Integration of oncology palliative care in a regional health care system.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 34-34
Author(s):  
Connie Edelen ◽  
Nicole Koesel
Keyword(s):  
Palliative Care ◽  
Healthcare System ◽  
Symptom Management ◽  
Symptom Control ◽  
Family Satisfaction ◽  
Cancer Center ◽  
Care Utilization ◽  
Full Time ◽  
Treatment Pathways ◽  
Regional Health Care

34 Background: Early incorporation of palliative medicine in cancer care has been shown to be associated with improved symptom control, quality of life, and patient and family satisfaction however integration in the outpatient setting remains deficient nationwide. Regional healthcare systems carry the additional challenge of providing consistent quality care across a diverse geographic area. We performed a retrospective review of oncology palliative care utilization in a regional healthcare system following the implementation of a fully integrated model of palliative care. Methods: In 2012, Levine Cancer Institute (LCI) and Carolinas Palliative Care collaborated to establish palliative care access across its 12-site regional cancer center. This was a transition from a vendor service to a fully embedded clinic at multiple LCI locations. The new model offered full time outpatient multidisciplinary services in addition to an inpatient oncology palliative care consult service. Standardization of care and early integration were augmented by the creation of symptom management guidelines and tumor treatment pathways with built in recommendations for palliative/supportive care. Results: New oncology palliative care referrals increased from 150 annually to over 475 in the first 12 months. The top diagnoses were lung (16%), breast (11%), and head and neck cancer (7.2%) with pain and symptom management as the primary reason for consultation. Ten symptom management pathways have been published for regional utilization, enabling primary palliative care and serving as a trigger for palliative specialist consultation. A toolkit was created to identify operational needs, clinical tools, and staffing at each site. Conclusions: The growth of oncology palliative care utilization by 317% demonstrates the success of a fully embedded program. This multidisciplinary model is being standardized across regional sites to ensure access to primary and secondary palliative care. Additional clinic sites and the application of telemedicine for rural areas are in development. Future research is needed to document outcomes associated with palliative care integration across the cancer trajectory in a regional healthcare system.

Embedded model palliative care (PC) at a community oncology practice in central Nebraska.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 64-64
Author(s):  
Cindy Kathman ◽  
Mehmet Sitki Copur ◽  
Penny Price ◽  
Carrie Edwards ◽  
Pornchai Jonglertham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Symptom Management ◽  
Hospice Care ◽  
Prognostic Index ◽  
Cancer Center ◽  
Care Utilization ◽  
Community Oncology ◽  
Oncology Practice ◽  
Active Cancer

64 Background: PC combined with cancer care has been shown to improve patient outcomes and caregiver satisfaction while lessening unnecessary health care utilization. 85% of cancer patients receive their oncology care in the communities they live. Establishing a viable and sustainable outpatient PC service in the community oncology setting is challenging and rare nationwide. We present our 18-month PC services since its implementation at Morrison Cancer Center, a community oncology practice. Methods: Cancer patients were referred to PC by oncologists for symptom management, psychosocial support, and Advanced Care Planning (APC). PC visits were provided at the oncology clinic, home, nursing home, or hospital by our PC team (APRN, Social Workers, Chaplain and RN's). Palliative Care Prognostic Index (PPI), time to PC consultation, proportion of patients --on chemotherapy, switching to hospice care, receiving chemotherapy within the last 30 days of life, visiting ER and/or being admitted to hospital within the last 30 days of life-- were studied. Results: Over an 18-month period 72 patients were referred for a total of 470 visits. Lung, pancreas, gastroesophageal, and head and neck cancers were topmost sites. PC referrals per quarter increased from an initial 4 to an 18 at 18 months. Mean time from diagnosis to PC referral was 5.6 months (range: 1-36). Referral reasons included symptom management/support (58%), goals of care (50%), and/or predetermined triggers (15%). Mean PPI score was 50% (range 30-70). All patients had ACP. While 83% of patients were able to continue on active cancer treatment, only 5% received chemotherapy within the last 30 days of life, and 4 % had two or more ER visits with or without a hospital admission. Eventually, 17% of PC patients transitioned to hospice care. Conclusions: A PC program fostering expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care team, and patients, without prematurely stopping active cancer treatments, is feasible and can be incorporated into a community oncology practice as demonstrated by the growth and success of our program. Our model may set an example for similar practices in the community oncology setting.

Embedding palliative care (pc) in a community-based cancer center: Benefits and barriers.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 153-153
Author(s):  
Jennifer Bayne ◽  
John Weems ◽  
Robert D. Siegel ◽  
Teresa N. Bowen ◽  
Leigh Stinnett ◽  
...  
Keyword(s):  
Palliative Care ◽  
South Carolina ◽  
Symptom Management ◽  
Hospital Admissions ◽  
Disease Process ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Full Time ◽  
Community Based ◽  
Oncology Patients

153 Background: The importance of involving PC early in the disease process of oncology patients is well documented. Decreased symptom burden, increased quality of life, and extended survival are proven outcomes; however, the provision of PC has largely been limited to the acute care setting in most institutions. Bon Secours St. Francis Health System, a community based healthcare system in Greenville, South Carolina, opened a comprehensive cancer center in late 2014. Our established inpatient PC team began seeing outpatients at the cancer center shortly after its opening. Methods: PC at the cancer center is provided in an “embedded” model of care. PC appointments were initiated at 20 hours/week and have been expanded to 28 hours/week, currently provided by NPs 24 hrs, MD 4 hrs, all of whom are certified in hospice and palliative care. Patients are seen during medical oncology, radiation oncology, or infusion appointments. In August 2015, the PC team began to participate in an interdisciplinary team meeting, reviewing new oncology patients and their expected or known needs. Results: Total visits for 2015: 559/158 new patients seen. Informal interviews from patients, oncology, and PC staff revealed the following benefits: better communication regarding treatment plans; improved symptom management; flexibility and convenience in meeting patients anywhere in the cancer center and; providing resources for staff regarding pain and symptom management and communication techniques. Barriers identified were: scheduling conflicts for patients with multiple appointments; less than full-time coverage by PC prohibits some patients from being seen during their oncology appointments; PC and oncology being separate administrative entities has required creative solutions in billing and staffing. Conclusions: Despite some barriers, the benefits of embedding a PC clinic in a community-based oncology center are clear and worthwhile. This clinic improves coordination of care between inpatient and outpatient services, which results in positive patient experiences. It is hoped that the early integration of PC in the ambulatory setting will result in a decrease in avoidable emergency room visits and hospital admissions.

Phase II Study of an Outpatient Palliative Care Intervention in Patients With Metastatic Cancer

2009 ◽  
Vol 27 (2) ◽  
pp. 206-213 ◽  
Author(s):  
Matthew Follwell ◽  
Debika Burman ◽  
Lisa W. Le ◽  
Kristina Wakimoto ◽  
Dori Seccareccia ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Metastatic Cancer ◽  
Symptom Control ◽  
Family Satisfaction ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale ◽  
The Mean

Purpose Although there is increasing advocacy for timely symptom control in patients with cancer, few studies have assessed outpatient palliative care clinics. This study assessed prospectively the efficacy of an Oncology Palliative Care Clinic (OPCC) in improving patient symptom distress and satisfaction. Patients and Methods Eligible patients were new referrals to an OPCC, had metastatic cancer, were at least 18 years old, and were well enough and able to speak and read English sufficiently to provide informed consent and complete questionnaires. Patients received a consultation by a palliative care team. The primary end points of symptom control and patient satisfaction were assessed using the Edmonton Symptom Assessment Scale (ESAS) and patient-adapted Family Satisfaction with Advanced Cancer Care (FAMCARE) scale at baseline, 1 week, and 1 month. Initial and follow-up scores were compared using paired t tests. Results Of 150 patients enrolled, 123 completed 1-week assessments, and 88 completed 4-week assessments. At baseline, the mean ESAS Distress Score (EDS) was 39.5. The mean improvement in EDS was 8.8 points (P < .0001) at 1 week and 7.0 points (P < .0001) at 1 month. Statistically significant improvements were observed for pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, dyspnea, insomnia, and constipation at 1 week (all P ≤ .005) and 1 month (all P ≤ .05). The mean improvement in FAMCARE score was 6.1 points (P < .0001) at 1 week and 5.0 points (P < .0001) at 1 month. Conclusion This phase II study demonstrates efficacy of an OPCC for improvement of symptom control and patient satisfaction with care. Randomized controlled trials are indicated to further evaluate the effectiveness of specialized outpatient palliative care.

Safety Aspects of Acupuncture in Palliative Care

2001 ◽  
Vol 19 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Jacqueline Filshie
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Tumour Progression ◽  
Clinical Stage ◽  
Symptom Control ◽  
Alternative Therapies ◽  
Current Status ◽  
Neutropenic Patients ◽  
Full Knowledge ◽  
Clotting Disorder

Acupuncture can mask symptoms of cancer and tumour progression. It is not safe to use such a therapy without full knowledge of the clinical stage of the disease, and the current status of orthodox therapy. Contraindications to acupuncture needling include an unstable spine, severe clotting disorder, neutropenia and lymphoedema. Whilst semi-permanent needles are used increasingly in symptom control and pain management they should not be used in patients with valvular heart disease or in vulnerable neutropenic patients. Acupuncture has an increasing role in support for pain and symptom management, but patients should not be advised to abandon conventional treatments in favour of complementary or alternative therapies alone, and should not have their hopes raised inappropriately, or have any guilt projected on to them for the cause of their cancer.

scholarly journals Oncology Fellow–Led Quality Improvement Project to Improve Rates of Palliative Care Utilization in Patients With Advanced Cancer

2020 ◽  
Vol 16 (8) ◽  
pp. e814-e822 ◽  
Author(s):  
Ramy Sedhom ◽  
Arjun Gupta ◽  
Mirat Shah ◽  
Melinda Hsu ◽  
Marcus Messmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Advanced Cancer ◽  
Metastatic Cancer ◽  
Cancer Center ◽  
Care Utilization ◽  
First Year ◽  
Improvement Project ◽  
Leadership Support ◽  
Ancillary Staff

PURPOSE: ASCO guidelines recommend palliative care (PC) referral for patients with advanced or metastatic cancer. Despite this, implementation has considerable hurdles. First-year oncology fellows at our institution identified low rates of PC utilization in their longitudinal clinic as a metric needing improvement. METHODS: A fellow-led multidisciplinary team aimed to increase PC utilization for patients with advanced cancer followed in he first-year fellows’ clinic from a baseline of 11.5% (5 of 43 patients, July to December of 2018) to 30% over a 6-month period. Utilization was defined as evaluation in the outpatient PC clinic hosted in the cancer center. The team identified the following barriers to referral: orders difficult to find in the electronic medical record (EMR), multiple consulting mechanisms (EMR, by phone, or in person), EMR request not activating formal consult, no centralized scheduler to contact or confirm appointment, and poor awareness of team structure. Plan-Do-Study-Act (PDSA) cycles were implemented based on identified opportunities. Data were obtained from the EMR. RESULTS: The first PDSA cycle included focus groups with stakeholders, standardizing referral process via single order set, identifying a single scheduler with bidirectional communication, and disseminating process changes. PDSA cycles were implemented from January to June of 2019. Rates of PC use increased from 11.5% before the intervention to 48.4% (48 of 99 patients) after the intervention. CONCLUSION: A multidisciplinary approach and classic quality improvement methodology improved PC use in patients with advanced cancer. The pilot succeeded given the small number of fellows, buy-in from stakeholders, and institutional and leadership support. Straightforward EMR interventions and ancillary staff use are effective in addressing underreferrals.

Quality improvement outcomes in an academic practice participating in ASCO’s Quality Oncology Practice Initiative (QOPI).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 206-206
Author(s):  
Mary Anne Fenton
Keyword(s):  
Palliative Care ◽  
Quality Control ◽  
Quality Improvement ◽  
Primary Care Physicians ◽  
Symptom Control ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Academic Practice ◽  
Improvement Interventions

206 Background: The ASCO QOPI is an instrument for community and academic practices to assess quality and adherence to guidelines in areas of treatment planning and goals, chemotherapy consent documentation, smoking cessation, symptom control, palliative care, and disease specific measures. Following data submission QOPI summary reports for the submitting practice and QOPI aggregate are available for review and comparison. Methods: The academic practice of Rhode Island Hospital Comprehensive Cancer Center has participated in QOPI since the fall of 2008. QOPI measure summary reports for our practice and comparison to the Academic Aggregate are reviewed by our physicians after each round of chart abstraction, measures are identified for improvement. Interventions include education on practice improvement and development of policy and procedures for implementation by our Quality Control Officer in compliance with hospital policies. Results: Presented is a summary of quality improvement interventions implemented. Additional areas of quality improvement have been identified based on QOPI data, and improvement plans are ongoing including treatment summaries for patient and primary care physicians, tools to assess patient emotional well being, documentation of family history and referral for genetic assessment. Conclusions: QOPI provides a platform for collection, analysis and comparison of quality measures. For the measures of formulating a pain plan the intervention was a reminder to document the plan. For the measure hospice enrollment, a reflection on our hospice enrollment has lead to an increase in referral to palliative care. The ASCO QOPI program is a tool for quality improvement, our Quality Control Officer was essential in implementation of our improvement projects. [Table: see text]

Results from year 1 of an embedded supportive oncology practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 40-40
Author(s):  
Bethann Scarborough ◽  
Emily Chai ◽  
Randall F. Holcombe ◽  
Eric Lee ◽  
Nathan Goldstein
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Utilization ◽  
Symptom Management ◽  
Care Utilization ◽  
First Year ◽  
Goals Of Care ◽  
Supportive Oncology ◽  
Oncology Practice ◽  
Over Time

40 Background: We present the findings from our first year of a Supportive Oncology practice embedded in a quaternary care center’s outpatient cancer practice. Methods: One palliative medicine physician saw patients 4 days per week. Oncologists made referrals for symptom management, psychosocial support, advance care planning, or by predetermined triggers for palliative care. Results: 239 patients were referred for a total of 821 visits. Palliative care referrals increased over time; 0.6% of the cancer center’s patients were referred in the first quarter and 1.5% were referred in the third quarter. Referral reasons included symptom management/support (90%), goals of care (5%), or triggers (6%). Six to 9 symptoms were addressed at 41% of visits. Sixteen percent of patients initially referred for symptoms were later seen for conversations regarding goals of care. Of these patients, 76% discussed goals of care with their oncologist, 61% were referred to hospice and 47% enrolled in hospice. Supportive oncology visits were associated with decreased health care utilization, with a downward trend in Emergency Department visits (0.82 vs. 0.72 per patient) and inpatient admissions (0.91 vs. 0.84 per patient) after the initial palliative care visit compared to use before the visit. Approximately 17% of all Supportive Oncology patients enrolled in hospice. Conclusions: Our first year of an embedded palliative care practice focused on building collaborative relationships. The steady referral growth over time indicates that oncologists increasingly accepted the program. While only a small proportion of patients were referred, the high visit complexity reflects this population’s acuity. Decreased health care utilization may be due to better symptom control or care aligned with patients’ values. Early referrals for symptom management facilitate goals of care discussions later on, and the importance of delivering a unified message on treatment options is seen in the hospice referral rate of 61% for the subset of patients who discussed goals of care with palliative care and oncology. Embedding palliative care in oncology fosters expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care, and patients.

The outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 131-131
Author(s):  
Si Won Lee ◽  
Hye Jin Choi
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Group Performance ◽  
Care Service ◽  
Symptom Control ◽  
Palliative Care Service ◽  
Cancer Center ◽  
Anticancer Treatment ◽  
Tertiary Cancer Center

131 Background: The importance of palliative care in cancer patients continues to be emphasized and studies are proving its importance. Several studies proved the improvement of quality of life in advanced cancer patients. The efficacy of symptom control based on outpatient palliative care service has not yet been reported in Korea. The objective of this study is to review the outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea. Methods: We retrospectively reviewed 155 cancer patients who used outpatient clinic at Yonsei Cancer Center in Korea between April 2014 and December 2014. Symptom severity was measured by modified Korean version of Edmonton Symptom Assessment System. Twelve symptoms were assessed: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, anorexia, constipation, wellbeing, financial distress. Higher score means worse symptom. ESAS scores at baseline and follow-up assessments were analyzed. Results: The 155 patients had following characteristics: female 52.3%, median age 65 years (range 58-75), Hepatobiliary-pancreatic cancer and lung cancer patients accounted for the largest portion (n = 37, 23.9%; n = 36, 23.2% respectively). Most patients were Eastern Cooperative Oncology Group performance status 1 (n = 28, 18.1%) or 2 (n = 24, 15.5%). Ninety-two (59.4%) patients were referred to the palliative care team after anti-cancer treatments were all finished. Overall the symptoms did not change significantly from baseline to 2 consecutive follow up assessment except anorexia ( p value = 0.0195). Patients who were on active anticancer treatment had tendency of higher ESAS score than those finished with the anticancer treatment. However, all symptoms except nausea were not statistically significant. Conclusions: Most patients in this study did not have severe symptom scores that would show the differences of the symptom changes. Nevertheless, although not statistically significant, we found that patients on active anticancer treatment had higher symptom burden than those who were finished with the anticancer treatment. More meticulous symptom management is necessary to improve the symptom control.

scholarly journals Referenciação Precoce para Cuidados Paliativos: O Racionamento dos Cuidados Eficientes de Saúde em Doentes Oncológicos

2019 ◽  
Vol 32 (7-8) ◽  
pp. 475 ◽  
Author(s):  
Paulo Reis-Pina ◽  
Rita Gameiro Dos Santos
Keyword(s):  
Palliative Care ◽  
Psychological Symptoms ◽  
Symptom Control ◽  
Death And Dying ◽  
Interdisciplinary Approach ◽  
Family Satisfaction ◽  
Effective Control ◽  
Early Integration ◽  
Oncological Treatment ◽  
Treatment Research

Palliative care in oncology is an interdisciplinary approach, centered on patients and their families, carried out along the course of neoplastic diseases, based on symptom control, assertive communication and shared decision-making. Although clinical guidelines recommend a holistic intervention, early integration of palliative care into traditional oncological treatment, research shows a great delay in referral of patients, restricting palliative care to end-of-life care. Why does there seem to be a rationing of the early referral, sometimes in violation of human dignity? To a large extent it has to do with lack of knowledge, training and education of health professionals about palliative care and the techniques to deal with the process of death and dying. Several studies have demonstrated the benefit of integrating palliative actions into the routine of active cancer treatments, not only in terms of effective control of physical and psychological symptoms, but also in terms of overall quality of life, patient and family satisfaction, health care costs and survival in some cases. It is necessary to take measures that encourage oncologists to obtain further training in palliative care, as a formal, compulsory internship, integrated in their specific training program. This way, a new generation of physicians will surely change the lives of cancer patients, and their families, integrating — without disproportionate rationing — oncology and palliative medicine.

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