Emerging Triggers for Palliative Care Consultation in Surgery: Interdisciplinary Strategies to Identify and Meet Palliative Care Needs in the Elective and Inpatient Settings (TH313)

Background: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. Methods: We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. Results: All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Conclusion: Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.

Download Full-text

Enhancing palliative care consultation workflow on an inpatient oncology unit.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.208 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 208-208

Author(s):

Amanda Hazeltine ◽

Kathryn Liziewski ◽

Ashley Lin ◽

Samantha Creamer ◽

Kathryn Walker ◽

...

Keyword(s):

Palliative Care ◽

Screening Tool ◽

Communication Process ◽

Care Needs ◽

Multidisciplinary Communication ◽

Pilot Survey ◽

Palliative Care Consultation ◽

Multidisciplinary Rounds ◽

Care Consultation ◽

Palliative Care Needs

208 Background: The American Society of Clinical Oncology practice guidelines recommend early palliative care integration for all patients with cancer. At UMass Memorial Medical Center from Sept. to Nov. 2020, only 16% (29/184) of patients on the inpatient oncology unit received a palliative care consultation. Of these consultations, 55% (16/29) were placed within 72 hours of admission. Results from a pre-pilot survey of nurses (n = 20) and providers (n = 14) about attitudes toward palliative care, team communication, and perceptions of barriers to palliative care consultation highlighted a lack of multidisciplinary communication and consensus on criteria for palliative care consultation. Methods: An evidence-based palliative care screening tool and multidisciplinary communication process was piloted to support team collaboration and early identification of oncology patients who may benefit from specialty-level inpatient palliative care. The primary objective was to increase the percentage of palliative care consultations placed within 72 hours of admission from 55% to 65%. Nurses screened patients upon unit arrival for palliative care needs. Patients who screened positive were discussed during daily multidisciplinary rounds, attended by the resource nurse, primary team, case manager and social worker. Results: In March 2021, the percentage of palliative care consultations placed by providers within 72 hours of inpatient admission increased to 68% (13/19). The proportion of patients who received palliative care consultation also increased to 29%. All the patients who screened positive for palliative care needs received a consultation. In a post-pilot survey of providers (n = 9) and nurses (n = 14), most providers (78%) reported that discussions of patients’ palliative care needs occurred more frequently during multidisciplinary rounds. A majority of nurses (57%) agreed the screening tool led to enhanced multidisciplinary communication. 63% of providers agreed that criteria for palliative care consultation was clearer as a result of the pilot; both nurse and provider perceptions of “lack of provider agreement on palliative care consultation criteria” as a barrier decreased compared to the pre-pilot survey. Although a majority of nurses (71%) found the screening tool easy to use, only half were comfortable with all the questions or understood them completely. All providers and 93% of nurses preferred to continue using the screening tool and communication process, and supported electronic medical record integration. Conclusions: The palliative care screening tool and workflow process had a positive impact on earlier identification of oncology patients who could benefit from specialty palliative care, and increased the total number of palliative care consultations. This improved process also enhanced team communication and collaboration. Next steps include refining the screening tool and EMR integration.

Download Full-text

Palliative Care for the Interstitial Lung Disease Patient a Must and Not Just a Need

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211040232 ◽

2021 ◽

pp. 104990912110402

Author(s):

Said Chaaban ◽

James McCormick ◽

Debra Gleason ◽

Jessica M. McFarlin

Keyword(s):

Palliative Care ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Disease Patient ◽

Care Needs ◽

Life Planning ◽

Palliative Care Consultation ◽

End Of Life Planning ◽

Planning Methods ◽

Palliative Care Needs

Patients with interstitial lung disease (ILD) have many unmet palliative care needs. The majority of patients with chronic ILD have poor access to a specialist in palliative medicine and that is due to several barriers. The mortality for the ILD patient is high and reaches up to 80% if admitted to the ICU with respiratory failure. Palliative care addresses symptoms in diseases where cure is unlikely or impossible. Palliative care consultation also ensures communication among patients, caregivers and providers regarding treatments, prognosis, and end of life planning. Methods: We performed a literature review on palliative care and ILD, accessing articles published since 2002. We found 71 articles related to the topic. We chose 37 that were most relevant and with no redundancy of information to include in this review. Objectives: Summarize the palliative care needs of patients with ILD, discuss the barriers to receiving palliative care, and summarize clinical practice for providing palliative care to this patient population.

Download Full-text

Early Identification of Pediatric Neurology Patients With Palliative Care Needs: A Pilot Study

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119844519 ◽

2019 ◽

Vol 36 (11) ◽

pp. 959-966

Author(s):

Ariel Maia Lyons-Warren ◽

Robert C. Stowe ◽

Lisa Emrick ◽

Jill Ann Jarrell

Keyword(s):

Palliative Care ◽

Pilot Study ◽

Hospital Admissions ◽

Quantitative Measure ◽

Social Needs ◽

Care Needs ◽

Negative Finding ◽

Pediatric Neurology ◽

Palliative Care Consultation ◽

Palliative Care Needs

Palliative care services are beneficial for pediatric neurology patients with chronic, life-limiting illnesses. However, timely referral to palliative care may be impeded due to an inability to identify appropriate patients. The aim of this pilot case–control study was to test a quantitative measure for identifying patients with unmet palliative care needs to facilitate appropriate referrals. First, a random subset of pediatric neurology patients were screened for number of hospital admissions, emergency center visits, and problems on the problem list. Screening results led to the hypothesis that having six or more hospital admissions in one year indicated unmet palliative care needs. Next, hospital admissions in the past year were counted for all patients admitted to the neurology service during a six-month period. Patients with six or more admissions as well as age- and gender-matched controls were assessed for unmet palliative care needs. In hospitalized pediatric neurology patients, having six or more admissions in the preceding year did not predict unmet palliative care needs. While this pilot study did not find a quantitative measure that identifies patients needing a palliative care consultation, the negative finding highlights an important distinction between unmet social needs that interfere with care and unmet palliative care needs. Further, the method of screening patients used in this study was simple to implement and provides a framework for future studies.

Download Full-text

Palliative Care Needs of Residents, Families, and Staff in Long-Term Care Facilities

Journal of Palliative Care ◽

10.1177/082585979200800205 ◽

1992 ◽

Vol 8 (2) ◽

pp. 23-29 ◽

Cited By ~ 24

Author(s):

Deborah Rutman ◽

Belinda Parke

Keyword(s):

Palliative Care ◽

Care Needs ◽

Term Care ◽

Palliative Care Consultation ◽

Extended Care ◽

Care Facilities ◽

Juan De Fuca ◽

Consultation Team ◽

Support Team ◽

Palliative Care Needs

While there is growing recognition that the physical needs of LTC residents have increased markedly in the 20 years, the palliative care needs of facility residents and their families are poorly understood. There also is a dearth of information on the educational and support needs of LTC facility staff vis-a-vis palliative care. Operating from the Juan de Fuca Hospital Society (a network of extended care facilities in Victoria), our Palliative Support Team (PST) was conceived in order to act as an educational resource to JdF staff as well as to provide expert consultation on palliative care issues. As part of the evaluation of this pilot program, a sample of 74 Juan de Fuca workers were interviewed to determine their perceptions of resident, family, and staff needs in relation to palliative care. In this paper, discussion is focused on the palliative care needs identified by professional caregivers. The ways in which a palliative care consultation team can address some of these needs are also discussed.

Download Full-text

Using the Surprise Question To Identify Those with Unmet Palliative Care Needs in Emergency and Inpatient Settings: What Do Clinicians Think?

Journal of Palliative Medicine ◽

10.1089/jpm.2016.0403 ◽

2017 ◽

Vol 20 (7) ◽

pp. 729-735 ◽

Cited By ~ 17

Author(s):

Samir A. Haydar ◽

Lisa Almeder ◽

Lauren Michalakes ◽

Paul K.J. Han ◽

Tania D. Strout

Keyword(s):

Palliative Care ◽

Care Needs ◽

Inpatient Settings ◽

Surprise Question ◽

Palliative Care Needs

Download Full-text

The Importance of Early Identifications of Palliative Care Needs in Emergency Wards

10.26226/morressier.5c76c8bde2ea5a7237612860 ◽

2019 ◽

Author(s):

Mia Grillfors Mård

Keyword(s):

Palliative Care ◽

Care Needs ◽

Palliative Care Needs

Download Full-text

What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

BMC Palliative Care ◽

10.1186/s12904-020-00700-3 ◽

2021 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Anne M. Finucane ◽

Connie Swenson ◽

John I. MacArtney ◽

Rachel Perry ◽

Hazel Lamberton ◽

...

Keyword(s):

Palliative Care ◽

Focus Groups ◽

Healthcare Professionals ◽

Psychological Needs ◽

Care Providers ◽

Specialist Palliative Care ◽

Care Needs ◽

Complex Needs ◽

Sequential Explanatory ◽

Palliative Care Needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

Download Full-text