scholarly journals Starting a Palliative Care Program at a Cancer Center

2021 ◽  
pp. 107-120
Author(s):  
Laura Shoemaker ◽  
Susan McInnes
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Quality Care ◽  
Care Program ◽  
Family Satisfaction ◽  
Care Patient ◽  
Cancer Center ◽  
Palliative Care Program ◽  
Strategic Investment ◽  
Care Services

AbstractPalliative care is now considered an integral component in the provision of comprehensive cancer care services, from diagnosis to treatment to ultimate recovery or death. High-quality evidence in the setting of both solid tumors and hematologic malignancies suggests that incorporation of palliative care is associated with higher quality care, greater patient and family satisfaction, improved clinician experience, more appropriate healthcare resource utilization, and better patient outcomes, including survival. Strategic investment, staffing, and support for a palliative care program also makes cancer care patient-centric and cost-effective. This chapter provides pragmatic guidance on setting up a palliative care program within a cancer center and discusses strategies and opportunities for early and late planning, launch of the program and its integration within other cancer services, making it sustainable, monitoring outcomes and quality, and using it as a platform for research.

Bringing palliative care to a Canadian cancer center: the palliative care program at Princess Margaret Hospital

2006 ◽  
Vol 14 (10) ◽  
pp. 982-987 ◽  
Author(s):  
Camilla Zimmermann ◽  
Dori Seccareccia ◽  
Allyson Clarke ◽  
David Warr ◽  
Gary Rodin
Keyword(s):  
Palliative Care ◽  
Care Program ◽  
Cancer Center ◽  
Palliative Care Program ◽  
Princess Margaret Hospital

Integrating contemplative and spiritual care in outpatient palliative care: A pilot study.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 247-247
Author(s):  
Craig D Blinderman ◽  
Alex Beth Schapiro
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Descriptive Analysis ◽  
Care Program ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Pilot Program ◽  
Palliative Care Program ◽  
Care Clinic

247 Background: Spiritual support is associated with better outcomes in cancer care and at the end of life (1, 2). Consensus guidelines advocate for incorporating spiritual care in the provision of specialist level palliative care (3). Contemplative care practices and chaplaincy interventions have the potential for mitigating existential distress, cultivating prognostic awareness, and fostering spiritual approaches to grieving and coping with advanced cancer. We present the results of a pilot program demonstrating the feasibility and impact of integrating a contemplative care chaplain in an outpatient palliative care program in a culturally diverse patient population in a large, academic cancer center. Methods: Case series and descriptive analysis. A description of 10 cases seen by a contemplative care chaplain in our outpatient palliative care clinic in the Herbert Irving Comprehensive Cancer Center (HICCC) at Columbia University will be presented. A descriptive analysis using a chaplaincy-centered model of assessment will highlight the domains of suffering and subjective integration of psychosocial and spiritual concepts. Results: Patients were generally in favor of meeting with and sharing their feelings openly with the chaplain. Patients’ describe important domains pertinent to their well being: meaning, family integration, spiritual practices, existential concerns, prognostic awareness. Subjective transformation and integration of the following constructs: “healing,” “gratitude,” “anger,” “hope,” “fear” were possible with only a few patient encounters. None of the patients were opposed to an initial visit and assessment. In only one case, the family requested not having further visits due to strong emotional reactions that came up. Conclusions: Preliminary results from a novel, pilot program integrating contemplative and spiritual care in an outpatient palliative care program suggest that it is a feasible intervention and should be considered in other cancer centers. Further studies will need to qualify and quantify the additional value and impact of spiritual care integrated in ambulatory palliative care services.

scholarly journals Patient and caregiver experiences with advanced cancer care: a qualitative study informing the development of an early palliative care pathway

2020 ◽  
pp. bmjspcare-2020-002578
Author(s):  
Sadia Ahmed ◽  
Syeda Farwa Naqvi ◽  
Aynharan Sinnarajah ◽  
Gwen McGhan ◽  
Jessica Simon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Cancer Care ◽  
Care Pathway ◽  
Healthcare Providers ◽  
Care Patient ◽  
Early Palliative Care ◽  
Telephone Interviews ◽  
Care Services ◽  
Life Threatening Illness

BackgroundPalliative care is an approach that improves the quality of life of patients and families facing challenges associated with life-threatening illness. In order to effectively deliver palliative care, patient and caregiver priorities need to be incorporated in advanced cancer care.AimThis study identified experiences of patients living with advanced colorectal cancer and their caregivers to inform the development of an early palliative care pathway.DesignQualitative patient-oriented study.Settings/participantsPatients receiving care at two cancer centres were interviewed using semistructured telephone interviews to explore their experiences with cancer care services received prior to a new developed pathway. Interviews were transcribed verbatim, and the data were thematically analysed.ResultsFrom our study, we identified gaps in advanced cancer care that would benefit from an early palliative approach to care. 15 patients and 7 caregivers from Edmonton and Calgary were interviewed over the phone. Participants identified the following gaps in advanced cancer care: poor communication of diagnosis, lack of communication between healthcare providers, role and involvement of the family physician, lack of understanding of palliative care and advance care planning.ConclusionsEarly palliative approaches to care should consider consistent and routine delivery of palliative care information, collaborations among different disciplines such as oncology, primary care and palliative care, and engagement of patients and family caregivers in the development of care pathways.

Program development in palliative care: Results from the NCI Community Cancer Centers Program (NCCCP).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 42-42
Author(s):  
Lynne Slaughter Padgett ◽  
Mary Helen Davis ◽  
Colleen Tallen ◽  
Angela Carrigan ◽  
Julia Howe Rowland
Keyword(s):  
Palliative Care ◽  
Program Development ◽  
Care Program ◽  
Symptom Assessment ◽  
Quality Measures ◽  
Palliative Care Program ◽  
Patient Identification ◽  
Care Services ◽  
Palliative Care Services ◽  
The Continuum

42 Background: Growing national attention to the need for metrics to document delivery of quality palliative care has resulted in a proliferation of measures and standards (e.g., Commission on Cancer, Quality Oncology Practice Initiative). While these standards offer benchmarks to strive for, there are few resources for programs to self-assess development of organizational infrastructure to achieve them. Methods: The NCCCP Cancer Palliative Care Matrix (PCM) is a performance measure and evaluation tool to aid palliative care program development in the community setting. The PCM was completed annually by 21 NCCCP sites from 2010 to 2013. Four domains related to quality measures are reported here. Proportional-odds logistic regression models were used to evaluate the relationship between year and level of response. Results: Variations in program development were seen in the quality domains of symptom assessment, palliative care services offered across the continuum of care, identification for palliative care services, and use of quality measures. In 2010, 13/21 sites reported that symptom assessment were not performed or performed inconsistently. By 2013, 13 sites reported consistent assessment with standardized tools, with 5 of these 13 able to review sequential patient assessment (p=0.002). Similar gains were seen in the domains of providing services across the continuum of cancer care and utilization of quality measures such as patient/provider satisfaction and service utilization (p=0.004, p<0.0001). Despite three years of effort, little change was seen in patient identification processes for palliative care services with only 6 of 21 sites in 2013, compared to 5 in 2010, reporting improvement in "upstream" patient identification regardless of cancer stage (p=0.065). Conclusions: Data suggest the utility of the PCM to evaluate process and quality outcomes in palliative care program development. In addition, identification of challenge and growth areas can be used to develop interventions to address quality performance in both clinical and research contexts.

Rehospitalization of advanced cancer patients in the year after diagnosis.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 10-10
Author(s):  
Robin L. Whitney ◽  
Janice Bell ◽  
Daniel J Tancredi ◽  
Patrick S. Romano ◽  
Richard J. Bold ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Minority Groups ◽  
Quality Care ◽  
Care Program ◽  
Poor Quality ◽  
Palliative Care Program ◽  
Advanced Cancer Patients ◽  
Hospitalization Rates ◽  
State Models

10 Background: Among individuals with advanced cancer (AC), frequent hospitalization is often at odds with patient preference and is increasingly viewed as a hallmark of poor quality care. Hospitalization contributes substantially to costs and regional spending variation in this population, but patterns and reasons are poorly described in the literature. Methods: California Cancer Registry data linked with hospital claims were used to quantify hospitalization in the year after diagnosis among individuals with AC [colorectal, pancreatic, prostate, breast, non-small cell lung cancer (NSCLC)] between 2009-2012 (n = 25, 032). Multi-state models and multilevel log-linear Poisson regression were used to model re-hospitalizations as a function of individual and hospital characteristics, accounting for the competing risk of mortality. Results: Among individuals with AC, 71% were hospitalized, 16% had at least 3 hospitalizations, and 64% of hospitalizations originated in the emergency department. Re-hospitalization rates were significantly higher for black, non-Hispanic (IRR 1.3; 95% CI: 1.1-1.4); Hispanic (IRR 1.1; 95% CI: 1.0-1.2); or Asian/Pacific Islander (IRR 1.1; 95% CI: 1.0-1.2) race/ethnicity vs. white, non-Hispanic; for public (IRR 1.4; 95% CI: 1.3-1.5) or no insurance (IRR 1.2; 95% CI: 1.0-1.5) vs. private; for lower SES quintiles (IRRs 1.1-1.3) vs. the highest; for 1 and 2 or more (IRR 1.1-1.6) comorbidities versus none, and for pancreatic cancer (IRR 2.1; 95% CI 1.9-2.2) and NSCLC (IRR 1.7; 95% CI 1.5-1.9) vs. colorectal cancer. Re-hospitalization rates were significantly lower after discharge from a hospital reporting an outpatient palliative care program (IRR 0.90; 95% CI 0.84-0.96). Conclusions: Individuals with AC experience a heavy burden of hospitalizations, many of which originate in the ED. Discharge from a hospital reporting an outpatient palliative care program appears to protect against re-hospitalization. Efforts to reduce hospitalization and provide care congruent with patient preferences might focus on improving access to outpatient palliative care, particularly among subgroups at greater risk, including racial/ethnic minority groups, those with lower SES, comorbidities and pancreatic or NSCLC.

Extended impact of an embedded palliative care program in a community cancer center.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 24-24
Author(s):  
Angela Kalisiak ◽  
Lyn A. Glenn ◽  
Mark Weinmeister
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Program ◽  
Quality Metrics ◽  
Care Quality ◽  
Cancer Center ◽  
Life Care ◽  
Palliative Care Program ◽  
Pancreas Carcinoma

24 Background: High-level evidence has demonstrated that earlier palliative care (PC) improves outcomes for patients with advanced cancers, but a limited PC workforce and lack of outpatient resources remain barriers to access. In 2010, a productive intersection of oncologist-driven response to new evidence and Providence Cancer Center assessment of end of life care quality metrics resulted in funding of an outpatient Oncology Palliative Care Program (OPCP). An initial NP/LCSW team began concurrent PC for advanced lung and pancreas carcinoma patients in a specialty clinic setting in 2011. Scope of service was expanded to include other diagnoses in 2012. Early positive outcomes and oncology team feedback led to Cancer Center funding of a second PC team at a separate service site in August 2013; the OPCP simultaneously transitioned to an embedded care model. Methods: Retrospective chart review of patient deaths for all Providence Medical Group (PMG) Cancer Center patients not served by OPCP; review of OPCP referral data since adoption of embedded model (n= 177). Quarterly quality metrics included: % patients on hospice at time of death; % patients with evidence of an Advance Care Planning (ACP) discussion documented in the electronic medical record (EMR); and % patients receiving chemotherapy at end of life. Results: A significant improvement in the % PMG oncology patients with evidence of an ACP discussion occurred from 2010 baseline of 59.5% to 74.5% in 2013 (z=4.03, p<.001). In addition, % patients receiving chemotherapy in the last 14 days of life decreased from 5.9% in 2010 to 2.7% in 2013 (z=1.9; p<.05). For patients referred to the OPCP, referral diagnoses evolved from 100% lung and pancreas carcinoma to 34 % lung and pancreas carcinoma and 66 % other diagnoses. Conclusions: Incremental growth of the Providence OPCP has demonstrated successful expansion to diagnoses beyond end stage lung carcinoma. Improvement in end of life care quality metrics for oncology patients not served by the program (perhaps by elevating "generalist" PC skills) may be an additional benefit and value of a highly visible embedded PC team in a community cancer center, particularly with respect to modeling best practice of early goals of care discussions and ACP.

Development of a telemedicine palliative care program in a cancer center.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 99-99
Author(s):  
Youngho Paul Kim ◽  
Reggie Saldivar ◽  
Robert Sidlow
Keyword(s):  
New York ◽  
Palliative Care ◽  
Ambulatory Care ◽  
Cancer Patients ◽  
Care Program ◽  
Geographic Area ◽  
Distributed Model ◽  
Cancer Center ◽  
Palliative Care Program ◽  
Main Campus

99 Background: Inpatient palliative care (PC) teams have increased their presence over the past decade, with over 90% of hospitals having access to PC specialists. However, such growth has not been mirrored in the outpatient setting; this is relevant for patients living far from major medical centers. Memorial Sloan Kettering Cancer Center (MSK) has expanded its ambulatory care footprint beyond New York City (NYC) to sites where PC is not currently available. To address the need for PC delivery to a geographically dispersed patient population, we developed a clinical initiative utilizing telemedicine technology. Methods: The Telemedicine Palliative Care Program (TPCP) was initiated after planning with multiple stakeholders, including clinical, legal, billing, compliance, ambulatory care, information systems, and scheduling departments. The TPCP provides PC consultation and management of patients via a “hub-and-spoke” model, whereby PC specialists are located at the main campus in NYC and patients are scheduled to be seen at one of six regional ambulatory cancer sites within a 50-mile radius. Regional ambulatory sites have video teleconference rooms equipped with Cisco (San Jose, CA) TelePresence MX300 hardware and Jabber software allowing for secure, high fidelity, real-time video communication with clinicians at the main campus who use iPads installed with Jabber software during their consultation sessions. Results: The TPCP is currently active at two regional sites in New York and New Jersey. Patient satisfaction, perception of quality of care, and patient outcomes will be measured. Preliminary results indicate that both patients and providers find this clinical program to be an extremely valuable experience. Conclusions: The technologic infrastructure is now available to deliver telemedicine-enabled PC for cancer patients in a geographically distributed model. Our early experience suggests that our program will help enable the convenient delivery of concurrent PC to cancer patients across a wide geographic area. This innovative clinical initiative has the potential to enable all MSK patients to access high-quality palliative care in a geography-agnostic manner, and eventually deliver such care to patients in their homes.

The wish to hasten death among ALS patients in a palliative care program

2007 ◽  
Vol 34 (S 2) ◽  
Author(s):  
R Jox ◽  
S Haarmann-Doetkotte ◽  
M Wasner ◽  
GD Borasio
Keyword(s):  
Palliative Care ◽  
Care Program ◽  
Palliative Care Program ◽  
Wish To Hasten Death ◽  
Als Patients
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