Indicators of Integration of Palliative Care Services into an existing Oncology Programme

Dr. John WeruAga Khan University Hospital

John.weru@aku.edu@drjohnweru

Background Scientific advances in novel cancer therapeutics have led to

longer lives for patients diagnosed with incurablemalignancies.

However, this is not matched with a similar availability ofefficacious supportive care interventions aimed at relievingsymptoms due to progressive disease and treatment sideeffects.

Accumulating data shows that there is meaningfulimprovement in the experiences of patients and familycaregivers by incorporating symptom management, quality oflife issues and treatment planning.

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Aim

This study set out to assess the understandingof clinicians regarding integration of palliativecare services into an existing oncologyprogramme.

Methodology

Questionnaires with statements either to agree or refute were sent out to 10 clinicians taking care/ involved in the care of cancer patients.

Four responses: a) strongly disagree, b) disagree, c) agree, d) strongly agree. If c or d, rate the importance from 1-10 with 10 being very important

The criteria comprised of: clinical processes, clinical outcomes, education and research as regards palliative care in oncology.

Results-- Clinical

• Q: In your opinion, should the following criteria be used as indicators of integration of palliative care services and oncology programmes in mid- to large- size hospitals (100 beds or more)

• Proportion of advanced cancer patients seen by palliative care before death---90%

• Median time from diagnosis of advanced cancer to outpatient palliative care consultation--- 50%

• Proportion of outpatients with pain ASSESSED on either of the last two visits before death--- 100%

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Results- Clinical

• Proportion of outpatients with pain intensity QUANTIFIED on either of the last 2 visits before death--- 100%

• Proportion of patients with 2 or more emergency room visits in last 30 days of life (negative indicator)--- 20%

• Proportion of patients with 2 or more hospital admissions in last 30 days of life (negative indicator)--- 30%

• Proportion of patients who died in a hospital (negative indicator)--- 20%

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Results- Education• Q: In your opinion, should the following criteria be used as

indicators of integration of palliative care services and oncology programmes in mid- to large- size hospitals (100 beds or more).

• Didactic palliative care curriculum for residents/ oncology fellows provided by palliative care teams--- 90%

• Oncology residents have routine rotation in palliative care---70%

• Combined palliative care and oncology educational activities for residents--- 70%

• Continuing medical education in palliative care for attending oncologists– 30% 7

Results- Research

• Q: In your opinion, should the following criteria be used as indicators of integration of palliative care services and oncology programmes in mid- to large-size hospitals (100 beds or more).

• Institutional funding for palliative oncology research-50%

• Tenured faculty in palliative care--- 60%

• Endowed leadership in palliative care--- 70%

Results- Research

• Peer reviewed publications in palliative oncology--- 90%

• Collaborative research between oncology and palliative care--- 20%

Results- Ethical legal

• Q: In your opinion, should the following criteria be used as indicators of integration of palliative care services and oncology programmes in mid- to large- size hospitals (100 beds or more).

• Ethical legal discussions on first contact--- 10%

• DNR orders discussed/instituted before death--- 90%

• Patient /family understanding of prognosis--- 70%

• Resolved patient/family/physician conflicts--- 40%

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Results

Criteria Agree Disagree Importance(5/10)

Clinical 72% 28% 80%

Education 32% 68% 46%

Research 26% 74% 38%

Ethical

legal

60% 40% 78%

Limitations

• Assumption that the contacted persons were aware of what palliative care is.

• Likely participant bias to answer in the affirmative/ negate.

• Researcher bias on sampling.

• Few people, ten participants, were studied making it difficult to generalize the findings.

Recommendation

• Need for training and research on the clinical implication of palliative care in oncology.

• Palliative care consults in comprehensive cancer centers are important and associated with improvement in a number of physical and psychological symptoms, such as pain, fatigue, depression and anxiety. Positive ethical legal outcomes.

• There is need for integrated palliative care which has the advantage of co-management in a complementary manner.

• For this to be feasible, palliative care education, competency developments and shared clinical processes & outcome are necessary components.