Personalizing the Setting of Palliative Care Delivery for Patients with Advanced Cancer: “Care Anywhere, Anytime”

Abstract

Opinion statement The specialty of palliative care has evolved over time to provide symptom management, psychosocial support, and care planning for patients with cancer throughout the disease continuum and in multiple care settings. This review examines the delivery and impact of palliative care in the outpatient, inpatient, and community-based settings. The article will discuss how these 3 palliative care settings can work together to optimize patient outcomes under a unifying model of palliative care “anywhere, anytime” and how to prioritize palliative care services when resources are limited. Many patients with advanced cancer receive care from each of the 3 branches of palliative care—outpatient, inpatient, and community-based settings—at some point along their disease trajectory. Early on, outpatient clinics provide longitudinal supportive care concurrent with active disease-modifying treatments. Telemedicine appointments can serve patients remotely to minimize their need to travel. When patients experience functional decline, community-based palliative care services can provide support and monitoring for patients at home. When patients develop acute symptomatic complications requiring admission, inpatient care consultation teams are essential for symptom management and goals-of-care discussions. For patients in severe distress, receiving care in a palliative care unit that provides intensive symptom control and facilitates complex discharge planning is ideal. Under a unifying model of palliative care designed to offer care “anywhere, anytime,” the 3 branches of palliative care could work in unison to support each other, minimize gaps in care, and optimize patient outcomes.

Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients

“…Allocating sufficient time in the visit to address any concerns and questions patients and families may have is vital. Feeling heard and understood by providers and obtaining the required help for pain and other symptoms are some of the main patient-reported experience measures in outpatient palliative care [ 9 , 29 , 30 , 31 ].…”

“…There is emerging literature on the benefits of telemedicine for cancer patients receiving palliative care [ 6 , 7 , 8 , 9 ]. One major advantage is eliminating travel requirements that often impose an immense physical burden on patients with limited mobility and high symptom burden [ 10 ].…”

The Importance of Being Early

“…Literature data unquestionably support the need for early intervention [27] rather than on demand [26].…”

“…Several trials have been conducted in order to understand the optimal intervention time for palliative care specialist, however, unequivocal results have not always been achieved [7][8][9][10]. Generally, EPC timing is suggested by symptoms reported, however, it would be desirable to identify signs and blood chemistry [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] to direct to the EPC schedule.…”

“…Policy makers who direct health expenditure are promoting the EPC since reduction in costs per individual patient is obtained [16,17] in the context of health systems with Universal Health Coverage too. Hui D, et al [27] have underlined the importance of the three branches of palliative care: outpatient palliative care clinics, inpatient palliative care and community-based palliative care. These three care settings should be simultaneously present and offered, based on patient clinical conditions and oncological treatment setting.…”