Earlier access to palliative medicine: An experience of integration into a community oncology practice.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 92-92 ◽  
Author(s):  
Sandra Burcham ◽  
Jacqueline Matthews
Keyword(s):  
Palliative Care ◽  
Care Provider ◽  
Well Being ◽  
Quality Data ◽  
Medical Decision ◽  
Cancer Center ◽  
Full Time ◽  
Psychosocial Needs ◽  
Community Oncology ◽  
Oncology Practice

92 Background: A growing body of evidence supports the integration of palliative care as a standard for comprehensive cancer care. Through our experience as an inpatient palliative care provider, with 50% of our population having advanced cancer, we recognized the value proposition to provide continuity in the outpatient setting. Innovative Care Solutions developed a partnership with a large, community oncology program late 2015 for a palliative care multidisciplinary team to be embedded into one location of their practice. Methods: A full-time palliative licensed independent social worker (LISW) was dedicated to educate and engage screening process development. Utilizing the NCCN Distress Thermometer, referrals for care provision were then directed by the LISW to the most appropriate palliative care provider. The LISW addressed communication, goals of care discussions and advance directives. Identification of symptoms, including high level distress or mental health needs, were scheduled to see the palliative physician or advanced practice nurse, available two half days per week within the cancer center. Results: In the first quarter of service, the LISW screened a total of 85 patients, with 54 requiring PC interventions. Complex symptom needs were identified in seventeen percent, thirty percent were seen for psychosocial needs, and twenty percent were seen for completion of an advance directive. Thirty-six percent were seen for medical decision making. Conclusions: Integrating palliative care services in a community-based oncology practice has realized numerous positive patient outcomes and opportunities for further design. Using an evidenced based screening tool, identification of needs in an early access model appear to enable the patient to improve adherence to the medical plan care and avoid ER utilization. Symptom management has shown improved quality of life scores and PPS, and patient’s seen for psychosocial needs are able to explore aspects of person, as opposed to illness, that has improved overall well-being. Further program design will focus on integration of screening for all patients with advanced solid tumor, recurrent/refractory, and formalization of quality data tracking benchmarked to a web-based registry.

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.

Development of an aid to decision-making form (ADF) integrated into a major institutional program in oncology: A tool to support care goal identification.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18646-e18646
Author(s):  
Laurence Vigouret-Viant ◽  
Clemence Legoupil ◽  
Aurelie Bardet ◽  
Celine Laurent ◽  
Michel Ducreux ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Performance Status ◽  
Medical Decision ◽  
Cancer Center ◽  
P Value ◽  
Ecog Performance Status ◽  
Advance Care ◽  
Aggressive Care

e18646 Background: For cancer patients, life-threatening complications may be difficult to anticipate, leading to complex medical decision-making processes. Since 2015, the Gustave Roussy Cancer Center has implemented a major institutional program including a Decision-Aid Form (ADF), outlining the anticipation of appropriate care for patient in case of worsening evolution. Methods: Between January and May 2017, all patients transferred from Site 1 to Site 2 of the hospital were prospectively included. In this study, we assessed the acceptability of the ADF, its using and its impact on the patient’s becoming. Results: Out of 206 patients included, 89.3% had an ADF. The planned stratification of care was notified in practically all cases. Conversely, the involvement of the palliative care team was notified in only 29% of the ADF. The value of the WHO/ECOG Performance Status was limited, varying between physicians. Finally, the field “information for patients and relatives” was insufficiently completed. Although a possible transfer to Intensive Care Unit was initially proposed in two-thirds of the patients, the majority (76%) of the 35 patients experiencing an acute event received exclusive medical or palliative care. The level of therapeutic commitment suggested by the ADF was never upgraded, and often revised towards less aggressive care, and especially without excess mortality for the patients who were initially designated to be eligible for intensive care. Moreover, the patient's survival at 6 months seems to be correlated with the anticipated level of care recorded on the FAD (Log-rank P value < 0,0001). Conclusions: The results of our study suggest that setting up a care stratification file in advance is possible in a French cultural setting and it could be helpful for clarifying prognosis assessment. To achieve complete acculturation, our extensive institutional program remains a cornerstone for the development of advance care planning. Since 2017, this program has widely spreaded ADF which is now integrated into the electronic medical record. Each physician can complete and modify the patient's ADF at any stage of the patient's disease course.

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]

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.

Increasing clinical trial enrollment with the use of incentives in a community oncology practice.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 205-205
Author(s):  
Elizabeth M Blanchard ◽  
Ann-Marie Soucy ◽  
Therese M. Mulvey
Keyword(s):  
Clinical Trials ◽  
Fiscal Year ◽  
Cancer Center ◽  
Incentive Programs ◽  
Community Oncology ◽  
Medical Oncologists ◽  
Investigator Initiated Trials ◽  
Clinical Trial Enrollment ◽  
Oncology Practice ◽  
Oncology Providers

205 Background: Clinical trials represent a critical component of progress in cancer care, however, enrollment of patients onto adult cancer clinical trials remains disturbingly low at 3-5 percent of patients. In an effort to increase enrollment onto open trials at our center as well as to meet our ACOS requirements, our community cancer center instituted an incentive program to compensate the time medical oncology providers spend enrolling patients onto trials. Methods: In October of 2013 (the beginning of fiscal year 2014), an incentive was given to medical oncologists in our practice if they met an enrollment target of 1% of patients onto trials open at our center. Comparison of enrollment was performed between fiscal year 2014, when the incentive existed, and corresponding months of fiscal year 2013. Results: Enrollment at our center from October 2012-May 2013 was 9 patients with an average of 1.125 per month. For the corresponding period of October 2013-May 2014, when the incentive existed, enrollment was 48 patients, with an average of 6 patients per month. This far exceeded the 1% threshold required to achieve the incentive and has not abated despite the completion of the metric. In addition, enrollment has been similar to unfunded investigator initiated trials and pharmaceutical trials. Cooperative group trials remain limited by lack of funding. All physicians in the group have qualified for the incentive. Conclusions: Incentive programs designed to compensate the time involved with enrolling patients onto clinical trials was very effective in this busy community oncology practice.

Integrating contemplative and spiritual care in outpatient palliative care: A pilot study.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 247-247
Author(s):  
Craig D Blinderman ◽  
Alex Beth Schapiro
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Descriptive Analysis ◽  
Care Program ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Pilot Program ◽  
Palliative Care Program ◽  
Care Clinic

247 Background: Spiritual support is associated with better outcomes in cancer care and at the end of life (1, 2). Consensus guidelines advocate for incorporating spiritual care in the provision of specialist level palliative care (3). Contemplative care practices and chaplaincy interventions have the potential for mitigating existential distress, cultivating prognostic awareness, and fostering spiritual approaches to grieving and coping with advanced cancer. We present the results of a pilot program demonstrating the feasibility and impact of integrating a contemplative care chaplain in an outpatient palliative care program in a culturally diverse patient population in a large, academic cancer center. Methods: Case series and descriptive analysis. A description of 10 cases seen by a contemplative care chaplain in our outpatient palliative care clinic in the Herbert Irving Comprehensive Cancer Center (HICCC) at Columbia University will be presented. A descriptive analysis using a chaplaincy-centered model of assessment will highlight the domains of suffering and subjective integration of psychosocial and spiritual concepts. Results: Patients were generally in favor of meeting with and sharing their feelings openly with the chaplain. Patients’ describe important domains pertinent to their well being: meaning, family integration, spiritual practices, existential concerns, prognostic awareness. Subjective transformation and integration of the following constructs: “healing,” “gratitude,” “anger,” “hope,” “fear” were possible with only a few patient encounters. None of the patients were opposed to an initial visit and assessment. In only one case, the family requested not having further visits due to strong emotional reactions that came up. Conclusions: Preliminary results from a novel, pilot program integrating contemplative and spiritual care in an outpatient palliative care program suggest that it is a feasible intervention and should be considered in other cancer centers. Further studies will need to qualify and quantify the additional value and impact of spiritual care integrated in ambulatory palliative care services.

Understanding the challenges for oncologists in predicting the end-of-life phase of care in cancer patients with advanced solid tumor diagnoses.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 281-281
Author(s):  
Aaron J. Lyss ◽  
Cheryl A. Crouse ◽  
Natalie R. Dickson ◽  
Jeffrey Patton ◽  
Christopher A. Waynick ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Clinical Pathways ◽  
Treatment Plan ◽  
Metastatic Cancer ◽  
Life Phase ◽  
Community Oncology ◽  
Medicare Patients ◽  
Oncology Practice

281 Background: Early advanced care planning and palliative care improves outcomes during the end-of-life phase of care (EOL) for metastatic cancer patients. Identifying patients who are likely to transition to EOL is a necessary step to prioritize limited palliative care resources and is integral to success in value-based payment models. We analyzed whether physician documentation of prognosis in a clinical pathways system (CPS) could reliably predict when patients are nearing EOL for a large community oncology practice of more than 70 medical oncologists. Methods: Tennessee Oncology (TO) requires physicians to use CPS for all Medicare patients. CPS prompts physicians to answer the “prognostic question” “would you be surprised if this patient died in the next year?” for all OCM patients with advanced solid tumors at the beginning of treatment or at the time of a change in treatment plan. Prognostic question responses were compared to actual dates of death documented in the practice management system. Results: A total of 5,266 distinct patients were expected to trigger an OCM episode during 2017. The CPS prompted a response to the prognostic question for 1,228 (23%) of these OCM patients. There were 665 (54%) positive prognoses (expect patient to live more than 1 year) and 563 (46%) negative prognoses (expect patient to die within 1 year). Physicians documented accurate prognoses in 712 (58%) of cases. For patients with positive prognosis 557 (84%) were accurate. For patients with negative prognosis 155 (21.8%) were accurate. Conclusions: We found that for patients with terminal cancer, it is difficult for physicians to accurately predict prognosis. These findings support the importance of ASCO guidelines pertaining to patient access to palliative care during the entirety of cancer treatment for all patients with metastatic cancer. [Table: see text]

Impact of a central review oncology clinical pharmacist in a community oncology practice.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 68-68
Author(s):  
Julianna Kula ◽  
Shannon Hough ◽  
Josh Howell
Keyword(s):  
Clinical Pharmacist ◽  
Cost Effective ◽  
Cost Of Care ◽  
Financial Impact ◽  
Full Time ◽  
Community Oncology ◽  
Medication Dose ◽  
Oncology Practice ◽  
Clinical Changes ◽  
The Impact

68 Background: The impact and role of a clinical pharmacist in a community oncology setting is not well-described in the literature. The US Oncology Network recently implemented a central clinical pharmacist review program (ClinReview) to offer oncology remote clinical pharmacist services to practices. Methods: An oncology-trained clinical pharmacist electronically reviewed recently placed or modified chemotherapy regimen orders within a community oncology practice. The ClinReview pharmacist identified opportunities to modify ordered therapy based on clinical components, waste reduction, or financial stewardship. Recommendations were discussed with the treating oncologist at the practice or modified if permitted by approved practice policy. The pharmacist was appointed at 0.5 full-time equivalents (FTE). Financial and workload metrics were tracked to monitor the impact of the pharmacist work. Results: In 10 weeks, 388 reviews were documented and 191 (49.2%) required a modification by the pharmacist. Recommended modifications included dose rounding (n=90, 47%), a clinical change (n=72, 38%), or product substitution (n=29, 15%). The most common clinical changes included modifications to supportive care (n=32, 44%), recommendations for additional monitoring (n=19, 26%), or modifications to anti-cancer medication dose or frequency (n=18, 25%). The financial impact of the pharmacist resulted in margin improvements totaling $106,043 and a $462,305 reduction in the total cost of care in medication expenses (Table). The expense of the pharmacist during this period was $18,095. The return on investment for the pharmacist compared to margin improvement was 590%. Conclusions: An oncology clinical pharmacist is a cost-effective and valuable member of the care team in community oncology practice. The pharmacist identified opportunities to improve medication safety, regimen optimization, and demonstrated significant financial impact for the practice, payers, and patients.[Table: see text]

scholarly journals Implementation of Electronic Patient-Reported Outcomes for Symptom Monitoring in a Large Multisite Community Oncology Practice: Dancing the Texas Two-Step Through a Pandemic

2021 ◽  
pp. 615-621
Author(s):  
Debra Patt ◽  
Lalan Wilfong ◽  
Kathryn Elizabeth Hudson ◽  
Amila Patel ◽  
Holly Books ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Text Message ◽  
Well Being ◽  
Ease Of Use ◽  
Self Report ◽  
Symptom Monitoring ◽  
Community Oncology ◽  
Patient Reported ◽  
Oncology Practice ◽  
E Mail

PURPOSE Among patients receiving chemotherapy, symptom monitoring with electronic patient-reported outcomes (ePROs) is associated with improved clinical outcomes, satisfaction, and compliance with therapy. Standard approaches for ePRO implementation are not established, warranting evaluation in community cancer practices. We present implementation findings of ePRO symptom monitoring across a large multisite community oncology practice network. METHODS Patients initiating a new systemic therapy at one of the 210 practice sites at Texas Oncology were invited to use the Navigating Cancer ePRO platform, with stepped-wedge implementation from July to December 2020. Participating patients received a weekly prompt by text message or e-mail to self-report common symptoms and well-being. Severe self-reported symptoms triggered a real-time notification to nursing triage to address the symptom. Enrollment and compliance were systematically tracked weekly with evaluation of barriers and facilitators to adoption and sustainability. RESULTS Four thousand three hundred seventy-five patients planning systemic treatment were enrolled and participated. Seventy-three percent (1,841 of 2,522) of enrolled patients completed at least one ePRO assessment. Among these individuals, 64% (16,299 of 25,061) of available weekly ePRO assessments were completed. Over a 10-week period, compliance declined from 72% to 52%. Barriers currently being addressed include lack of a second reminder text or e-mail prompt, inconsistent discussion of reported ePROs by clinicians at visits, and COVID-related changes in workflow. Facilitators included ease of use and patient and staff engagement on the importance of PROs for symptom management. CONCLUSION ePROs can be effectively implemented in community oncology practice. Utilization of ePROs is high but diminishes over time without attention to barriers. Ongoing work to address barriers and optimize compliance are underway.

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