Palliative Care Improves Outcomes in Patients with SCD, With Crawford Strunk, MD

Incorporating a palliative care team into a comprehensive sickle cell disease (SCD) care center substantially reduced inpatient length of stay and improved outpatient pain management, according to a recent study.1

Presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition in Orlando, Florida, by Crawford Strunk, MD, associate staff member at the Cleveland Clinic, these data have emphasized the importance of further implementing interdisciplinary care in this largely underserved population.1

SCD is an extremely morbid condition, with recurrent hospitalizations common for vaso-occlusive crises and complications of end-organ damage. Although prior research has indicated the effectiveness of palliative care in adult patients with SCD, a 2022 study examining data from 987,555 SCD-related hospitalizations showed that only 9.2% of cases received palliative care.2

“The big picture for our results is that, if you have access to palliative care, our study demonstrates that integrating them into your sickle cell comprehensive care model is integral to helping reduce length of stay and improve outpatient and inpatient pain management,” Strunk told HCPLive in an interview. “It also improves opioid stewardship and provides wraparound care for patients who suffer from chronic pain and acute-on-chronic pain.”

For this study, the Cleveland Clinic Department of Palliative and Supportive Care collaborated with the Cleveland Clinic Sickle Cell Medical Neighborhood (SCMN), which provides comprehensive lifespan care for patients with SCD. The SCMN includes medical and pediatric subspecialties, but did not initially include palliative care, individualized pain care plans, or guided inpatient pain management.1

The SCMN and Department of Palliative and Supportive Care worked to formulate a structured program, with key interventions including the embedding of a palliative care consult and hematology consult trigger into the inpatient SCD hospital admission order set, the establishment of outpatient palliative care follow-up for outpatient pain management recommendations, and the development and implementation of Individualized Care Plans (ICPs) for high utilizing patients.1

The inpatient palliative care and hematology consult trigger was activated in the inpatient SCD hospital admission order set in April 2024, and ICPs for high-utilizer patients were implemented in November 2024. From April 2024 to March 2025, enrollment in the SCMN grew from 190 patients to 231; during this time, the mean annualized hospitalization rate per patient decreased from 1.4 to 1.3 admissions per patient, and the mean inpatient length of stay for adults with SCD decreased from 9.1 to 3.2 days.1

Additionally, during the study period, patients received care across multiple care settings, including quaternary care centers, community hospitals, and outpatient clinics. Regular interdisciplinary care meetings were shown to build confidence among palliative care and SCMN clinicians, which fostered improved opioid stewardship and the implementation of shared decision-making protocols.1

Strunk highlighted reductions in inpatient length of stay and improvements in outpatient pain management resulting from the implementation of a palliative care team. Additionally, the study authors noted plans to continue examining the efficacy of palliative care regarding cost savings and broader applicability outside of SCD patients.1

“What I also recommend is that if you have palliative care available through your cancer center or through an independent group, integrating them can be significantly helpful for pain management strategies and cost reduction for the hospitals in terms of services provided,” Strunk said.

References

1. Strunk C, Neale K, Albright C, et al. Integrating palliative care improves pain management and reduces length of stay in a comprehensive Lifespan Sickle Cell Center. Blood. 2025;146(Supplement 1):123-123. doi:10.1182/blood-2025-123

2. Nwogu-Onyemkpa E, Dongarwar D, Salihu HM, et al. Inpatient palliative care use by patients with sickle cell disease: a retrospective cross-sectional study. BMJ Open. 2022;12(8):e057361. Published 2022 Aug 16. doi:10.1136/bmjopen-2021-057361