The availability/accessibility gap of palliative care and supportive care services at 40 National Cancer Institute-designated cancer centers.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 122-122
Author(s):  
Kathryn Hutchins ◽  
Geoffrey Hamlyn ◽  
Abby Johnston ◽  
Rishonda Thomas ◽  
James Tian ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Education ◽  
Quantitative Measure ◽  
Complete Information ◽  
Cancer Center ◽  
Cancer Centers ◽  
Care Services ◽  
Palliative Care Services ◽  
Genetic Assessment

122 Background: All NCI-designated, comprehensive cancer centers report having consultative palliative care services alongside six other supportive care services. Inaccuracies in the understanding of these services among frontline office staff may undermine their accessibility to patients. We investigated how easily new patients could access these services when first contacting a major cancer center. Methods: We used a ‘mystery shopper’ format to simulate calls made by a family member of a recently diagnosed patient. We used a standardized call script, describing a female patient, age 58, recently diagnosed with inoperable liver cancer. We called each center four times on different days and evaluated quantitative and qualitative components. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 38.2% of callers were unable to receive complete information about supportive care services. Overall, only 37.6% of callers (60.8% of those reaching someone who could answer questions) were told all 7 supportive care services were offered. In 9.5% of calls, call recipients gave an answer other than “yes” to whether the cancer center offered palliative care. Callers were told regarding palliative care: that it was for end of life patients only (2 calls), that there weren’t doctors who focused on symptom management (3), its availability depends on review of medical records (2), or that the call recipient was unsure either of the availability of palliative care (10), or did not know what the term meant (2). Availability responses other than “yes” were obtained in the following frequencies: multidisciplinary approach (14.6%), patient navigation (12.1%), genetic assessment (9.5%), psychological services (7.6%), and cancer education services (6.4%). Conclusions: Despite the stated availability of seven key supportive care services, accessibility was limited in one-third of calls. In about 10% of cases where a person was reached, the call recipient was unable to confirm that palliative care was offered. Further research is needed to close the availability vs. accessibility gap in oncology palliative and supportive care.

The availability versus accessibility gap in supportive care services at 40 NCI-designated cancer centers.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 283-283 ◽  
Author(s):  
Kathryn Hutchins ◽  
Geoffrey Hamlyn ◽  
Abby Johnston ◽  
Rishonda Thomas ◽  
James Tian ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Education ◽  
Private Insurance ◽  
Quantitative Measure ◽  
Complete Information ◽  
Cancer Center ◽  
Team Approach ◽  
Supportive Services ◽  
Cancer Centers ◽  
Care Services

283 Background: Many cancer centers have developed and fostered several supportive care services to ease the stress of a cancer diagnosis. The availability of such services is key to Commission on Cancer (CoC) for accreditation, which many cancer centers pursue and patients seek as a measure of quality. Despite the stated availability of supportive care services, we wondered how easily new patients could access these services when first contacting a major cancer center. Methods: We used a ‘mystery shopper’ format to simulate calls made by a family member of a recently diagnosed patient to 40 NCI-designated cancer centers. We called each center four times on different days, twice with the caller reporting Medicaid insurance, twice with private insurance. We evaluated quantitative and qualitative components of the call, including time to next available appointment and reported availability of the 7 supportive services reported to the CoC. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 38.2% of callers were unable to receive complete information about the number of supportive care services offered, whether because they were unable to reach a person or because the person they reached did not know whether one or more of the services was offered. Overall, only 37.6% of callers (60.8% of those who reached a person who could answer their questions) were told that all seven supportive care services were offered. Call recipients responded with an answer other than yes to whether the cancer center offered a multidisciplinary team approach (14.6%), patient navigation services (12.1%), genetic assessment/counseling (9.5%), palliative care (9.5%), counseling/psychological services (7.6%), or cancer education services (6.4%). Conclusions: Despite the stated availability of seven key supportive care services, we were unable to access all services during a call to establish an appointment about one-third of the time. For individual services, about 10% of the time we were told such services did not exist at the cancer center. Further research is needed to close the availability vs. accessibility gap in oncology supportive care.

Integration and expansion of palliative care work force.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 126-126
Author(s):  
Lynn Bowlby ◽  
Robin Turner ◽  
David Casarett ◽  
Fred Johnson ◽  
Ebony Boulware ◽  
...  
Keyword(s):  
Palliative Care ◽  
Faculty Member ◽  
Training Program ◽  
Fellowship Training ◽  
Cancer Center ◽  
Severe Illness ◽  
Care Clinic ◽  
Intensive Training ◽  
Care Services ◽  
Palliative Care Services

126 Background: The specialty of Hospice and Palliative Medicine has grown out of the need for care of patients who are living longer with cancer and other serious illness and struggle with symptoms, decisions and care. Cancer patients and others often do not have access to Palliative Care services due to availability or accessibility of PC services. Since 2012, fellowship training is required for board eligibility but available programs do not meet the workforce need. As described by Weissman and Meier, viewing Palliative care services in the context of a primary, secondary or tertiary focus , allows for the expansion of these services outside of the traditional fellowship training. With additional intensive training, it is possible that experienced physicians can fill workforce gaps by providing primary palliative care in the providers practice area such as a clinic. Methods: The faculty member who will participate in a yearlong training program based in the Palliative Care Clinic is the Director of the Outpatient Clinic. This clinic is the center of the Duke resident ambulatory experience for the duration of their training. The complexity of these patients is high and often the DOC is the only place that these patients receive care. The Palliative Care training program will provide the faculty member the opportunity to see patients in the cancer center with board certified palliative care physicians. There will be 3 areas of focus for the trainee: clinical experience, didactic information and mentorship from a board certified palliative care provider around faculty identified cases from her own practice. Results: We have developed a yearlong intensive training program for experienced faculty to gain skills in Palliative Care. Conclusions: 1. It is hoped that this will allow for integration of primary palliative care into patient care areas where there is no formal palliative care program. 2. Integration of Palliative Care principles in the clinic to address symptoms of chronic severe illness as well as difficult conversations with more confidence and skill. 3. Earlier palliative care management–develop a systematic approach to assessing needs in high risk populations ie. Hospital Discharge reviews, now commonly done at the clinic.

Comparability of the Cancer Supportive Care Clinical Studies Collaborative (CSCCSC) study population to national referrals to other specialist palliative care services.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 63-63
Author(s):  
David Christopher Currow ◽  
Hiromichi Matsuoka ◽  
Samuel Allingham ◽  
Belinda Fazekas ◽  
Linda Brown ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Clinical Studies ◽  
Symptom Control ◽  
Population Characteristics ◽  
Phase Iii ◽  
Trial Participation ◽  
Care Services ◽  
Significant Difference ◽  
Palliative Care Services

63 Background: There are no agreed national nor international criteria for referral to palliative care. Key population characteristics have been defined to aid the generalizability of research findings in palliative care clinical studies. To codify differences in key demographic factors between patients with cancer participating in the Australian national Cancer Supportive Care Clinical Studies Collaborative (CSCCSC) phase III symptom control studies and the population referred to other Australian palliative care services. Methods: This study compares two contemporaneous consecutive cohorts generated through clinical trial participation and the national palliative care clinical quality improvement registry in Australia. Age, sex, cancer diagnosis, language, and socio-economic status were compared. Results: Cohorts were people with cancer: enrolled in CSCCSC phase III clinical studies (n=902; 17 sites); and registered by the Australian national Palliative Care Outcomes Collaboration (PCOC; n=75,240; 117 sites). Participants in CSCCSC studies were younger than those of PCOC (median 71 (IQR 62, 79) versus median 73 (IQR 63, 81); p=0.003 respectively). There was no significant difference in sex (p=0.483). Patients who spoke English accounted 95.0% of enrollees in the CSCCSC group and 92.2% in the PCOC group (p = 0.004). Clinical study participants had higher socioeconomic status that the PCOC group (p=0.022). Conclusions: Overall, the slightly different demographic patterns are reflective of the differences often seen between phase III trials and the populations to whom the results will be applied. Age differences particularly need to be taken into account when considering the best way to apply each study’s findings.

Using a supportive care framework to understand and improve palliative care among cancer patients in Africa

2015 ◽  
Vol 14 (3) ◽  
pp. 284-301 ◽  
Author(s):  
David S. Busolo ◽  
Roberta L. Woodgate
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Care Needs ◽  
African Countries ◽  
Research Education ◽  
Patients With Cancer ◽  
Care Services ◽  
Incidence And Mortality ◽  
Palliative Care Services

ABSTRACTObjective:Cancer incidence and mortality are increasing in Africa, which is leading to greater demands for palliative care. There has been little progress in terms of research, pain management, and policies related to palliative care. Palliative care in Africa is scarce and scattered, with most African nations lacking the basic services. To address these needs, a guiding framework that identifies care needs and directs palliative care services could be utilized. Therefore, using the supportive care framework developed by Fitch (Fitch, 2009), we here review the literature on palliative care for patients diagnosed with cancer in Africa and make recommendations for improvement.Method:The PubMed, Scopus, CINAHL, Web of Science, Embase, PsycINFO, Social Sciences Citation Index, and Medline databases were searched. Some 25 English articles on research from African countries published between 2004 and 2014 were selected and reviewed. The reviewed literature was analyzed and presented using the domains of the supportive care framework.Results:Palliative care patients with cancer in Africa, their families, and caregivers experience increasing psychological, physical, social, spiritual, emotional, informational, and practical needs. Care needs are often inadequately addressed because of a lack of awareness as well as deficient and scattered palliative care services and resources. In addition, there is sparse research, education, and policies that address the dire situation in palliative care.Significance of Results:Our review findings add to the existing body of knowledge demonstrating that palliative care patients with cancer in Africa experience disturbing care needs in all domains of the supportive care framework. To better assess and address these needs, holistic palliative care that is multidomain and multi-professional could be utilized. This approach needs to be individualized and to offer better access to services and information. In addition, research, education, and policies around palliative care for cancer patients in Africa could be more comprehensive if they were based on the domains of the supportive care framework.

scholarly journals State of palliative care services at US cancer centers: An updated national survey

Cancer ◽  
2020 ◽  
Vol 126 (9) ◽  
pp. 2013-2023 ◽  
Author(s):  
David Hui ◽  
Allison De La Rosa ◽  
Joseph Chen ◽  
Seyedeh Dibaj ◽  
Marvin Delgado Guay ◽  
...  
Keyword(s):  
Palliative Care ◽  
National Survey ◽  
Cancer Centers ◽  
Care Services ◽  
Palliative Care Services

Palliative Care Services in the NeuroICU: Opportunities and Persisting Barriers

2021 ◽  
pp. 104990912098721
Author(s):  
Michael Morris ◽  
Emily L. Mroz ◽  
Cristina Popescu ◽  
Jacqueline Baron-Lee ◽  
Katharina M. Busl
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Supportive Services ◽  
Missed Opportunities ◽  
Care Services ◽  
Palliative Care Services

Background: End-of-life (EOL) supportive care, including palliative and hospice services, is an area of increasing importance in critical care. Neurointensivists face unique challenges in providing timely supportive care to terminally ill patients expected to expire in the NeuroICU. Objective: This study explored the extent of effective utilization of, and recorded barriers to, palliative and hospice services in a dedicated 30-bed NeuroICU at a large academic medical center. Design: A retrospective chart review of patients who expired in the NeuroICU was conducted. The timeline from patient admission to arrival of palliative care services was traced. Qualitative review of chart notes was used to identify barriers to provision of palliative services. Setting: A total of 330 patients expired in the NeuroICU during the study period, including 176 from the neurology and 154 from the neurosurgical service. Results: Across services, 146 expired patients were never referred to palliative care or hospice services. Of those referred, over one-third were referred more than 4 days past admission to the NeuroICU. On average, patients were referred with less than 1 day before expiration. Common barriers to referral for supportive services were documented (e.g., patient expected to expire, family declined service). Conclusions: Despite benefits of palliative care and an in-hospital hospice opportunity, we identified lack of referral, and particularly delays in referral to services as significant barriers. Our study highlights these as missed opportunities for patients and families to receive maximum benefits from these services. Future research should solidify triggers for EOL services in this setting.

scholarly journals Palliative Care Services at Cancer Center Janakpur, Nepal

2020 ◽  
Author(s):  
Sanjay Gupta ◽  
Richa Mishra ◽  
Anshu kumar Thakur ◽  
pamesh pamesh
Keyword(s):  
Palliative Care ◽  
Cancer Center ◽  
Care Services ◽  
Palliative Care Services

Perspectives on palliative care in a multisite oncology practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 52-52
Author(s):  
Kenneth D. Bishop ◽  
Angela Marie Taber
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Patients ◽  
Nurse Practitioners ◽  
Effective Means ◽  
Cancer Center ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Palliative Care Services ◽  
Care Consultation

52 Background: The Institute of Medicine reported that many cancer patients do not receive palliative care to manage symptoms. It is possible that practitioners do not identify palliative care as an important component of high-quality cancer care, or do not know how to most efficiently utilize available palliative care consultative services. Methods: An anonymous electronic survey was sent to physicians, nurses, nurse practitioners, physician assistants, and social workers (n=99) in our multi-site, single-institution Cancer Center. Results: Sixty-five responses were received (66% response rate). Eighty-three percent of respondents reported working primarily in the outpatient setting. Fifty-nine percent reported their patients ‘rarely use the ER for pain management’ while 16% reported their patients ‘frequently require ER visits for pain management’. Ninety-two percent considered palliative care ‘an integral part of a multidisciplinary team’ while 6% reported palliative care consultation to be ‘cumbersome to consult and coordinate with’. The most common reason for consultation was end-of-life discussions (38%) followed by chronic pain management (33%). Seventy-seven percent reported consulting between 1 and 5 times per month, 14% between 6-10 times per month, and 5% greater than 11 times per month. Thirteen percent reported that they were able to manage patient symptoms adequately themselves. The average rating for convenience of consulting palliative care was 3.8/5. Fifty-eight percent reported the most effective means of communication with palliative care consultants was through the medical record, whereas 42% reported that most effective communication took place in person. Sixty percent reported a preference for palliative care practitioners from within the division of hematology/oncology. Conclusions: Our survey suggests that the majority of oncology practitioners value palliative care consultation and are willing to incorporate palliative care services into patient management. It is possible that practitioners overestimate their utilization of palliative care services and that optimizing the convenience of consultation and communication would result in better integration of palliative care for cancer patients.

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