The impact of a hospice consultation team on the care of veterans with advanced cancer

To address the needs of patients with advanced cancer all Veterans' Affairs hospitals were asked to establish teams of clinicians whose focus was to deliver expert palliative care. At the Philadelphia Veterans' Affairs Medical Center, our Hospice Consultation Team brought together professionals who had worked together informally in some of the outpatient oncology clinics. We conducted a prospective study of all consults received during the first year of the team's operation to determine whether or not the team approach would duplicate already available services or provide improved care. We identified 164 new medical/nursing problems in 75 patients, 85% of which we were able to resolve. There were 152 new psychosocial/spiritual problems, but only 40%-61% were resolved. Of 22 patients followed in oncology clinics, new problems were identified and resolved in 21. We conclude that the expertise of the Hospice Consultation Team members along with the team process provided improved care to these patients.