Kathleen E Bickel1, Kristen McNiff2, Mary K Buss2, Arif Kamal2, Dale Lupu2, Amy P Abernethy2, Michael S Broder2, Charles L Shapiro2, Anupama Kurup Acheson2, Jennifer Malin2, Tracey Evans2, Monika K Krzyzanowska2. 1. White River Junction VA Medical Center; Geisel School of Medicine at Dartmouth, White River Junction, VT; Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center, Boston, MA; Duke University Medical Center, Durham, NC; American Academy of Hospice and Palliative Medicine, Glenview, IL; Partnership for Health Analytic Research, Beverly Hills, CA; Mt Sinai Ichan School of Medicine, New York, NY; Providence Cancer Center, Portland, OR; Anthem, Indianapolis, IN; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Princess Margaret Cancer Centre, Toronto, Ontario, Canada kathleen.bickel@outlook.com. 2. White River Junction VA Medical Center; Geisel School of Medicine at Dartmouth, White River Junction, VT; Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center, Boston, MA; Duke University Medical Center, Durham, NC; American Academy of Hospice and Palliative Medicine, Glenview, IL; Partnership for Health Analytic Research, Beverly Hills, CA; Mt Sinai Ichan School of Medicine, New York, NY; Providence Cancer Center, Portland, OR; Anthem, Indianapolis, IN; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Abstract
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.
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.
Authors: Lara Traeger; Chelsea Rapoport; Emily Wright; Areej El-Jawahri; Joseph A Greer; Elyse R Park; Vicki A Jackson; Jennifer S Temel Journal: J Palliat Med Date: 2019-11-13 Impact factor: 2.947