 | 7–34 | 0.04 |
| Unknown or not answered | 0 | 0 | |||||
| Fellows ≥5 in the program | 4 | 18 | 5–40 | 1 | 17 | 0–64 | >0.99 |
| Unknown or not answered | 1 | 0 | |||||
| Training for mid-level providers | 23 | 43 | 30–58 | 11 | 42 | 23–63 | >0.99 |
| Unknown or not answered | 8 | 9 | |||||
| Mandatory rotation for medical oncology |
14 | 27 | 16–42 | 4 | 22 | 6–48 | 0.76 |
| Unknown or not answered | 10 | 17 | |||||
| Mandatory rotation for radiation oncology |
1 | 2 | 0–10 | 0 | 0 | - | >0.99 |
| Unknown or not answered | 10 | 19 | |||||
| Mandatory rotation for pediatric oncology |
3 | 6 | 1–17 | 0 | 0 | - | 0.57 |
| Unknown or not answered | 12 | 19 | |||||
| Mandatory rotation for medical students |
6 | 12 | 4–23 | 2 | 13 | 2–38 | >0.99 |
| Unknown or not answered | 9 | 19 | |||||
| Palliative Care Research | |||||||
| Research programs | 28 | 46 | 33–59 | 6 | 17 | 7–34 | 0.007 |
| Unknown or not answered | 0 | 0 | |||||
| Receives research funding | 19 | 70 | 50–86 | 4 | 80 | 28–99 | >0.99 |
| Unknown or not answered | 1 | 1 | |||||
| Peer reviewed grants | 13 | 68 | 43–87 | 3 | 75 | 19–99 | >0.99 |
| Unknown or not answered | 0 | 0 | |||||
| Private foundations/philanthropy |
12 | 63 | 38–84 | 3 | 75 | 19–99 | >0.99 |
| Unknown or not answered | 0 | 0 | |||||
| Funding source private industry |
9 | 47 | 24–71 | 2 | 50 | 7–93 | >0.99 |
| Unknown or not answered | 0 | 0 | |||||
| Funding source institutional sources |
8 | 42 | 20–67 | 3 | 75 | 19–99 | 0.32 |
| Unknown or not answered | 0 | 0 | |||||
Abbreviations: CI, confidence interval; NCI, National Cancer Institute; Q1–Q3, interquartile range
a
Total number of respondents
b
Comparisons were made between NCI and non-NCI cancer centers using the Fisher’s exact test for categorical variables, and the Mann-Whitney test for continuous variables. Confidence intervals were computed using the exact binominal test. Missing values were not included in the analyses.
c
Unless stated otherwise