Skip to main content

Analysis

How to Offer Palliative Care in Oncology Outpatient Clinics

By Christopher Cheney  
   January 03, 2019

This approach features a collaboration between the clinical team and a nurse practitioner specialized in palliative care.

In oncology outpatient clinics, a structured, scheduled, and systematic approach can deliver palliative care to cancer patients at any stage of their illness, recent research shows.

Previous research has shown that combining palliative care with oncologic care generates several benefits, including increased survival and improved symptoms, quality of life, and satisfaction with care. In cost savings, providing palliative care to cancer patients reduces utilization of emergency and intensive care.

"Rapid growth over the past two decades has increased the availability of palliative care specialists from 25% to 75% in U.S. hospitals with more than 50 beds. However, access to such specialists in the outpatient setting remains limited, and in all care settings, workforce shortages and other factors constrain the role of these specialists in meeting the palliative care needs of patients," researchers wrote recently in the Journal of Oncology Practice.

The researchers found that a systematic assessment of palliative care needs from the time of diagnosis reveals actionable information and opportunities to utilize palliative care, the lead author of the study told HealthLeaders this week.

Nurses play a crucial role in the palliative care model featured in the study, said Anjali Varma Desai, MD, assistant attending, Supportive Care Service & Hospital Medicine Service, Memorial Sloan Kettering Cancer Center in New York.

"Oncology nurses and teams can excel in their role as providers of primary palliative care, which is then augmented by access to palliative care specialists," she said.

The oncologic palliative care model at Memorial Sloan Kettering has four primary elements.

1. Adopting collaborative approach
 

Offering palliative care to all newly diagnosed patients with cancer was a collaborative effort between oncology clinic teams and palliative care specialists. With nursing staff carrying the heaviest workload, the oncology clinic teams focused on primary/nonspecialist palliative care and enlisted specialists for clinician support and direct patient consultation.

2. Systematic assessments
 

On a visit-based schedule, patients reported symptoms, decision-making preferences, illness understanding, and core values.

  • During every clinic visit, patients rated 10 physical, psychological, and spiritual symptoms using a scale from 0 to 10.
     
  • During visit 1 (first follow-up visit after cancer diagnosis) patients were asked about preferences for receiving medical information and designation of a healthcare proxy.
     
  • During visit 2, patients reported their understanding of the expected course of their illness and treatment.
     
  • During visits 3 and 4, an intervention led by the oncology nurse featured discussions of the patient's core values. These discussions are an opportunity for the patient to express preferences about specific care goals.
     
  • During visit 4, caregivers provided an assessment of their well-being.

3. Implementing palliative care
 

Palliative care services were offered in two Memorial Sloan Kettering outpatient clinics, with an attending oncologist and oncology registered nurse on staff. Palliative care assessments including symptoms, information preferences, treatment understanding, and patient values were pretested then implemented incrementally.

4. Engaging patients
 

During visit 1, the oncologist and registered nurse told patients that palliative care would be a part of their cancer care such as attention to symptoms.

The outpatient clinics adopted a Care, Coach, Consult model. The oncologist and registered nurse provided primary palliative care, with the nurse on the frontline. The nurse practitioner specializing in palliative care coached multiple oncology teams and was a resource for direct care and advice on symptom management, communication, and care planning.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

In most outpatient care settings, access to palliative care specialists is limited.

Providing palliative care at outpatient oncology clinics improves clinical outcomes and reduces costs.

Nurses play the key role in a new model for palliative care at oncology clinics.


Get the latest on healthcare leadership in your inbox.