End-of-life care patterns associated with hospital-based palliative care consultation: a single-center cohort with national data linkage

In routine oncology practice, palliative care (PC) is commonly delivered through hospital-based consultation services integrated within existing workflows. Evidence describing real-world end-of-life (EOL) care patterns associated with consultation-based palliative care remains limited. We examined EOL care patterns associated with hospital-based palliative care consultation using linked clinical and nationwide data. This retrospective cohort study used linked data from a tertiary hospital and the Korean National Health Insurance Service. We included 18,048 decedents with advanced lung, stomach, colorectal, liver, or pancreaticobiliary cancer between 2018 and 2022. To minimize selection bias, 1:2 propensity score matching was performed. Outcomes included advance care planning documentation completion, aggressive EOL interventions, hospice utilization, and medical costs. After matching 4,102 patients with PC consultation and 7,910 controls, the consultation group showed significantly higher completion of advance statements (58.0% vs. 32.1%) and more patient-led decisions. During the final month of life, the consultation group had significantly fewer intensive care unit admissions (4.9% vs. 10.3%), emergency department visits (48.6% vs. 54.4%), and cardiopulmonary resuscitations (2.9% vs. 10.7%) (all P < 0.001). Hospice utilization was substantially higher in the consultation group (73.2% vs. 19.5%). Furthermore, PC consultations were associated with significantly lower medical costs during the final month and last two weeks of life. Hospital-based palliative care consultation was associated with higher rates of advance care planning and hospice use, lower use of high-intensity EOL interventions, and modestly lower medical costs. These findings suggest that consultation-based palliative care within routine oncology workflows may meaningfully influence EOL care delivery.