由于其在指导关怀目标（GOC）讨论中的作用，临终关怀（Palliative care）自COVID-19大流行以来得到了增加的关注。我们评估了在实施全员参与、多组成部分、跨学科的关怀目标规划（myGOC）计划之前和之后，门诊临终关怀转诊时间的变化。我们回顾了2019年6月至11月（myGOC之前）和2020年6月至11月（myGOC之后）从支持护理中心（SCC）随机选取的200次咨询就诊。收集了有关埃德蒙顿症状评估量表（ESAS）评分、从住院登记到SCC就诊的时间、SCC就诊至死亡/最后一次随访的时间以及预先护理规划（ACP）笔记的数据。采用Kaplan-Meier曲线评估总体生存期（OS）。SCC咨询就诊后的中位数OS分别为15.2个月（95％CI：11.7-19.7）和myGOC计划后的14.0个月（95％CI：10.8-17.9）（p=0.646）。SCC就诊至死亡/最后一次随访的时间中位数没有显著差异（myGOC后为11.95个月 vs. 12.0个月；p=0.841），与患者首次就诊我中心和SCC之间的时间中位数也没有显著差异（myGOC后为6.1个月 vs. 5.29个月；p=0.689）。myGOC后接受治疗的患者ESAS症状评分较低、表现状态较好 [2（1-2） vs. 2（1-3）；p=0.018]，且医学肿瘤学团队撰写的ACP笔记较多（25.5% vs. 4.5%；p<0.001）。在SCC就诊前后，OS没有显著差异，可能与天花板效应有关。更多的肿瘤学家与患者进行了ACP讨论，而myGOC后患者的ESAS症状评分较低，可能表明更多的患者被转诊进行了GOC讨论和ACP，而不是因为症状困扰。 版权所有 © 2023. Elsevier Inc. 发表

Palliative care has received increased interest since the COVID-19 pandemic due to its role in guiding goals of care (GOC) discussions.We assessed the change in the timing of outpatient palliative care referrals before and after implementing an institution-wide multicomponent interdisciplinary GOC (myGOC) program.We reviewed 200 random Supportive Care Center (SCC) consult visits each from June-November 2019 (before myGOC) and June-November 2020 (after myGOC). Data regarding Edmonton Symptom Assessment Scale (ESAS) scores, time from hospital registration to SCC visit, SCC visit until death/last follow-up, and advance care planning (ACP) notes were collected. Kaplan-Meier curves were used to evaluate overall survival (OS).The median OS from the SCC consult visit was 15.2 months (95% CI:11.7-19.7) before and 14.0 months (95% CI:10.8-17.9) after the myGOC program (p=0.646). There were no significant differences in the median time between the SCC consult visit to death/last follow-up (11.95 vs. 12.0 months after myGOC; p=0.841) and the first visits to our cancer center and SCC (6.1 vs. 5.29 months after myGOC; p=0.689). Patients seen after myGOC had significantly lower ESAS symptom scores, better performance status [2(1-2) vs. 2(1-3); p=0.018], and more ACP notes composed by medical oncology teams (25.5% vs. 4.5%; p<0.001).There were no significant differences in OS among patients seen in the SCC before and after myGOC, likely related to a ceiling effect. More oncologists had ACP discussions with patients, and patients had lower symptom scores on ESAS after myGOC, likely indicating that more patients were referred for GOC discussions and ACP rather than for symptom distress.Copyright © 2023. Published by Elsevier Inc.