Use of Palliative Care Services in a Tertiary Cancer Center

Dalal, Shalini; Bruera, Sebastian; Hui, David; Yennurajalingam, Sriram; Dev, Rony; Williams, Janet L.; Masoni, Charles; Ihenacho, Ijeoma; Obasi, Emmanuel; Bruera, Éduardo

doi:10.1634/theoncologist.2015-0234

Cited by 52 publications

(42 citation statements)

References 36 publications

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“…Furthermore, they also reported that a larger proportion of their own patients with advanced cancer were referred to palliative care, with a gradient effect observed. Our findings are consistent with the observation that palliative oncologists who are dually trained in oncology and palliative care often refer a high proportion of their patients to palliative care when practicing oncology [18].This association could also help explain the steady growth of the palliative care program at our institution [6].…”

Section: Discussionsupporting

confidence: 90%

“…This model of integrated, collaborative care has been shown to improve patient outcomes, including quality of life, symptom distress, illness understanding, satisfaction, and even survival [3,4]. Oncologists generally agree that palliative care delivery is one of their key responsibilities [5]; however, how much primary and secondary palliative care their patients actually receive is likely affected by many factors, such as local resource availability, patient preference, oncologist's palliative care training, and their attitudes toward end-of-life (EOL) care [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

et al. 2016

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Background. It is unclear how oncologists' attitudes toward end-of-life (EOL) care affect the delivery of care. The present study examined the association between oncologists' EOL care attitudes and (a) timely specialist palliative care referral, (b) provision of supportive care, and (c) EOL cancer treatment decisions. Methods. We randomly surveyed 240 oncology specialists at our tertiary care cancer center to assess their attitudes toward EOL care using a score derived from the Jackson et al. qualitative conceptual framework (0 5 uncomfortable and 8 5 highly comfortable with EOL care). We determined the association between this score and clinicians' report of specialist palliative care referral, provision of supportive care, and EOL cancer treatment decisions. Results. Of the 182 respondents (response rate of 76%), the median composite EOL care score was 6 (interquartile range,

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

et al. 2016

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“…It is staffed by 18 board‐certified palliative care physicians, together with palliative care‐trained registered nurses, pharmacists, social workers, counselors, and psychologists. It predominantly serves patients who have advanced cancer and also serves a relatively smaller number of patients who have early stage disease and early remission . The patient and his or her family are initially assessed by the nurse, who gathers pertinent clinical information.…”

Section: Methodsmentioning

confidence: 99%

Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic

Arthur

Edwards

et al. 2016

Cancer

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UDTs were used infrequently among outpatients with advanced cancer who were receiving chronic opioid therapy. Younger age, positive CAGE questionnaire results, early stage cancer or no evidence of disease status, higher pain intensity, and lower fatigue scores were significant predictors of UDT ordering. More than 50% of UDT results were abnormal. More research is necessary to better characterize aberrant opioid use in patients with advanced cancer. Cancer 2016;122:3732-9. © 2016 American Cancer Society.

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“…Several centers have published their experience with freestanding outpatient clinics . In most cases, these clinics have begun as single, one‐half–day clinics per week and have grown quickly with increasing demand . Large cancer centers, such as The University of Texas MD Anderson Cancer Center and the Princess Margaret Cancer Center, have clinics that operate daily and offer both booked and urgent same‐day appointments.…”

Section: Innovative Models Of Care Deliverymentioning

confidence: 99%

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

Hui

Hannon

Zimmermann

et al. 2018

CA A Cancer J Clinicians

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272

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Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-science review directed at the practicing cancer clinician, we will first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. We will then provide conceptual models to support team-based, timely and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multi-dimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventative care to minimize crises at the end-of-life. Targeted palliative care involves identifying patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, we will summarize the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time.

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Use of Palliative Care Services in a Tertiary Cancer Center

Cited by 52 publications

References 36 publications

Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

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