Algorithm-Based Palliative Care in Patients With Cancer: A Cluster Randomized Clinical Trial

Question  Do default specialty palliative care orders with opting out and accountable justification increase consultation and improve outcomes in patients with cancer in an outpatient setting?

Findings  In this randomized clinical trial conducted in a community oncology network between November 2022 and December 2023 among 562 patients with advanced cancer identified by an automated electronic health record algorithm, default orders increased palliative care consultation (44% vs 8%) and decreased end-of-life systemic therapy (6% vs 16%) compared with usual care but did not improve patient-reported or hospice outcomes.

Meaning  The findings suggest that default algorithm-based palliative care orders are a scalable implementation strategy to increase palliative care referrals and reduce intensive end-of-life care.