RPD208 - Improving Patient Engagement in Community Palliative Care Through Statistical Call Analysis

Key Message : High patient decline rates for our community palliative care service (I) prompted a mixed-methods analysis of introductory calls. Statistical analysis revealed that proactively pursuing patient engagement was the key predictor of service acceptance. This data-driven insight is now reshaping our communication strategies to improve patient enrollment, experience and outcomes.

Abstract: Abstract Background / Purpose/Objective(s)
Our Enhanced Community Care Management (ECCM) palliative service faced a significant barrier to growth, with 33% of eligible patients declining enrollment during multidisciplinary introductory calls. This high decline rate jeopardized our ability to meet patient census goals and, more importantly, deliver needed supportive care to a vulnerable population. A systematic literature search identified no prior studies evaluating this topic. The purpose of this quality analysis was to analyze initial introductory calls of the patient engagement phase and identify key, evidence-based drivers of declining services to develop targeted, effective improvement strategies.

Approach
We conducted a mixed-methods study analyzing 77 recorded introductory calls from a cohort of 798 patients declining our services between April and May 2025. Using an internally derived standardized observation template with interrater reliability, six observers rated each call on a 5-point Likert scale across several communication domains (e.g., clarity, tone, active engagement). Two-tailed t-tests compared mean scores of accepted versus declined services. Qualitative data from observer comments were thematically analyzed to contextualize quantitative findings.

Implications / Lessons Learned
Statistical analysis revealed a highly significant difference between accepted and declined calls in one key behavior: "actively pursued opportunities to engage the patient" (mean 3.85 vs 2.57, p=0.00023). Additionally, using our custom-developed rating system, the 'clarity of the service description' registered a poor satisfaction score of -11.84 across all calls, indicating a universal problem, though not the primary differentiator for acceptance. Qualitative themes like "Lack of Specificity" and "Accepting 'No' Too Easily" directly corroborated the quantitative data.

While multiple factors were important, statistical analysis proved proactive, skilled conversation is the most critical element for successful patient engagement. Through root cause analysis, we identified solutions to trial for improving patient engagement, including the implementation of immersive shadowing (II).

References: (I) Center to Advance Palliative Care. About palliative care. 2025. Available from: https://www.capc.org/about/palliative-care/. Accessed May 5, 2025.
(II) Serious Illness Messaging Toolkit. Evidence-Based Messaging for Serious Illness Care. 2025. Available from: https://seriousillnessmessaging.org/. Accessed May 5, 2025.