scholarly journals 1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

2018 ◽  
Vol 14 (12) ◽  
pp. e775-e785 ◽  
Author(s):  
Anjali V. Desai ◽  
Virginia M. Klimek ◽  
Kimberly Chow ◽  
Andrew S. Epstein ◽  
Camila Bernal ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Outpatient Clinic ◽  
Core Values ◽  
Newly Diagnosed ◽  
Care Needs ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Palliative Care Needs

Background: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. Methods: We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. Results: All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Conclusion: Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.

Enhancing palliative care consultation workflow on an inpatient oncology unit.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 208-208
Author(s):  
Amanda Hazeltine ◽  
Kathryn Liziewski ◽  
Ashley Lin ◽  
Samantha Creamer ◽  
Kathryn Walker ◽  
...  
Keyword(s):  
Palliative Care ◽  
Screening Tool ◽  
Communication Process ◽  
Care Needs ◽  
Multidisciplinary Communication ◽  
Pilot Survey ◽  
Palliative Care Consultation ◽  
Multidisciplinary Rounds ◽  
Care Consultation ◽  
Palliative Care Needs

208 Background: The American Society of Clinical Oncology practice guidelines recommend early palliative care integration for all patients with cancer. At UMass Memorial Medical Center from Sept. to Nov. 2020, only 16% (29/184) of patients on the inpatient oncology unit received a palliative care consultation. Of these consultations, 55% (16/29) were placed within 72 hours of admission. Results from a pre-pilot survey of nurses (n = 20) and providers (n = 14) about attitudes toward palliative care, team communication, and perceptions of barriers to palliative care consultation highlighted a lack of multidisciplinary communication and consensus on criteria for palliative care consultation. Methods: An evidence-based palliative care screening tool and multidisciplinary communication process was piloted to support team collaboration and early identification of oncology patients who may benefit from specialty-level inpatient palliative care. The primary objective was to increase the percentage of palliative care consultations placed within 72 hours of admission from 55% to 65%. Nurses screened patients upon unit arrival for palliative care needs. Patients who screened positive were discussed during daily multidisciplinary rounds, attended by the resource nurse, primary team, case manager and social worker. Results: In March 2021, the percentage of palliative care consultations placed by providers within 72 hours of inpatient admission increased to 68% (13/19). The proportion of patients who received palliative care consultation also increased to 29%. All the patients who screened positive for palliative care needs received a consultation. In a post-pilot survey of providers (n = 9) and nurses (n = 14), most providers (78%) reported that discussions of patients’ palliative care needs occurred more frequently during multidisciplinary rounds. A majority of nurses (57%) agreed the screening tool led to enhanced multidisciplinary communication. 63% of providers agreed that criteria for palliative care consultation was clearer as a result of the pilot; both nurse and provider perceptions of “lack of provider agreement on palliative care consultation criteria” as a barrier decreased compared to the pre-pilot survey. Although a majority of nurses (71%) found the screening tool easy to use, only half were comfortable with all the questions or understood them completely. All providers and 93% of nurses preferred to continue using the screening tool and communication process, and supported electronic medical record integration. Conclusions: The palliative care screening tool and workflow process had a positive impact on earlier identification of oncology patients who could benefit from specialty palliative care, and increased the total number of palliative care consultations. This improved process also enhanced team communication and collaboration. Next steps include refining the screening tool and EMR integration.

scholarly journals E10-B Palliative Care Needs at Different Phases in the Illness Trajectory: A Survey Study in Patients with Cancer

2016 ◽  
Vol 52 (6) ◽  
pp. e45
Author(s):  
Kim Beernaert ◽  
Koen Pardon ◽  
Lieve Van den Block ◽  
Dirk Devroey ◽  
Martine De Laat ◽  
...  
Keyword(s):  
Palliative Care ◽  
Survey Study ◽  
Care Needs ◽  
Illness Trajectory ◽  
Patients With Cancer ◽  
Palliative Care Needs

Pulmonary referrals to specialist palliative medicine: a survey

2021 ◽  
pp. bmjspcare-2021-003386
Author(s):  
Michael Bonares ◽  
Kenneth Mah ◽  
David Christiansen ◽  
John Granton ◽  
Andrea Weiss ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Chronic Respiratory Disease ◽  
Life Care ◽  
Care Needs ◽  
Patients With Cancer ◽  
Referral Criteria ◽  
Referral Practices ◽  
Palliative Care Needs

ObjectivesPatients with chronic respiratory disease have significant palliative care needs, but low utilisation of specialist palliative care (SPC) services. Decreased access to SPC results in unmet palliative care needs among this patient population. We sought to determine the referral practices to SPC among respirologists in Canada.MethodsRespirologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional and attitudinal factors were analysed using regression analyses.ResultsThe response rate was 64.7% (438/677). Fifty-nine per cent of respondents believed that their patients have negative perceptions of palliative care and 39% were more likely to refer to SPC earlier if it was renamed supportive care. While only 2.7% never referred to SPC, referral was late in 52.6% of referring physicians. Lower frequency of referral was associated with equating palliative care to end-of-life care (p<0.001), male sex of respirologist (p=0.019), not knowing referral criteria of SPC services (p=0.015) and agreement that SPC services prioritise patients with cancer (p=0.025); higher referral frequency was associated with satisfaction with SPC services (p=0.001). Late referral was associated with equating palliative care to end-of-life care (p<0.001) and agreement that SPC services prioritise patients with cancer (p=0.013).ConclusionsPossible barriers to respirologists’ timely SPC referral include misperceptions about palliative care, lack of awareness of referral criteria and the belief that SPC services prioritise patients with cancer. Future studies should confirm these barriers and evaluate the effectiveness of strategies to overcome them.

Health professionals' views on services for patients with cancer-related palliative care needs

2006 ◽  
Vol 13 (1) ◽  
pp. 15-21
Author(s):  
Margaret Thomson ◽  
Paula Hourston ◽  
Jo Ladley ◽  
Leigh Findlay ◽  
Aileen Kelly
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Care Needs ◽  
Patients With Cancer ◽  
Palliative Care Needs

Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database

2016 ◽  
Vol 34 (7) ◽  
pp. 685-691 ◽  
Author(s):  
Motoko Sano ◽  
Kiyohide Fushimi
Keyword(s):  
Palliative Care ◽  
Elderly Patients ◽  
End Of Life ◽  
Hospital Setting ◽  
Geriatric Oncology ◽  
National Database ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern. Objective: To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database. Methods: We conducted a multicenter cohort study of patients aged ≥65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage ≥3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using χ2 and logistic regression analyses. Results: We included 26 012 patients in this analysis. The mean age was 75.74 ± 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young–old, and patients with primary cancer. Conclusion: Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.

scholarly journals The Role of Palliative Care in Oncology

2017 ◽  
Vol 34 (04) ◽  
pp. 307-312 ◽  
Author(s):  
Rajiv Agarwal ◽  
Andrew Epstein
Keyword(s):  
Palliative Care ◽  
Symptom Burden ◽  
Well Being ◽  
Care Needs ◽  
Patients With Cancer ◽  
Living With Cancer ◽  
Palliative Care Needs ◽  
Shed Light

AbstractPalliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.

scholarly journals Patterns of Palliative Care Consultation Among Elderly Patients With Cancer

2016 ◽  
Vol 14 (4) ◽  
pp. 439-445 ◽  
Author(s):  
Eric J. Roeland ◽  
Daniel P. Triplett ◽  
Rayna K. Matsuno ◽  
Isabel J. Boero ◽  
Lindsay Hwang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Elderly Patients ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation

Neuropalliative Care in the Inpatient Setting

2021 ◽  
Vol 41 (05) ◽  
pp. 619-630
Author(s):  
Adeline L. Goss ◽  
Claire J. Creutzfeldt
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Treatment Options ◽  
Inpatient Setting ◽  
Shared Decision ◽  
Care Needs ◽  
Goals Of Care ◽  
Advanced Stages ◽  
Palliative Care Needs

AbstractThe palliative care needs of inpatients with neurologic illness are varied, depending on diagnosis, acuity of illness, available treatment options, prognosis, and goals of care. Inpatient neurologists ought to be proficient at providing primary palliative care and effective at determining when palliative care consultants are needed. In the acute setting, palliative care should be integrated with lifesaving treatments using a framework of determining goals of care, thoughtfully prognosticating, and engaging in shared decision-making. This framework remains important when aggressive treatments are not desired or not available, or when patients are admitted to the hospital for conditions related to advanced stages of chronic neurologic disease. Because prognostic uncertainty characterizes much of neurology, inpatient neurologists must develop communication strategies that account for uncertainty while supporting shared decision-making and allowing patients and families to preserve hope. In this article, we illustrate the approach to palliative care in inpatient neurology.

Sign in / Sign up

Export Citation Format

Share Document