Palliative Care 2015: Panel Presents Recommendations to Improve Primary Palliative Care Services in Medical Oncology

Palliative Care 2015: Panel Presents Recommendations to Improve Primary Palliative Care Services in Medical Oncology

By Jo Cavallo
ASCO POST

Key Points:
  • ASCO and the American Academy of Hospice and Palliative Medicine issued a new guidance statement that provides the first formal consensus-based recommendations regarding the types of palliative care services that constitute high-quality primary palliative care in oncology.
  • The majority of palliative care services in the guidance statement include symptom assessment and management, communication and shared decision-making, and advance care planning.
  • The proposed recommendations will help oncology practices improve their primary palliative care delivery to patients, determine which services they already provide, and whether the services are provided consistently to all eligible patients.

When integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, because the number of palliative care specialists in the United States is too small to meet the number of patients requiring palliative care, the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM) partnered to develop recommendations to help medical oncology practices identify essential palliative care services and deliver high-quality primary palliative care to all patients with cancer.

Most of the recommendations included in a guidance statement released by ASCO and AAHPM pertain to symptom assessment and management, communication, shared decision-making, and advance care planning. The guidance statement (Abstract 108) by Bickel et al is being presented at the  2015 Palliative Care in Oncology Symposium, being held October 9–10 in Boston.

Methodology for Developing the Guidance Statement

A panel of physicians, patient advocates, social workers, nurses, and nurse practitioners was assembled to rank 966 different palliative care service items, divided into nine domains, each describing an aspect of palliative care delivery for patients with advanced cancer. Using a modified Delphi methodology, 31 multidisciplinary panelists ranked each service item according to importance, feasibility, and scope.

Study Results

The 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 care planning (78%). 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.

Under the domain of appropriate palliative care and hospice referral, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients with an expected survival of less than 3 months or poor performance status (Zubrod status 3–4) to hospice care.

Improving Access to Palliative Care

“This is still an early-stage definition project, but this [guidance statement] is necessary because to improve palliative care delivery and access for patients with cancer, we must first define and agree on what oncology practices should be providing,” said Kathleen Bickel, MD, MPhil, Assistant Professor of Medicine at the White River Junction Veterans Affairs Medical Center and the Dartmouth Geisel School of Medicine, and lead author of the study, at a press briefing announcing the panel’s recommendations. “These goals may adapt and change over time, but we hope this work will serve as a foundation for future palliative care–related quality measures, quality improvement initiatives, and educational activities and will help oncology practices improve the delivery of primary palliative care.”

Commenting on the study results, ASCO expert and moderator of the press briefing, Don S. Dizon, MD, Clinical Co-Director of Gynecologic Oncology at Massachusetts General Hospital, said “Given the importance of addressing symptom burden for our patients, particularly with advanced malignancy, such guidelines will be helpful to delineate what palliative care services could be reasonably expected as part of usual medical oncology vs what should be referred to as specialists within palliative care.”

The source of the research funding for this study was not disclosed. For full disclosures of the study authors, view the study abstract at abstract.asco.org.

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