New primary palliative care (PC) model for community cancer clinics (CCC).

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 159-159
Author(s):  
Cheruppolil R. Santhosh-Kumar ◽  
Deborah Gray ◽  
Stephanie Struve ◽  
Carol Huibregtse ◽  
Qiaofang Chen
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Flow Diagram ◽  
Clinical Psychologist ◽  
Early Integration ◽  
Therapy Dog ◽  
Family Conference ◽  
Care Family ◽  
Oncology Unit ◽  
Service Gap

159 Background: Our CCC serving a mixed rural/urban population is part of a large integrated healthcare system in Eastern WI. The closest PC specialist/team is 45 miles away at one of the tertiary care facilities. To fill this service gap we implemented a primary PC model. An initial outpatient palliative care family conference (OFC) and use of cancer nurse navigators (CNN)are hallmarks of this program. Methods: The VLCC, housed in a standalone facility is staffed by two medical oncologists and one radiation oncologist and has an infusion center and a full-fledged radiation oncology unit with support staff, including cancer nurse navigators, research nurses, social workers, a clinical psychologist, a pharmacist, a nutritionist, a therapy dog and a chaplain. Specialized pain management teams and services like acupuncture and hypnotherapy are readily available in the community. The patients have had access to multiple clinical trials since 2004. A team of a physician champion, a CNN and a social worker prioritized the needs and designed a program with support from system leadership. A CNN took additional training in PC. Funding from a research grant provided support for an occupational therapist (OT). Difficulties in communication was identified early as a barrier to integration of PC. OFCs were designed and conducted to discuss multiple domains of palliative care and referrals were made to different services. Pre and post enrollment surveys were administered. The following flow diagram was used (see Table). Results: In 2015, of 334 new patient visits for all stages of cancer, 32 were managed through the new PC model. Patient satisfaction scores were near 100%. Detailed methodology and data analyses will be presented. Conclusions: A successful new model of early integration of PC that is easily replicable in communities without access to specialist PC services is presented. [Table: see text]

Structured outpatient palliative care family conferences to enhance early integration of palliative care in advanced cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 36-36
Author(s):  
Cheruppolil R. Santhosh-Kumar ◽  
Deborah Gray ◽  
Stephanie Struve ◽  
Carol Huibregtse
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Direct Result ◽  
Do Not Resuscitate ◽  
Advanced Directives ◽  
Early Integration ◽  
Early Palliative Care ◽  
Family Conference ◽  
Nurse Navigator ◽  
Care Family

36 Background: Integrating early palliative care with cancer treatment improves quality of life and survival. Effective communication among physicians, patients and their loved ones is crucial to end-of-life, hospice and palliative care discussions. To address the inherent challenges in these discussions, we implemented a structured outpatient palliative care family conference (OFC) program at our community cancer clinic. Methods: A team comprising a hematologist/oncologist, cancer nurse navigator and social worker developed a toolkit for conducting an OFC, recognizing that each family conference is a unique adaptive challenge. New patients with advanced malignancies and limited life expectancy (<12 months) were offered a 90-minute structured OFC attended by the care team, patient and family members and or friends. Pre and post-conference patient satisfaction surveys and other data were collected prospectively. Results: From March 2014 through May 2015, fortyOFC were conducted (16 female and 24 male patients, median age: 67 years). Diagnoses were advanced gastrointestinal (14), lung (12), hematologic (6) and other (8) malignancies. As a direct result of the OFC program, 18 patients ordered do-not-resuscitate bracelets, 15 completed advanced directives, 7 submitted paperwork for disabled parking permits, 7 were referred to hospice and 4 for rehabilitation therapy. Further results are shown in the table. Conclusions: Structured outpatient palliative care family conferences improve satisfaction of end-of-life discussions and facilitate integration of palliative care options. Enhanced communication between providers, patients and loved ones eases the challenges of such discussions. The OFC approach could be a model for integrating palliative care in community cancer clinics. [Table: see text]

Specialist palliative care along the trajectory of illness

2021 ◽  
pp. 103-110
Author(s):  
Breffni Hannon ◽  
Stein Kaasa ◽  
Camilla Zimmermann
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Optimal Time ◽  
Future Research ◽  
Optimal Timing ◽  
Early Integration ◽  
Early Palliative Care ◽  
Care Services ◽  
Healthcare Settings ◽  
Palliative Care Services

The benefits of early, integrated palliative care have been demonstrated through several randomized controlled trials. These benefits include improved quality of life, satisfaction with care, symptom management, and, in some cases, survival. Despite heterogeneity in study design and execution, as well as limitation to mainly the oncology population, these trials have answered the question of why patients should receive palliative care early in their disease trajectory. Attention must now shift to the practicalities of early integration; these include questions about when is the optimal time to refer to palliative care services, who is best placed to provide palliative care supports, where early palliative care should be provided, and how best to integrate early palliative care services across the care continuum. This chapter summarizes current evidence supporting early integration of palliative care; describes the respective roles of primary, secondary, and tertiary care providers in the delivery of early palliative care; explores the optimal timing and venues for the delivery of early palliative care; and outlines a hierarchy of integration models to best meet the needs of all patients throughout the illness trajectory. Although rooted in evidence primarily from oncology trials conducted in North American and European settings, these options may be adaptable across a variety of healthcare settings, irrespective of available resources and stages of development of palliative care services. Future research should include patients from non-oncology populations, and focus on models of integration that include primary and secondary providers, rather than relying only on tertiary palliative care.

Effects of VA Facility Dog on Hospitalized Veterans Seen by a Palliative Care Psychologist: An Innovative Approach to Impacting Stress Indicators

2016 ◽  
Vol 35 (1) ◽  
pp. 5-14 ◽  
Author(s):  
Cheryl A. Krause-Parello ◽  
Cari Levy ◽  
Elizabeth Holman ◽  
John E. Kolassa
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Palliative Care Service ◽  
The United States ◽  
Clinical Psychologist ◽  
Stress Indicators ◽  
Therapy Dog ◽  
Time Period ◽  
And Control ◽  
Animal Assisted Intervention

The United States is home to 23 million veterans. In many instances, veterans with serious illness who seek healthcare at the VA receive care from a palliative care service. Animal-assisted intervention (AAI) is gaining attention as a therapeutic stress reducing modality; however, its effects have not been well studied in veterans receiving palliative care in an acute care setting. A crossover repeated-measures study was conducted to examine the effects of an animal-assisted intervention (AAI) in the form of a therapy dog on stress indicators in 25 veterans on the palliative care service at the VA Eastern Colorado Healthcare System in Denver, CO. Veterans had a visit from a therapy dog and the dog’s handler, a clinical psychologist (experimental condition) and an unstructured visit with the clinical psychologist alone (control condition). Blood pressure, heart rate, and the salivary biomarkers cortisol, alpha-amylase, and immunoglobulin A were collected before, after, and 30-minutes after both the experimental and control conditions. Significant decreases in cortisol were found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.007) and control condition ( p = 0.036). A significant decrease in HR was also found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.0046) and control ( p = 0.0119) condition. Results of this study supported that a VA facility dog paired with a palliative care psychologist had a measurable impact on salivary cortisol levels and HR in veterans.

Barriers between providers and families regarding palliative care integration in a multidisciplinary pediatric oncology practice.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 121-121
Author(s):  
Lauren Draper ◽  
Samantha Pannier ◽  
Karely Mann ◽  
Douglas Beaty Fair ◽  
Holly Perlman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Pediatric Oncology ◽  
Current System ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Providers ◽  
Major Barrier ◽  
Early Integration ◽  
Strongly Agree

121 Background: Pediatric oncology patients are known to have high symptom burden. The pediatric oncology population is a natural fit for early integration of palliative care (PC), yet there are often systemic and communication barriers. We assessed oncologists and supportive care providers’ beliefs about PC and described how well prognosis is currently communicated between clinical team members and families. Methods: Primary Children’s Hospital (PCH) is the only pediatric tertiary care hospital serving the Mountain West region. We conducted surveys and semi-structured interviews with all pediatric oncologists at PCH (N = 12) and supportive care providers such as nurses and social workers (N = 13). Surveys were also administered to caregivers of patients (N = 23). Descriptive statistics were generated. Results: Oncologists and and supportive care providers differ even in their beliefs about who should receive PC and when it should begin. 41.7% (N = 5) of attending pediatric oncologists strongly agreed that their patients could benefit from a comprehensive PC consultation and that this should happen around the time of diagnosis. Of the supportive care providers only 15% (N = 2) strongly agree that their patients could benefit from a PC consultation, but 38% strongly agree it should begin at the time of diagnosis. Of the physicians, 33% (N = 4) believe the system currently in place is “adequate,” while only 8% (N = 1) of supportive care providers agree. Physicians report 100% of the time that they “often or always” discuss prognosis with a family, but only 44% (N = 10) of caregivers strongly agree that prognosis was clearly explained. 57% (N = 4) of patients report additional emotional support would have been helpful. Conclusions: Less than half of providers feel their patients could benefit from a PC consultation, despite the majority feeling the current system is inadequate. Also, providers and caregivers perceive discussions about prognosis, a key part of comprehensive PC, in different ways. Our findings demonstrate that a major barrier to the integration of a comprehensive PC program may be a lack of agreement among providers on the team and ineffective communication with families.

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

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