Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement

Purpose: Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. Methods: An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Results: Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. Conclusion: This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts.

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Defining high-quality palliative care in oncology practice: An ASCO/AAHPM Guidance Statement.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.108 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 108-108 ◽

Cited By ~ 2

Author(s):

Kathleen Elizabeth Bickel ◽

Kristen K. McNiff ◽

Mary K. Buss ◽

Arif Kamal ◽

Dale Lupu ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Care Delivery ◽

Care Service ◽

Performance Status ◽

Palliative Care Service ◽

Symptom Burden ◽

Psychosocial Assessment ◽

Poor Performance Status ◽

High Quality

108 Background: When integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to subspecialty palliative medicine for referral. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. Methods: An expert steering committee developed a list of 966 palliative care service items, divided into nine domains, each describing an aspect of palliative care delivery for patients with advanced cancer. Using a modified Delphi methodology, 31 multi-disciplinary panelists ranked each service item according to importance, feasibility and scope. Results: Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision-Making (79%); and Care Planning (78%). Lowest proportions were in: Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea and pain. Under the domain of Appropriate Palliative Care and Hospice Referral, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients with an expected survival of under 3 months or poor performance status (Zubrod 3-4) to hospice. Conclusions: This statement describes high-quality palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find the guidance useful to inform operational changes and quality improvement efforts.

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Consensus development: Within general oncology practice, what constitutes high-quality palliative care delivery?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.280 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 280-280

Author(s):

Kathleen Elizabeth Bickel ◽

Kristen McNiff ◽

Jennifer Malin ◽

Amy Pickar Abernethy ◽

Anupama Kurup Acheson ◽

...

Keyword(s):

Palliative Care ◽

Care Delivery ◽

Symptom Assessment ◽

The United States ◽

Scope Of Practice ◽

Care Practice ◽

High Quality ◽

Consensus Definition ◽

Diverse Range ◽

Oncology Practice

280 Background: Multiple studies illustrate the benefits of combined palliative and standard cancer care, but oncology practices need guidance to fill existing gaps in delivering high quality palliative care (PC) to cancer patients. As a first step, ASCO and the American Academy of Hospice and Palliative Medicine (AAHPM) sought to develop a consensus definition of which PC aspects are within the purview of general adult oncology practice in the United States. Methods: An ASCO and AAHPM steering group used existing publications to define 9 domains of PC in oncology: Symptom Assessment and Management (A&M), Psychosocial A&M, Spiritual and Cultural A&M, Communication and Shared Decision-Making, Care Planning, Appropriate Palliative Care and Hospice Referral, Coordination and Continuity of Care, Carer Support, and End-of-Life Care. Within each domain, key PC activities were itemized and described (e.g. pain assessment using a standardized scale at every clinical encounter), totaling 966 activities. A 31-member multidisciplinary panel participated in a modified RAND Delphi process, rating each activity on a 9-point scale according to 3 constructs: importance, feasibility, and scope of practice. Composite scoring categorized activities as either reasonably within scope of oncology practice, uncertain, or typically not in scope. Results: The response rate for each round was 94%. Notable panelist concerns included the breadth of palliative care practice, the varied access that oncology practices have to PC resources, and the varied individual knowledge and comfort with specific activities. Despite multiple small ranking changes between surveys, only 41 activities changed in scope of practice category. Of 966 activities, 62% were ranked as reasonably within scope of oncology practice, 36% were uncertain, and 2% were typically not in scope. Conclusions: Despite the diverse range of PC activities, panelists strongly agreed that more than half were reasonably within the scope of adult medical oncology practice. These items provide a foundation for improving palliative care delivery within an oncology practice, with suggestions for future performance measures and quality improvement activities.

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The Griffith Area Palliative Care Service: A Pilot Project

Australian Health Review ◽

10.1071/ah030011 ◽

2003 ◽

Vol 26 (2) ◽

pp. 11 ◽

Cited By ~ 10

Author(s):

Ian Hatton ◽

Keith Mcdonald ◽

Lynette Nancarrow ◽

Keith Fletcher

Keyword(s):

Health Care ◽

Palliative Care ◽

Health Care Services ◽

Care Delivery ◽

Care Service ◽

Palliative Care Service ◽

Pilot Project ◽

Service Development ◽

Care Services ◽

Rural And Remote Areas

In September 2000 the Commonwealth released, as part of its National Palliative Care Strategy under the AustralianHealth Care Agreements, a National Framework for Palliative Care Service Development. The new NationalFramework stressed an important set of values to guide models of palliative care delivery. It notes that the challenge isto secure the place of palliative care as an integral part of health care across Australia, routinely available within localcommunities to those people who need it. Care and support for people who are dying and their families need to bebuilt not only into health care services, but also into the fabric of communities and their support networks. While fewwould disagree with this, little is known about how best to achieve it in rural Australia. The Griffith Area PalliativeCare Service (GAPS) is a two-year pilot project delivering a palliative care service through a truly integrated approachto care for patients, their carers and families within the Griffith Local Government Area and Carrathool Shire areas.This paper describes how GAPS is successfully meeting the challenges of service provision to rural and remote areas.

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Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

Acta Oncologica ◽

10.1080/0284186x.2020.1736335 ◽

2020 ◽

Vol 59 (6) ◽

pp. 620-627

Author(s):

Daniela D’Angelo ◽

Marco Di Nitto ◽

Diana Giannarelli ◽

Ileana Croci ◽

Roberto Latina ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Advanced Cancer ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Care Service ◽

Palliative Care Service

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Home Palliative Care for Advanced Cancer: PC Can Be Introduced at Diagnosis or at Relapse in Thai Society, Independent of Oncology Service

Journal of Global Oncology ◽

10.1200/jgo.18.76800 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 112s-112s

Author(s):

I. Nuchprayoon

Keyword(s):

Palliative Care ◽

Cancer Therapy ◽

Advanced Cancer ◽

Care Service ◽

Palliative Care Service ◽

Metastatic Breast ◽

Cancer Center ◽

Ageing Population ◽

Oncology Service ◽

At Home

Background: Thailand is a resource-limited country with universal health care. Cancer services are available for everyone for free, but the system has been overloaded due to limited number of qualified specialist physicians, nurses, radiology technicians, and growing demand from ageing population. Patients with advanced cancer are often not referred to a palliative care (PC) service until multiple treatment failure. Aim: To provide a better access to PC, we initiated an independent palliative care counseling and home service, focusing on families of patients with advanced cancer. Methods: The families of patients with advanced cancer were referred to our home palliative care service through cancer patient support groups, self-referral or from other physicians. Eligibility for PC was guided through a Thai national guideline of cancer treatment as well as by NCCN guideline. Early stage cancer were excluded from the service and referred to oncology service of patient's choice. For each family, we arranged a family meeting/counseling session at patient's home or a designated place and introduce palliative care as well as cancer therapy options. If the patient choose palliative care, then we provide home PC. Patients are followed at home by home visits, and continually communicated online and by phone. Family members visits palliative clinic for morphine and other medications. Results: In the first 3 years of operation, 53 adult patients with advanced or recurrent cancer and their families were counseled. Fifty chose home palliative care service, exclusively (30) or along with a hospital oncology service (20), while 3 patients preferred life-prolonging cancer therapy. The average age (±SD) of patients were 60 (±16) years. The most common cancers were stage IV or metastatic breast (7), lung (6), colorectal (6), and leukemia/lymphoma (6). The median survival time of this PC cohort was 3.1 months, with 16 (32%) living > 6 months, and 10 (20%) > 1 year. Of 36 patients who had died, 22 (61%) died at home, 13 (36%) at a local hospital, and 1 (3%) at a cancer center. Conclusion: For advanced cancer patients, palliative care can be introduced early and efficiently by PC team and most people would prefer PC. PC counseling may serve as an entry point to cancer care system. For patients who choose early palliative care, it can reduce burden on the existing busy oncology service, while providing satisfaction on patients and family.

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Documentation of Assessment of Spiritual Concerns of Adult Advanced Cancer Patients: An Audit in a Hospital-based Specialist Palliative Care Service

Indian Journal of Palliative Care ◽

10.25259/ijpc_49_21 ◽

2021 ◽

Vol 0 ◽

pp. 1-8

Author(s):

Jayita Deodhar ◽

Naveen Salins ◽

Mary Ann Muckaden

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Service ◽

Palliative Care Service ◽

Practice Change ◽

Care Staff ◽

Specialist Palliative Care ◽

Patient Assessment ◽

Advanced Cancer Patients

Objectives: Spirituality is a significant dimension of quality palliative care service provision. The purpose of our audit was to assess current practice and improve documentation of spiritual concerns of adult advanced cancer patients in a specialist palliative care (SPC) service in a tertiary care cancer centre. Materials and Methods: In a standard-based audit, we measured the percentage of patient assessment forms with documentation of assessed spiritual concerns at a baseline and reaudit after practice change measures. We set the optimum standard that at least 60% of the case forms would have patients’ spiritual concerns recorded. We implemented the following measures – (1) engaging our palliative care staff in team discussions on existing practice and identifying problems and (2) conducting a structured 2 h training module for assessment and documentation of patients’ spiritual concerns. Results: About 70.8% and 93.4% of the patient assessment forms included had documentation of assessed spiritual concerns which is higher than the standard we set at 60% and 90% at baseline and after implementing practice change, respectively. In the reaudit, we found that documentation specific to spirituality and overall psychological assessment improved. We identified that a persisting problem was the lack of recording of spiritual assessment in the patients’ follow-up notes. Conclusion: We achieved the benchmark of a standard-based audit on documentation of assessed spiritual concerns of advanced cancer patients in our SPC service. Regular audits in clinical service delivery and documentation should be integrated into quality improvement measures in palliative care.

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Association between Depressive Disorder and Clinical Factors in Mexican Patients with Advanced Cancer in Palliative Care Service

10.26226/morressier.5c76c8b7e2ea5a723761207b ◽

2019 ◽

Author(s):

Oscar Rodríguez-Mayoral

Keyword(s):

Palliative Care ◽

Depressive Disorder ◽

Advanced Cancer ◽

Care Service ◽

Palliative Care Service ◽

Clinical Factors ◽

Mexican Patients

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Role of palliative care department in modifying ICU admissions for patients with advanced cancer: A study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19517 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19517-e19517 ◽

Cited By ~ 1

Author(s):

Rakesh - ROY

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Service ◽

Information Source ◽

Palliative Care Service ◽

Do Not Resuscitate ◽

Exclusion Criteria ◽

Care Department ◽

Operative Care

e19517 Background: Admission of cancer patients are on the rise in the Intensive Care Unit due to advancement in healthcare facilities. But limited number of ICU beds, health resources and lack of structured Palliative Care services are a matter of concern. Methods: A retrospective study was conducted in an Indian tertiary cancer centre from Jan – Jun 2010 to find out total number and cause of ICU admission of advanced cancer patients when a Palliative Care Department did not exist. Information source were case files and interviews after appropriate consent. Exclusion criteria - age < 18 years, post operative care, complications arising from a major surgery, established oncological emergencies, patients with curative intent. With a 24 hr Palliative Care department under operation from Aug 2010 - another similar study was performed from Jan – Jun 2011. Results: Jan – Jun 2010: Total admissions 542. 297 patients matched the exclusion criteria. Of the remaining 245 patients (45.2%) considered for the study 35 patients (14.2%) died. 11 patients (4.4%) were put on ventilator. Average occupancy of bed 5 days. Commonest cause was respiratory distress. Review of the case notes revealed 54 patients (22%) were admitted due to lack of Palliative Care service. Study was repeated from Jan – Jun 2011 after the initiation of a Palliative care Department from Aug 2010. Out of 487 patients, 195 patients (40%) were considered for study. 18 (9.2%) died. 6 patients (3%) were put on ventilator. The average duration of stay was 4 days. Components of Palliative Care like good communication, early consent from patients as to where they wish to die, do not resuscitate policy for some patients in the background of ethical issues, 24 hour Palliative care service, emergency helpline, home based care, good psychological counselling etc were identified as the key reasons for reduced admissions. Conclusions: Effective round the clock Palliative care service can increase ICU bed turnover, reduce misery of the patients and their family members, save resources, giving patients with longer survival chances a hope to live longer.

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A three step process to create a palliative medicine co-management model of care on an inpatient hematology unit.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.141 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 141-141

Author(s):

Gene Decastro ◽

Bridget Earle

Keyword(s):

Palliative Care ◽

Palliative Medicine ◽

Performance Metrics ◽

Care Delivery ◽

Palliative Care Service ◽

University Hospital ◽

Management Model ◽

Inpatient Service ◽

Step Process ◽

Complex Patients

141 Background: Northwell Health’s North Shore University Hospital (NSUH) campus has a dedicated hematology unit. This cohort of patients is under-represented on our inpatient palliative care service, comprising < 1% of initial consultations in 2016. Given recent recommendations by the American Society of Clinical Oncology about comprehensive cancer care, and recognizing the growing need for palliative care for patients with hematological malignancies, our goal was to initiate a concurrent hematologic and palliative care delivery model. Methods: A three step process was initiated – inpatient service buy-in and joint workgroup development, concurrent care delivery, and linkage to outpatient partners. The first step was to obtain buy-in with faculty stakeholders at our institution, including Hematology-Oncology leadership. There was immediate support for a partnership. Next, a workgroup was assembled to jointly generate a needs assessment survey to determine how best to assist in the care of these complex patients. Additionally, we identified key metrics to measure, and linked our inpatient service with outpatient care via our Supportive Oncology practice. Results: The five month process culminated in biweekly “screening rounds” with the Hematology team which were initiated in June 2017 and used as a first step to identify high-need patients for consultation. The workgroup agreed upon performance metrics which included hematologic diagnosis, reason for consult, time to consult from admission, length of stay, documentation of advance directives and goals of care, and outpatient referrals. Conclusions: Through relationship management, workgroup development, and care transition to community, an inpatient supportive care co-management model for patients with hematologic malignancies was successfully implemented using a three-step process. This format and strategy can be replicated for other services with complex patients. Future analysis of the outcome metrics will be able to provide feedback to the Palliative – Hematology services. By creating health care pathways with an emphasis on Palliative Medicine co-management, we are poised to deliver comprehensive care and measure its impact.

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