Oncology fellows' current practice regarding concurrent outpatient oncology and palliative care.

122 Background: It is accepted that Palliative Care provides additional support and improves overall care to oncology patients. Literature supports early referral and integration of Palliative Care with standard oncology care and is a guideline from the American Society of Clinical Oncology. In order to make palliative care integration a standard of care, Oncology Fellows should be learning to integrate during their fellowship years. There is little information regarding the Palliative Care experience in the outpatient setting for Oncology Fellows in the United States. This study looked at the current practice model in regards to concurrent Oncology and Palliative Care in the outpatient setting. Methods: An electronic nationwide survey of medical Oncology Fellows was conducted in the second half of the academic year in 2018. Results: 43 of 191, 22.5% Fellows contacted at 17 institutions responded. 98% of the fellows’ hospital systems offered ambulatory palliative care with 79% having a palliative care specialist available during their ambulatory Oncology clinic. 55% of the Fellows’ patient referrals are occurring when they still have multiple lines of cancer directed treatment planned, and the most common initial referral reason is for symptom management. 97% of fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics. Although no participants stated their initial consult request was for psychosocial and/or spiritual support, 95% strongly agreed or agreed that Palliative Care helps ensure these issues are addressed. Conclusions: Early integration of Palliative Care is occurring in the 17 responding institutions around the country as 97% of Fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% of oncology fellows indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics.

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The experience of the "Program of palliative care in an outpatient setting in the Dnipro City for 2018-2021" implementation: the problems and prospects

Health of Society ◽

10.22141/2306-2436.10.2.2021.238582 ◽

2021 ◽

Vol 10 (2) ◽

pp. 61-67

Author(s):

A.V. Tsarenko ◽

A.A. Babskiy ◽

Yu.V. Krynychniy ◽

Yu.Yu. Shchetko

Keyword(s):

Health Care ◽

Palliative Care ◽

Outpatient Setting ◽

Palliative Care Team ◽

City Council ◽

Care Team ◽

Specialized Palliative Care ◽

The Government ◽

The City ◽

At Home

Background. Many Ukrainian authors noted that an innovative System of Palliative and Hospice Care (PHC) and Social Services for Palliative Care (SSPC) the creation and implementation are the most important medical and social tasks of the Government and society in Ukraine today which appreciate the civilization and humanity of our state and society. PHC are a modern patient-family-oriented humanitarian approach that contributes to the preservation of the human dignity of palliative care patients (PCP) and can ensure the proper quality of life of PCP and their relatives. According to the WHO and the Council of Europe Committee of Ministers Recommendations, palliative care should be one of the priorities of the Health Care Government Policy in the European region. The purpose of the study: the "Program of palliative care in an outpatient setting in Dnipro City for 2018-2021" the implementation analysis. Materials and methods. The work used national and international legal documents and literature sources, data from medical statistics, methods of systemic and structural-functional analysis, bibliosemantic and statistical research methods. Results. The international and national legal documents and scientific literature a content analysis showed that in accordance with modern approaches and standards, PHC is provided taking into account the PCP and its family members needs, wishes and consent, depending on medical, demographic, socio-economic and cultural ethnic features of the region. A comparative analysis of the PHC state in Ukraine and Dnipro City showed some regional features, in particular, the significant need to provide PHC and SSPC to patients at home and the need and ensure a mechanism of cooperation between primary health care physicians, inpatient health care and social care institutions to develop. In 2017, the “Program of outpatient palliative care in Dnipro City for 2018–2021” (hereinafter - the Program) was developed and approved at the City Council session, which allowed the PHC and SSPC multidisciplinary and interagency approaches implementation, effective interdepartmental coordination, cooperation and the continuity of PHC and SSPC to ensure. The Multidisciplinary Mobil Specialized Palliative Care Team has been working in close contact with family doctors and social workers in the city since June 2019. As part of the Program, PCP are provided with medicines, technical and other means of care and rehabilitation free of charge or on preferential terms. In addition, the Palliative Care Team provides PCP, if indicated, oxygen concentrators and anti-decubitus mattresses. The Program creates points for renting medical care for PCP (wheelchairs, walkers, anti-decubitus mattresses, crutches, etc.), as well as providing patients with medical care at home (urine and feces, diapers, etc.). In 2020, UAH 300,000 was allocated from the Program budget for the Palliative Care Team with medical equipment, medicines and rehabilitation technical means complete set. In total, it is planned to allocate over UAH 40 million from the Dnipro City Budget for the Program implementation. Conclusions. 1. Thus, today in Dnipro City the Comprehensive Palliative Care System at home is implemented due to co-financing from the State Budget and due to the "Program of palliative care in outpatient conditions in Dnipro City for 2018-2021", approved by the Dnipro City Council the deputies. 2. An important condition for comprehensive provision of the Dnipro City population needs in PHC and SSPC is the Dnipro City Council support to create a modern accessible, high-quality and efficient PHC and SSPC service, which an effective interagency coordination, continuity and cooperation between health care providers and social care institutions provides, Multidisciplinary Mobil Specialized Palliative Care Team creation and development of in each the city district, the coordination and continuity of inpatient PHC in the city health provides. 3. There is both the Government support and municipal or regional budgets support for PHC Programs in many developed countries. The international PHC standards and experience implementation can significantly the provision of needs and the quality of life of both PCP and their families improve.

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Utilization of palliative care services in patients who died from stage IV non-small cell lung cancer (NSCLC): A retrospective study from a tertiary care center in rural Maine.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.95 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 95-95

Author(s):

Sheila Rajan ◽

Anannya Patwari ◽

Vineel Bhatlapenumarthi ◽

Antoine Joseph Harb

Keyword(s):

Palliative Care ◽

Tertiary Care ◽

Stage Iv ◽

Outpatient Setting ◽

Palliative Care Team ◽

Care Team ◽

Cancer Center ◽

Inpatient Setting ◽

Care Services ◽

Palliative Care Services

95 Background: It is known that palliative care involvement in metastatic NSCLC cancer patients has been shown to improve quality of life in previous studies. The aim of our study was to analyze the utilization of palliative care services among patients who died from NSCLC and the setting in which these patients first received palliative care. Methods: This is a retrospective chart review analysis of patients with stage IV NSCLC who were diagnosed at Eastern Maine Medical center and the affiliated cancer center who died between January 2016 and December 2018. We collected demographic data, date and stage of diagnosis, location of palliative referral, location of first palliative care contact with the patient, time between diagnosis and death, utilization of hospice services and time between the initial palliative care consult and death. Results: 255 patients with stage IV NSCLC died between 2016 and 2018. Mean age was 65.5 years. Women were 49% and men were 51%. Majority (60%) of patients had good performance status with ECOG score between 0-1 at presentation. All 255 patients were referred to palliative care. The location of initial palliative care referral following diagnosis was 40% from the hospital, 32% from the oncology clinic and 28% from the outpatient specialist or PCP office. Overall, 174 patients (68%) were seen by palliative care and 81 (32%) were not seen. Of the patients seen 119 (68%) had their initial palliative evaluation in the hospital, and 55 (32%) in the clinic. Majority (55%) had more than one follow-up visit. Consults initiated in the inpatient setting were more likely to be seen by palliative care than in the outpatient setting (p 0.0009). Time between diagnosis to palliative care consult was less than one month in 39%, 1-2 months in 25%, 2-6 months in 21%, and more than 6 months in 14% patients. Patients seen by palliative care had a more likelihood to end up on hospice (p 0.09). The majority of patients seen by palliative care (53%) died within a month of initial consultation. Conclusions: All patients in our study population were referred to palliative care with 100% provider compliance. Among these, 68% were seen by palliative care. Interestingly, inpatient referrals were more likely to be seen by palliative care than the outpatient referrals. We think this is likely related to ease of access to palliative care team in the hospital as well as some of the patients being at terminal stages of their disease. About 33% of patients died within a month of their initial diagnosis, likely giving palliative care team a shorter window of opportunity to be seen in the outpatient setting. Prioritizing referrals of stage IV NSCLC patients might decrease the wait time after initial referral and increase the availability of palliative care services to these patients.

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