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1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

Desai, Anjali V ; Klimek, Virginia M ; Chow, Kimberly ; Epstein, Andrew S ; Bernal, Camila ; Anderson, Kelly ; Okpako, Molly ; Rawlins-Duell, Robin ; Kramer, Dana ; Romano, Danielle ; Goldberg, Jessica I ; Nelson, Judith E

Journal of oncology practice, 2018-12, Vol.14 (12), p.e775-e785

United States: American Society of Clinical Oncology

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Título:
1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting
Autor: Desai, Anjali V ; Klimek, Virginia M ; Chow, Kimberly ; Epstein, Andrew S ; Bernal, Camila ; Anderson, Kelly ; Okpako, Molly ; Rawlins-Duell, Robin ; Kramer, Dana ; Romano, Danielle ; Goldberg, Jessica I ; Nelson, Judith E
Assuntos: Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; Clinical Decision-Making ; Female ; Gastrointestinal Neoplasms - epidemiology ; Gastrointestinal Neoplasms - pathology ; Gastrointestinal Neoplasms - therapy ; Humans ; Male ; Medical Oncology - trends ; Middle Aged ; Myelodysplastic Syndromes - epidemiology ; Myelodysplastic Syndromes - pathology ; Myelodysplastic Syndromes - therapy ; Palliative Care ; Special Series: Real-World Approaches to Quality Improvement in Oncology
É parte de: Journal of oncology practice, 2018-12, Vol.14 (12), p.e775-e785
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Descrição: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.
Editor: United States: American Society of Clinical Oncology
Idioma: Inglês

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1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

Desai, Anjali V ; Klimek, Virginia M ; Chow, Kimberly ; Epstein, Andrew S ; Bernal, Camila ; Anderson, Kelly ; Okpako, Molly ; Rawlins-Duell, Robin ; Kramer, Dana ; Romano, Danielle ; Goldberg, Jessica I ; Nelson, Judith E

United States: American Society of Clinical Oncology

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