# Examining Variability in Intra-Hospital Patient Referrals to Specialized Palliative Care: A Comprehensive Analysis of Disciplines and Mortality

## TL;DR

This study examines how patients are referred to palliative care in Austrian hospitals and finds that certain conditions and symptoms are linked to higher mortality rates in palliative care units.

## Contribution

The study identifies key referral reasons and cancer types associated with PCU mortality, highlighting gaps in SPC access and integration.

## Key findings

- 19% of assessed patients were admitted to the PCU, predominantly cancer patients with lung and breast cancer.
- Pain, nutritional problems, and end-of-life care were significant predictors of PCU mortality.
- 78.4% of PCU patients died in the unit, with outcomes varying by cancer type.

## Abstract

Background: In Austria, specialized palliative care (SPC) access is limited, with unclear referral criteria, making it challenging to identify hospitalized patients requiring SPC and determine referral timing and mortality at the palliative care unit (PCU). Methods: This retrospective cohort study analyzed patients who underwent a palliative care (PC) needs assessment between March 2016 and November 2021 and were subsequently admitted to the PCU of Austria’s largest academic hospital. Demographic, clinical, and standardized referral form data were used for analysis, employing descriptive statistics and logistic regression. Results: Out of the 903 assessed patients, 19% were admitted to the PCU, primarily cancer patients (94.7%), with lung (19%) and breast cancer (13%) being most prevalent. Common referral reasons included pain (61%) and nutritional problems (46%). Despite no significant differences in referral times, most patients (78.4%) died in the PCU, with varying outcomes based on cancer type. Referral reasons like pain (OR = 2.3), nutritional problems (OR = 2.4), and end-of-life care (OR = 6.5) were significantly associated with the outcome PCU mortality. Conclusions: This study underscores Austria’s SPC access imbalance and emphasizes timely PC integration across disciplines for effective advance care planning and dignified end-of-life experiences in PCUs.