Effect of intervention on quality measures of symptom management in the Michigan Oncology Quality Consortium (MOQC).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 70-70 ◽  
Author(s):  
Jeffrey B. Smerage ◽  
Katie Abstoss ◽  
Jane Severson ◽  
J. Cameron Muir ◽  
Claudia Jane Martin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Lessons Learned ◽  
Care Services ◽  
Training Materials ◽  
Palliative Care Services ◽  
Oncology Care ◽  
Specific Care ◽  
Oncology Practice ◽  
Scale 8

70 Background: Michigan oncology practice groups that participated in MOQC [JOP 5(6):281, 2009] used the Quality Oncology Practice Initiative (QOPI) tool. Adherence to processes of disease specific care was high, but poor in domains associated with palliative care. These measures did not change over time [Health Affairs. 31(4):718, 2012]. These findings prompted us to test interventions to improve quality in palliative care domains. Methods: MOQC created a process, based on the IHI Framework for Spread, to assist oncology practice groups in establishing their own primary Palliative Care services, including the implementation of Edmonton Symptom Management Scale. 8 practice groups formed teams of local change agents to participate in the Palliative Care Demonstration (PC Demo) project. The teams participated in 3 in-person and 4 online learning sessions over 8 months, led by palliative care and quality experts. Teams were provided tools, training materials, and necessary support to implement the improvements and measure their success. The learning network facilitated the sharing of best practices and lessons learned throughout the process. The teams presented their results broadly to other MOQC participants at project conclusion. Results: Success was measured using palliative care-focused ASCO QOPI results. PC Demo sites consecutively improved their scores in many of the QOPI measures, and their rate of improvement from Fall 2011 to Spring 2012 was greater than that of their peers. Conclusions: We observed that collecting and distributing data in our consortium was insufficient to improve palliative oncology care. Providing practice groups with the appropriate infrastructure improved their capacity and capability to make the necessary changes to improve performance. [Table: see text]

American Society of Clinical Oncology Provisional Clinical Opinion: The Integration of Palliative Care Into Standard Oncology Care

2012 ◽  
Vol 30 (8) ◽  
pp. 880-887 ◽  
Author(s):  
Thomas J. Smith ◽  
Sarah Temin ◽  
Erin R. Alesi ◽  
Amy P. Abernethy ◽  
Tracy A. Balboni ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Clinical Oncology ◽  
Metastatic Cancer ◽  
Expert Consensus ◽  
Care Services ◽  
Palliative Care Services ◽  
Oncology Care ◽  
American Society

Purpose An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership following publication or presentation of potentially practice-changing data from major studies. This PCO addresses the integration of palliative care services into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. Clinical Context Palliative care is frequently misconstrued as synonymous with end-of-life care. Palliative care is focused on the relief of suffering, in all of its dimensions, throughout the course of a patient's illness. Although the use of hospice and other palliative care services at the end of life has increased, many patients are enrolled in hospice less than 3 weeks before their death, which limits the benefit they may gain from these services. By potentially improving quality of life (QOL), cost of care, and even survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Until recently, data from randomized controlled trials (RCTs) demonstrating the benefits of palliative care in patients with metastatic cancer who are also receiving standard oncology care have not been available. Recent Data Seven published RCTs form the basis of this PCO. Provisional Clinical Opinion Based on strong evidence from a phase III RCT, patients with metastatic non–small-cell lung cancer should be offered concurrent palliative care and standard oncologic care at initial diagnosis. While a survival benefit from early involvement of palliative care has not yet been demonstrated in other oncology settings, substantial evidence demonstrates that palliative care—when combined with standard cancer care or as the main focus of care—leads to better patient and caregiver outcomes. These include improvement in symptoms, QOL, and patient satisfaction, with reduced caregiver burden. Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice, and reduced use of futile intensive care. While evidence clarifying optimal delivery of palliative care to improve patient outcomes is evolving, no trials to date have demonstrated harm to patients and caregivers, or excessive costs, from early involvement of palliative care. Therefore, it is the Panel's expert consensus that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden. Strategies to optimize concurrent palliative care and standard oncology care, with evaluation of its impact on important patient and caregiver outcomes (eg, QOL, survival, health care services utilization, and costs) and on society, should be an area of intense research. NOTE. ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical trials and cannot be assumed to apply to the use of these interventions in the context of clinical practice. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.

Integration of specialist palliative care services into a multidisciplinary adolescent and young adult (AYA) oncology team.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 64-64
Author(s):  
Rachel Elizabeth Hughes ◽  
Kate Thompson
Keyword(s):  
Palliative Care ◽  
Young Adult ◽  
Clinical Oncology ◽  
Symptom Management ◽  
Symptom Burden ◽  
Multidisciplinary Care ◽  
Adolescent And Young Adult ◽  
Curative Intent ◽  
Care Services ◽  
Palliative Care Services

64 Background: Palliative care is recommended alongside standard oncological care for patients with advanced cancer or high symptom burden (Smith TJ, Temin S, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of Clinical Oncology. 2012;30(8)880-7.). AYA oncology patients are distinguished by several age-specific developmental and biopsychosocial factors, resulting in a unique impact profile (Wein S, Pery S, Zer A. Role of palliative care in adolescent and young adult oncology. J Clin Oncol. 2010;28:4819-4824). Methods: To examine the benefits of multidisciplinary AYA care, a palliative care fellow was incorporated into an existing AYA oncology team in Australia, for a 12 month period. This role facilitated assessment/management of symptoms, general health issues, treatment toxicity, end of life care and bereavement support. Results: Between 2012 and 2013, of 83 new patients were referred to the AYA oncology service, 27 (32.5%) were referred the palliative care fellow. Notably, 37% of patients referred were receiving curative intent treatment. 10 patients (37%) were referred at diagnosis for symptom management. Pain was the most frequent reason for referral (n=17 63%). A total of 7 patients (26%) were referred for advanced disease/terminal care. Conclusions: Evaluation demonstrates that onsite availability of palliative care services is acceptable, facilitates early referral and has encouraged collaborative, AYA multidisciplinary care. A significant additional finding has been recognition of the demand for symptom management of patients early in their cancer experience. Further development and evaluation of AYA specific palliative care is warranted.

Integration of palliative care services into standard oncology practice at diagnosis of metastatic lung cancer at VA New York Harbor Healthcare System.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 165-165
Author(s):  
Felix Manuel Rivera Mercado ◽  
Carol Luhrs ◽  
Alice Beal ◽  
Maura Langdon ◽  
Joan Secrest ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Stage Iv ◽  
Major Advance ◽  
Metastatic Lung Cancer ◽  
Care Services ◽  
National Quality ◽  
Metastatic Lung ◽  
Palliative Care Services ◽  
Oncology Practice

165 Background: The 2012 ASCO provisional clinical opinion addressed the integration of palliative care into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. The inclusion of Palliative Care among the National Quality Forum (NQF) framework represented a major advance in palliative care. NQF metrics include chemotherapy administered in the last 14 days of life, hospice less than 3 days before death, ICU or hospital admission, more than one Emergency Room visit in the last 30 days, and death in hospital. Although the use of hospice and other palliative care services has increased, many are enrolled in hospice less than 3 weeks before death. By improving quality of life, cost, and survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Methods: Retrospective chart review study of lung cancer patients diagnosed at VA from 2010-2013. Inclusion criteria: > 18 years of age with new diagnosis of metastatic lung cancer. Exclusion criteria: < 18 years of age, Stage I-III lung cancer. Results: Total of 125 patients were diagnosed with Stage IV lung cancer. The mean time from diagnosis to death was only 185 days (6.1 months). The VA NYHHS patients were more likely to visit the ED, be admitted to the hospital and ICU in the last 30 days of life, and subsequently die in the hospital. Conclusions: Several confounders were identified, including climate related closure of facilities (2012 Sandy storm), lack of social support, low ICU admission criteria, burial benefits for patients dying in a VA, and delay in transition to Hospice. Currently 392 patients with stage IV solid tumors diagnosed 2010-2014 are being studied. [Table: see text]

Palliative care in intensive care environments

2016 ◽  
Author(s):  
Richard D.W. Hain ◽  
Satbir Singh Jassal
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Symptom Management ◽  
Paediatric Intensive Care Unit ◽  
Significant Proportion ◽  
Care Planning ◽  
Care Environment ◽  
Care Services ◽  
Palliative Care Services ◽  
Significant Attention

A significant proportion of deaths in childhood, even those from life-limiting conditions, happen in an intensive care environment. An effective interface between palliative care services and the neonatal or paediatric intensive care unit is important but also presents certain specific challenges. This chapter looks at some of these challenges. It covers advance emergency care planning and compassionate extubation, examining the practicalities, symptom management, and parallel planning involved in this stage of care. Significant attention is also given to the ethics of compassionate extubation and symptoms during compassionate extubation.

Using a statewide collaborative approach to improve primary palliative care performance.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 53-53
Author(s):  
Katie Abstoss ◽  
Tallat Mahmood ◽  
Claudia Jane Martin ◽  
J. Cameron Muir ◽  
Jane Alcyne Severson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Statistical Significance ◽  
Symptom Assessment ◽  
Measurement Tool ◽  
Improvement Rate ◽  
Care Services ◽  
Edmonton Symptom Assessment Scale ◽  
Palliative Care Services ◽  
Oncology Practice ◽  
Care Performance

53 Background: The Michigan Oncology Quality Consortium (MOQC) is a statewide collaborative of oncology practices. Using the Quality Oncology Practice Initiative (QOPI) measurement tool, MOQC identified a gap in the provision of palliative care. We designed and tested interventions to enhance the capacity and capabilities of the oncologist to deliver primary palliative care earlier in a patient’s course. Methods: MOQC created a process to assist oncology care teams in providing primary palliative care services using the Edmonton Symptom Assessment Scale tool. 11 practices participated in two pilots over 18 months. During and after these pilots, we disseminated tools for improvement, including customized palliative care dashboards, to the entire consortium. Pilot teams also shared their successes, insights, and best practices during semiannual live consortium meetings. Results: Shown are palliative care-focused QOPI results, comparing baseline (Fall 2011, F11) and post project (Spring 2013, S13) for all MOQC practices compared with all participating QOPI practices, using a paired t-test. MOQC sites outperformed the QOPI national average on multiple palliative care measures. Furthermore, the MOQC improvement rate since the project initiation was greater than that of national. Although clinically important, the measures did not reach standard statistical significance. Conclusions: Running successive pilot projects improved primary palliative care performance of the teams involved; additionally, this momentum and gain in knowledge facilitated dissemination of innovation and measurable improvement in all members of a statewide consortium. [Table: see text]

Renal failure

2019 ◽  
pp. 547-560
Keyword(s):  
Palliative Care ◽  
Renal Failure ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Symptom Management ◽  
End Stage Renal Failure ◽  
Care Services ◽  
Palliative Care Services ◽  
End Stage

This chapter describes the issues associated with providing palliative care to patients with renal failure, and covers initiation of renal replacement therapy, conservative treatment, symptom management for patients with advanced renal disease, and issues surrounding stopping renal replacement therapy. As obesity and diabetes increase, so does the incidence of chronic renal disease and end-stage renal failure. Determining the exact number of patients dying of renal failure is challenging. Often the cause of death will be ascribed to an associated contributing factor, e.g. diabetes mellitus, or the final acute event resulting in death, e.g. myocardial infarction. However, we know that renal failure is an independent risk factor for cardiovascular disease and is associated with a high all-cause mortality.1 In addition, patients with end-stage renal failure have a significant symptom burden and therefore it is important that patients have access to palliative care services to assist with symptom management, advanced care planning, and, where appropriate, decisions around dialysis and transplantation.

Palliative medicine integration in the USA: cancer centre executives’ attitudes

2021 ◽  
pp. bmjspcare-2020-002835
Author(s):  
Joseph Chen ◽  
Allison de la Rosa ◽  
Dejian Lai ◽  
Rony Dev ◽  
Frances Lee Revere ◽  
...  
Keyword(s):  
Palliative Care ◽  
Resource Limitation ◽  
Perceived Barriers ◽  
Major Barrier ◽  
Cancer Centre ◽  
Care Services ◽  
Care Integration ◽  
Palliative Care Services ◽  
The Usa ◽  
Oncology Practice

ObjectivesTo compare cancer centre (CC) executives’ attitudes towards palliative care between National Cancer Institute-designated CCs (NCI-CCs) and non-NCI-designated CCs (non-NCI-CCs) in 2018 and to examine the changes in attitudes and beliefs between 2009 and 2018.MethodsCC chief executives at all NCI-CCs and a random sample of non-NCI-CCs were surveyed from April to August 2018. Twelve questions examined the executives’ attitudes towards palliative care integration, perceived barriers and self-assessments. The primary outcome was agreement on the statement ‘a stronger integration of palliative care services into oncology practice will benefit patients at my institution.’ Survey findings from 2018 were compared with data from 2009 to examine changes in attitudes.Results52 of 77 (68%) NCI-CCs and 88 of 126 (70%) non-NCI-CCs responded to the survey. A vast majority of executives at NCI-CCs and non-NCI-CCs endorsed palliative care integration (89.7% vs 90.0%; p>0.999). NCI-CCs were more likely to endorse increasing funding for palliative care (52.5% vs 23.1%; p=0.01) and hiring physician specialists (70.0% vs 37.5%; p=0.004) than non-NCI-CCs. The top three perceived barriers among NCI-CCs and non-NCI-CCs were limited institutional budgets (57.9% vs 59.0%; p=0.92), poor reimbursements (55.3% vs 43.6%; p=0.31), and lack of adequately trained palliative care physicians and nurses (52.6% vs 43.6%; p=0.43). Both NCI-CCs and non-NCI-CCs favourably rated their palliative care services (89.7% vs 71.8%; p=0.04) with no major changes since 2009.ConclusionCC executives endorse integration of palliative care, with greater willingness to invest in palliative care among NCI-CCs. Resource limitation continues to be a major barrier.

scholarly journals Early integration of palliative care services with standard oncology care for patients with advanced cancer

2013 ◽  
Vol 63 (5) ◽  
pp. 349-363 ◽  
Author(s):  
Joseph A. Greer ◽  
Vicki A. Jackson ◽  
Diane E. Meier ◽  
Jennifer S. Temel
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Early Integration ◽  
Care Services ◽  
Palliative Care Services ◽  
Oncology Care
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