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Evaluating cancer patient satisfaction before and after daily multidisciplinary care for thoracic surgery inpatients.

9605 Background: Significant subpopulations of cancer inpatients in the SUPPORT trial were dissatisfied with their pain control. (Desbiens, Wu et al. 1996) The hospitalized thoracic surgical patient is a person at risk for uncontrolled symptoms and burdens due to advanced cancer at time of presentation.


METHODS
This is a retrospective, observational, study of 1188 thoracic surgery patients undergoing elective surgical procedures for lung cancer at an NCI-approved cancer hospital over a 3-year period. Patients with primary and secondary lung cancer, undergoing elective thoracic surgery procedures were evaluated before (n=660, "Period 1") and after (n=528, "Period 2") an 8-month, daily, collaborative multidisciplinary Intervention Period to improve pain control and to facilitate transition for discharge. The collaborative process also identified thoracic surgical patients who needed more complex symptom management and additional support for advanced disease. Patient satisfaction with pain therapy and referrals to hospice were analyzed before and after the intervention period.


RESULTS
Pain satisfaction scores improved from baseline in each sequential period (Period 1 = 9.0 SD 1.71, Intervention Period = 9.4 SD 1.37, and Period 2 = 9.5 SD 1.03, p<0.0001). The percentage of patients referred to hospice increased from 0.15% to 1.7% (p<0.0001).


CONCLUSIONS
Innovative collaboration between thoracic surgery specialists and a palliative medicine service improved patients' satisfaction with pain control. The collaborative relationship resulted in an increase in referrals to hospice for patients with advanced cancer. These improvements were sustained by the thoracic surgery service after a daily collaborative intervention period ceased. No significant financial relationships to disclose.