{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:52:59Z","timestamp":1781650379341,"version":"3.54.5"},"reference-count":40,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"6","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>This study evaluates a quality improvement project to improve access to specialty palliative care (PC) for individuals with advanced cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A California health care organization implemented a social worker (SW)\u2013led program to improve education about, and referrals to, PC for patients with advanced cancer at one clinic (intervention site), whereas three control sites continued usual care. We used a rigorous intention-to-treat difference-in-difference analysis to detect whether the intervention increased PC referrals (primary outcome) at the intervention versus control sites while accounting for preimplementation trends. We used multivariable logistic and Poisson regressions to compare primary and exploratory outcomes (advance care planning and end-of-life outcomes: PC visits before death, acute care use within 30 days of death, and systemic therapy within 14 days of death) in the preimplementation and postimplementation period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The analytic cohort included 555 patients (177 preimplementation, 378 postimplementation): 147 (26.5%) at the intervention site and 408 at control sites, with 312 (56.2%) deceased. At the intervention site postimplementation, 52 (51.5%) of 101 patients received the SW-led intervention. At the intervention site, PC referrals increased from 30.4% to 32.7% (\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      26.7% to 25.3% at control sites). PC visits increased from 21.7% to 28.7% (\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      21.4% to 22%), and among decedents, any PC visits increased from 53.1% to 75% (\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      57% to 66.9%). In adjusted multivariable analyses, the only near-significant difference-in-difference PC effect was that decedents at the intervention site had higher odds of receiving PC before death (OR, 3.09 [95% CI, 0.89 to 10.67];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .07).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This SW-led intervention was not associated with significantly increased PC referrals. When translating evidence from trials to real-world quality improvement efforts, context and changes to the intervention may affect effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/op-25-00077","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T19:59:53Z","timestamp":1753473593000},"page":"999-1008","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Quality Improvement Effort With Proactive Social Worker Communication to Enhance Palliative Care Access"],"prefix":"10.1200","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9910-0869","authenticated-orcid":true,"given":"Ellis C.","family":"Dillon","sequence":"first","affiliation":[{"name":"Center on Aging, University of Connecticut, Farmington, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9470-4839","authenticated-orcid":true,"given":"Amandeep","family":"Grewal","sequence":"additional","affiliation":[{"name":"Sutter Health, Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6616-5970","authenticated-orcid":true,"given":"Su-Ying","family":"Liang","sequence":"additional","affiliation":[{"name":"Sutter Health, Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-2745","authenticated-orcid":true,"given":"Harold","family":"Luft","sequence":"additional","affiliation":[{"name":"Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5031-0543","authenticated-orcid":true,"given":"Martina","family":"Li","sequence":"additional","affiliation":[{"name":"(Formerly) Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Colocci","sequence":"additional","affiliation":[{"name":"Medical Oncology, Palo Alto Medical Foundation, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Lai","sequence":"additional","affiliation":[{"name":"Palliative Care and Support Services, Palo Alto Medical Foundation, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9943-5762","authenticated-orcid":true,"given":"Manali I.","family":"Patel","sequence":"additional","affiliation":[{"name":"Medical Oncology, Stanford University, Stanford, CA"},{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2015.0119"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2014.0132"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000678"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.16840"},{"key":"e_1_3_7_6_2","first-page":"CD011129","article-title":"Early palliative care for adults with advanced cancer","volume":"6","author":"Haun MW","year":"2017","unstructured":"Haun MW, Estel S, R\u00fccker G, et al: Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 6:CD011129, 2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000852"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.017897"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.0033"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909120969202"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2020.0111"},{"key":"e_1_3_7_12_2","first-page":"117822421668888","article-title":"Barriers to access to palliative care","volume":"10","author":"Hawley P","year":"2017","unstructured":"Hawley P: Barriers to access to palliative care. Palliat Care 10:1178224216688887, 2017","journal-title":"Palliat Care"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05492-z"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-2871-6"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.1055"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.21.00351"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.5271"},{"key":"e_1_3_7_18_2","first-page":"1139","article-title":"Effect of a community health worker intervention on acute care use, advance care planning, and patient-reported outcomes among adults with advanced stages of cancer: A randomized clinical trial","volume":"8","author":"Patel MI","year":"2022","unstructured":"Patel MI, Kapphahn K, Dewland M, et al: Effect of a community health worker intervention on acute care use, advance care planning, and patient-reported outcomes among adults with advanced stages of cancer: A randomized clinical trial. JAMA Oncol 8:1139-1148, 2022","journal-title":"JAMA Oncol"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.19.00152"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.2446"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009032"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.16153"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2022.09.004"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2022.101166"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-018-4306-0"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.4103\/2229-3485.184823"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.4103\/2229-3485.83221"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.4338\/ACI-2013-12-RA-0100"},{"key":"e_1_3_7_29_2","unstructured":"Reference deleted"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2022.4666"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.329"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-020-00671-5"},{"key":"e_1_3_7_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909119885899"},{"key":"e_1_3_7_37_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-132"},{"key":"e_1_3_7_38_2","first-page":"3765","article-title":"Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer","volume":"26","author":"Ugalde A","year":"2018","unstructured":"Ugalde A, O\u2019Callaghan C, Byard C, et al: Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer. Support Care Cancer 26:3765-3771, 2018","journal-title":"Support Care Cancer"},{"key":"e_1_3_7_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.05.016"},{"key":"e_1_3_7_40_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003422"},{"key":"e_1_3_7_41_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2013.001020"}],"container-title":["JCO Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/OP-25-00077","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:00:53Z","timestamp":1781647253000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/OP-25-00077"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1200\/OP-25-00077"],"URL":"https:\/\/doi.org\/10.1200\/op-25-00077","relation":{},"ISSN":["2688-1527","2688-1535"],"issn-type":[{"value":"2688-1527","type":"print"},{"value":"2688-1535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-28","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}