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El-Jawahri A, Webb JA, Breffni H, Zimmermann C. Integrating Palliative Care and Hematologic Malignancies: Bridging the Gaps for Our Patients and Their Caregivers. Am Soc Clin Oncol Educ Book 2024; 44:e432196. [PMID: 38768404 DOI: 10.1200/edbk_432196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Patients with hematologic malignancies (HMs) struggle with immense physical and psychological symptom burden, which negatively affect their quality of life (QOL) throughout the continuum of illness. These patients are often faced with substantial prognostic uncertainty as they navigate their illness course, which further complicates their medical decision making, especially at the end of life (EOL). Consequently, patients with HM often endure intensive medical care at the EOL, including frequent hospitalization and intensive care unit admissions, and they often die in the hospital. Our EOL health care delivery models are not well suited to meet the unique needs of patients with HMs. Although studies have established the role of specialty palliative care for improving QOL and EOL outcomes in patients with solid tumors, numerous disease-, clinician-, and system-based barriers prevail, limiting the integration of palliative care for patients with HMs. Nonetheless, multiple studies have emerged over the past decade identifying the role of palliative care integration in patients with various HMs, resulting in improvements in patient-reported QOL, symptom burden, and psychological distress, as well as EOL care. Importantly, these studies have also identified active components of specialty palliative care interventions, including strategies to promote adaptive coping especially in the face of prognostic uncertainty. Future work can leverage the knowledge gained from specialty palliative care integration to develop and test primary palliative care interventions by training clinicians caring for patients with HMs to incorporate these strategies into their clinical practice.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jason A Webb
- Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Hannon Breffni
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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2
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Godfrey S, Steiner JM, Damluji AA, Sampath R, Chuzi S, Warraich H, Krishnaswami A, Bernacki G, Goodlin S, Josephson R, Mulrow J, Doherty C. Palliative Care Education in Cardiovascular Disease Fellowships: A National Survey of Program Directors. J Card Fail 2024:S1071-9164(24)00116-7. [PMID: 38616006 DOI: 10.1016/j.cardfail.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Palliative care (PC) is an essential component of high-quality care for people with cardiovascular disease (CVD). However, little is known about the current state of PC education in CVD training, including attitudes toward integration of PC into training and implementation of PC by the program's leadership. METHODS We developed a nationwide, cross-sectional survey that queried education approaches, perspectives and barriers to PC education in general CVD fellowship training. The survey was distributed to 392 members of the American College of Cardiology Program Director (PD) listserv, representing 290 general CVD fellowships between 1/2023 and 4/2023. We performed descriptive and ꭕ2 analyses of survey data. RESULTS Of the program's representatives, 56 completed the survey (response rate = 19.3%). Respondents identified themselves as current PDs (89%), associate PDs (8.9%) or former PDs (1.8%), representing a diverse range of program sizes and types and regions of the country. Respondents reported the use of informal bedside teaching (88%), formal didactics (59%), online or self-paced modules (13%), in-person simulation (11%), and clinical rotations (16%) to teach PC content. Most programs covered PC topics at least annually, although there was variability by topic. We found no associations between program demographics and type or frequency of PC education. Most respondents reported dissatisfaction with the quantity (62%) or quality (59%) of the PC education provided. Barriers to PC education included an overabundance of other content to cover (36%) and perceived lack of fellow (20%) or faculty (18%) interest. Comments demonstrated the importance of PC education in fellowship, the lack of a requirement to provide PC education, difficulty in covering all topics, and suggestions of how PC skills should be taught. CONCLUSIONS In a national survey of CVD educational leadership concerning approaches to PC education in CVD training, respondents highlighted both challenges to implementation of formal PC curricula in cardiology training and opportunities for comprehensive PC education.
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Affiliation(s)
- Sarah Godfrey
- University of Texas Southwestern Medical Center, Dallas, TX.
| | | | - Abdulla A Damluji
- Inova Center of Outcomes Research, Falls Church, VA; Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Gwen Bernacki
- University of Washington Medical Center, Seattle, WA; Veterans' Administration of Puget Sound, Seattle, WA
| | - Sarah Goodlin
- Patient-Centered Education and Research, Oregon Health and Sciences University, Portland, OR
| | | | - John Mulrow
- Cardiology Clinic of San Antonio, San Antonio, TX
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Di Lorenzo S, Mozzi L, Salmaso F, Silvagni C, Soffientini S, Valenti V, Zagonel V. A multicentre survey on the perception of palliative care among health professionals working in haematology. Support Care Cancer 2024; 32:253. [PMID: 38536470 PMCID: PMC10973048 DOI: 10.1007/s00520-024-08452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with haematologic malignancies have less access to palliative care and are referred later than patients with solid tumours. We developed a survey to investigate this phenomenon, with the intention of analysing palliative care perceptions among health professionals who treat haematology patients and identifying barriers and facilitators to referrals to palliative care services. METHODS This was a multicentre exploratory descriptive web-based survey. A questionnaire was administered to 320 medical and nursing staff members from five Italian haematological units and San Marino's hospital to investigate their perception of palliative care. Quantitative and qualitative analyses were performed. RESULTS A total of 142/320 healthcare professionals completed the survey, achieving a 44% response rate. Most of the respondents supported the integration of haematology and palliative care and were aware of the role of palliative care. Despite this, only half had an in-hospital palliative care team, and only a few had previously attended a specific training course. The majority agreed with palliative care referral when the prognosis was less than 3 months or when the symptoms were incoercible and with blood transfusions even in the last stages of the disease. Many considered the presence of an in-hospital palliative care team or a case manager, as well as structured palliative care training, as fundamental facilitators of palliative care referrals. CONCLUSION These results showed that healthcare professionals in haematology generally hold a favourable attitude and a high interest in integrating palliative care into their patients' care. The low referral rate could depend on clinical, cultural, and organisational issues.
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Affiliation(s)
- Sara Di Lorenzo
- Clinical Hematology and Bone Marrow Transplant and Cellular Therapies Center, Carlo Melzi", Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lisa Mozzi
- Clinical Hematology, Azienda Ospedaliera Ulss 8 Berica, "St. Bortolo" Hospital, Vicenza, Italy
| | - Flavia Salmaso
- Palliative Care Unit, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
| | - Claudia Silvagni
- Continuity of Care Center, Istituto Per La Sicurezza Sociale, Cailungo, Republic of San Marino
| | - Silvia Soffientini
- Integrated Home Care Unit, AULLS 6 Euganea - Terme Colli District, Padua, Italy
| | - Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), "Dino Amadori", Via P. Maroncelli 40, Meldola, FC, 47014, Italy.
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
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4
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Molinares D, Parke S, Yadav R, Liu D, Williams J, Bruera E. Knowledge, attitudes, and beliefs of oncology trainees on function and cancer rehabilitation medicine. PM R 2023; 15:982-989. [PMID: 36762725 DOI: 10.1002/pmrj.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improved function is associated with reduced morbidity and mortality in patients with cancer. Cancer rehabilitation medicine (CRM) is a subspecialty of physical medicine and rehabilitation (PM&R) that focuses on improving function in patients with cancer. One of the barriers to patients accessing CRM services is the lack of referrals from oncology providers. Understanding the knowledge, attitudes and beliefs of oncology trainees regarding the importance of function and the role of CRM is essential to reducing educational gaps and improving patients' access to essential rehabilitation services. OBJECTIVE To determine oncology trainees' knowledge, attitude and beliefs about the importance of function and the role of CRM in the care of patients with cancer. SETTING The study was conducted at a comprehensive cancer center in the United States. INTERVENTION Descriptive survey study was administered to postgraduate oncology trainees who spent at least 1 day a week providing patient care. MAIN OUTCOME Participants' report of their knowledge, attitudes, and beliefs on the importance of function and CRM in the care of patients with cancer. RESULTS The survey was sent to 197 oncology trainees with a response rate of 67% (n = 132) and 126 were ultimately included. All participants believed that function is important in the care of patients with cancer. The majority believed that better function improves treatment tolerance (94%) and survival (84%). Most reported that having CRM physicians (80%) and an inpatient rehabilitation unit (88%) in the oncological setting is important; however, most participants reported that they refer fewer than 25% of their patients to CRM services. Participants with prior exposure to PM&R were significantly more likely to consult PM&R compared to those without exposure (p = .005). Most oncology trainees (81%) believed that education in CRM should be part of their oncology training. CONCLUSION This study demonstrates that oncology trainees believe that function is important. They also believe that access to CRM would improve treatment tolerance and survival, but most report that they rarely refer patients to CRM services. Most trainees desire increased exposure to CRM during oncology training.
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Affiliation(s)
- Diana Molinares
- Department of Physical Medicine and Rehabilitation, University of Miami Health System, Miami, Florida, USA
| | - Sara Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Rajesh Yadav
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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5
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Albert MJ, Collins ME, Bauman JR. Hematology/Oncology Fellows' Training in Palliative Care: A Narrative Review. J Palliat Med 2023. [PMID: 37130299 DOI: 10.1089/jpm.2022.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Palliative care (PC) education is a vital and required part of hematology-oncology fellows' education to build PC skills, attitudes, and knowledge. However, previous research has shown that education in PC is inadequate. This narrative review of the literature on primary PC education during hematology-oncology fellowship programs aims at identifying the current state of PC education, existing gaps, and potential future directions for improving PC education. Fourteen articles were identified and reviewed. The types of articles included trainee and program leadership responses, and interventions designed to improve PC education. Results from each study are reported. Overall, trainees and program leadership rate current PC education as varied, often inadequate, and in need of improvement. Educational interventions show that some form of PC education increases perceived knowledge and confidence in PC skills. Future studies are needed to develop the most effective and impactful educational models.
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Affiliation(s)
- Madeline J Albert
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Molly E Collins
- Supportive Oncology and Palliative Care, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jessica R Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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6
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Pennarola A, Yoshioka T, Shah D, Larson S. Primary Palliative Care Education for Graduate Medical Trainees: Impacts and Needs. Am J Hosp Palliat Care 2023; 40:387-395. [PMID: 35583487 DOI: 10.1177/10499091221102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As demand for palliative care (PC) services rise, there are insufficient numbers of PC specialists to provide PC for the US population. "Primary palliative care" refers to PC services that are administered by non-specialist PC providers. Educating trainees in graduate medical education (GME) programs is 1 strategy for expanding primary palliative care, though questions remain regarding the impact of PC education for GME trainees and where additional education is needed. This study is a multicenter, cross-sectional, web-based survey study of GME trainees assessing the needs for and impacts of primary palliative care education. The survey assessed the implementation of and participants' confidence with fundamental PC skills. The survey also asked about prior exposure to PC education and for participants' beliefs regarding areas that would be particularly helpful for future education. 170 residents and fellows from diverse training backgrounds participated in the survey out of 851 potential participants (response rate 19.98%). Exposure to PC education was associated with higher confidence and increased frequency of implementation of fundamental PC skills. Of the forms of education that were assessed, clinical/experiential education was associated most often with higher confidence and higher frequency of use of PC skills. Discussing goals of care, pain management for seriously ill patients, and communicating difficult information were those skills most frequently identified as important for additional training. This study demonstrates that by improving existing PC education or increasing access to PC education for GME trainees, it may be possible to improve primary palliative care.
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Affiliation(s)
- Adam Pennarola
- 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tammy Yoshioka
- 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dhruvi Shah
- 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sharon Larson
- 20284Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research (LIMR), Wynnewood, PA, USA
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7
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Leonberg-Yoo AK, Gilbert SJ. Teaching Conservative Kidney Management and Other Palliative Care Skills in Nephrology Fellowships. Semin Nephrol 2023; 43:151396. [PMID: 37573769 DOI: 10.1016/j.semnephrol.2023.151396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Offering and providing effective conservative kidney management (CKM) for patients with end-stage kidney disease who do not want dialysis is a foundational skill that all nephrology fellows should learn during fellowship training. However, the current educational landscape in fellowship training programs is sparse and is not recognized currently as a skill within the Accreditation Council for Graduate Medical Education (ACGME) guidelines. Moreover, there is no standardized curriculum, methods of assessment of this learning objective, and no structure for implementation within general and subspecialty nephrology training programs. In this article, we discuss the current educational resources available for fellowship training programs, including interactive communication skills workshops such as NephroTalk, that address core concepts of CKM and assess communication skills and attitudes of trainees. Additional assessment tools should be prioritized when developing a CKM curriculum, including assessment of symptom management and medical knowledge acquisition. We propose that the ACGME nephrology milestones specifically highlight CKM as an important component within the ACGME nephrology milestones, thus ensuring that trainees understand how and when to offer CKM (knowledge), implement it effectively (skills), and conceptualize it as an appropriate course for patients in a number of varied situations (attitudes). We also outline a subspecialty pathway for palliative nephrology, to align with the recent American Society of Nephrology Task Force Recommendation to provide subspecialty training beyond core competencies, for those interested in pursuit of advanced training that ultimately can shape the CKM landscape in education and policy making.
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Affiliation(s)
- Amanda K Leonberg-Yoo
- Department of Medicine, Renal-Electrolyte & Hypertension Division, University of Pennsylvania, Philadelphia, PA.
| | - Scott J Gilbert
- Department of Medicine, Division of Nephrology, Tufts University School of Medicine, Boston, MA
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8
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Patel S, Hoge G, Fellman B, Kaur S, Heung Y, Bruera E, Hui D. Timing of referral to outpatient palliative care for patients with haematologic malignancies. Br J Haematol 2022; 198:974-982. [PMID: 35866185 DOI: 10.1111/bjh.18365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
Outpatient palliative-care facilitates timely supportive-care access; however, there is a paucity of studies on the timing of referral in the outpatient setting for patients with haematologic malignancy. We examined the trend in timing of outpatient palliative-care referrals over a 10-year period in patients with haematologic malignancies at our comprehensive cancer centre. We included consecutive patients with a diagnosis of haematologic malignancy who were seen at our outpatient palliative-care clinic between 1 January 2010 and 31 December 2019. We collected data on patient characteristics, symptom burden and supportive-care interventions at outpatient palliative-care consultation. The primary outcome was time from outpatient palliative-care consultation to death or last follow-up. In all, 384 patients were referred by leukaemia (n = 143), lymphoma (n = 213), and stem cell transplant (n = 28) services. The median time from outpatient palliative-care referral to death was 3.4 years (IQR 2.4-5.3) with a significant increase in both the number of referrals per year (p = 0.047) and the timing of referral between 2010 and 2019 (p = 0.001). Patients with haematologic malignancies were referred in a timely fashion to our outpatient palliative-care clinic, with earlier and greater numbers of referrals over time.
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Affiliation(s)
- Sameer Patel
- Department of Palliative Care, Rochester General Hospital, Rochester, New York, USA
| | - Geordyn Hoge
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan Fellman
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharanpreet Kaur
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yvonne Heung
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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9
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Biersching T, Schweda A, Oechsle K, Nauck F, Rosenbruch J, Schuler U, Hense J, Neukirchen M, Weber M, Junghanss C, Kramer T, Ostgathe C, Thuss-Patience P, Van Oorschot B, Teufel M, Schuler M, Bausewein C, Tewes M. The OUTREACH study: oncologists of German university hospitals in rotation on a palliative care unit-evaluation of attitude and competence in palliative care and hospice. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04131-w. [PMID: 35831764 DOI: 10.1007/s00432-022-04131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The effect of the duration of an educational rotation presented at a palliative care unit on the palliative care knowledge gain and the increase of palliative care self-efficacy expectations are unclear. METHODS This national prospective multicenter pre-post survey conducted at twelve German University Comprehensive Cancer Centers prospectively enrolled physicians who were assigned to training rotations in specialized palliative care units for three, six, or twelve months. Palliative care knowledge [in %] and palliative care self-efficacy expectations [max. 57 points] were evaluated before and after the rotation with a validated questionnaire. RESULTS From March 2018 to October 2020, questionnaires of 43 physicians were analyzed. Physicians participated in a 3- (n = 3), 6- (n = 21), or 12-month (n = 19) palliative care rotation after a median of 8 (0-19) professional years. The training background of rotating physicians covered a diverse spectrum of specialties; most frequently represented were medical oncology (n = 15), and anesthesiology (n = 11). After the rotation, median palliative care knowledge increased from 81.1% to 86.5% (p < .001), and median palliative care self-efficacy expectations scores increased from 38 to 50 points (p < .001). The effect of the 12-month rotation was not significantly greater than that of the 6-month rotation. CONCLUSION An educational rotation presented in a specialized palliative care unit for at least six months significantly improves palliative care knowledge and palliative care self-efficacy expectations of physicians from various medical backgrounds.
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Affiliation(s)
- T Biersching
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - A Schweda
- West German Cancer Centre, Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital Essen, 45147, Essen, Germany
| | - K Oechsle
- Palliative Care Unit, Department for Oncology, Haematology and Bone Marrow Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Nauck
- Department of Palliative Medicine, University Medical Centre Göttingen, Göttingen, Germany
| | - J Rosenbruch
- Department of Palliative Medicine, LMU Munich Hospital, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany
| | - U Schuler
- University Palliative Care Centre, Carl Gustav Carus University Hospital, Dresden, Germany
| | - J Hense
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Neukirchen
- Interdisciplinary Centre for Palliative Medicine, University Tumor Centre Düsseldorf - Comprehensive Cancer Centre, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.,Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - M Weber
- Interdisciplinary Department for Palliative Medicine, University Medicine Mainz, Johannes-Gutenberg-University, Mainz, Germany
| | - C Junghanss
- Division of Medicine, Dept. of Haematology, Oncology and Palliative Medicine, University Medical Centre, Rostock, Germany
| | - T Kramer
- Palliative Medicine at the University Centre for Tumor Diseases (UCT), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - C Ostgathe
- Palliative Medicine Department, Comprehensive Cancer Centre CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - P Thuss-Patience
- University Tumor Centre, Charité University Medicine Berlin, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - B Van Oorschot
- Interdisciplinary Centre for Palliative Medicine, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - M Teufel
- West German Cancer Centre, Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital Essen, 45147, Essen, Germany
| | - M Schuler
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Partner Location Essen University Hospital, Essen, Germany
| | - C Bausewein
- Department of Palliative Medicine, LMU Munich Hospital, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany
| | - M Tewes
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.
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10
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Whitsett MP, Ufere NN, Patel A, Shea JA, Jones CA, Fix OK, Serper M. Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey. Hepatol Commun 2022; 6:1680-1688. [PMID: 35411683 PMCID: PMC9234628 DOI: 10.1002/hep4.1939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable. We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepatology fellows enrolled in accredited fellowship programs during the 2020-2021 academic year. We assessed the frequency of PC provision and comfort with physical and psychological symptom management, psychosocial care, communication skills, advance care planning, and end-of-life care. A total of 45 of 56 (79%) of transplant hepatology fellows responded to the survey; 50% (n = 22) were female. Most trained at centers performing over 100 transplants per year (67%, n = 29) distributed evenly across geographic regions. Most fellows (69%, n = 31) had a PC or hospice care rotation during residency, and 42% (n = 19) of fellows received education in PC during transplant hepatology fellowship. Fellows reported feeling moderately to very comfortable with communication skills such as breaking bad news (93%, n = 41) and leading family meetings (75%, n = 33), but nearly one-third (30%, n = 13) reported feeling not very or not at all comfortable assessing and managing anxiety and depression (30%, n = 13) and spiritual distress (34%, n = 15). Nearly one-quarter (22%, n = 10) had never discussed or documented advance care plans during fellowship. Fellows wished to receive future instruction on the assessment and management of physical symptoms (68%, n = 30) and anxiety and depression (64%, n = 28). Conclusion: Our survey highlights gaps in PC experience and education during transplant hepatology fellowship, lack of comfort in managing psychological distress and advance care planning, and desire to improve skills, particularly in symptom management. Future studies should investigate how to enhance transplant hepatology competencies in these PC domains and whether this impacts clinical care, advance care planning, or patient experience.
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Affiliation(s)
- Maureen P Whitsett
- Division of Gastroenterology and HepatologyCleveland ClinicClevelandOhioUSA
| | - Nneka N Ufere
- Liver CenterGastrointestinal UnitMassachusetts General HospitalBostonMassachusettsUSA
| | - Arpan Patel
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA.,Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Judy A Shea
- Division of General Internal MedicineDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Christopher A Jones
- Department of Internal MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Oren K Fix
- Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Marina Serper
- Division of Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA.,Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA.,Leonard Davis InstituteUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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11
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Dantigny R, Ecarnot F, Economos G, Perceau-Chambard E, Sanchez S, Barbaret C. Knowledge and use of prognostic scales by oncologists and palliative care physicians in adult patients with advanced cancer: A national survey (ONCOPRONO study). Cancer Med 2021; 11:826-837. [PMID: 34951151 PMCID: PMC8817080 DOI: 10.1002/cam4.4467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prognostic scales exist to estimate patient survival in advanced cancer. However, there are no studies evaluating their use and practice. The objective of this study was to evaluate in a nationwide study the proportion of oncologists and palliative care physicians who had knowledge of these scales. METHODS A descriptive, national, cross-sectional study was conducted via an online questionnaire to oncologists and palliative care physicians across France. RESULTS Palliative care physicians had better knowledge of the scales than oncologists (42.3% (n = 74) vs. 27.8% (n = 33), p = 0.015). The Palliative Performance Status (PPS) and Pronopall Scale were the best-known (51.4% (n = 55) and 65.4% (n = 70), respectively) and the most widely used (35% (n = 28) and 60% (n = 48), respectively). Improved training in the use of these scales was requested by 85.4% (n = 251) of participants, while 72.8% (n = 214) reported that they did not use them at all. Limited training and lack of consensus on which scale to use were cited as the main obstacles to use. CONCLUSION This is the first national study on the use of prognostic scales in advanced cancer. Our findings highlight a need to improve training in these scales and to reach a consensus on scale selection.
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Affiliation(s)
- Raphaëlle Dantigny
- Department of Supportive and Palliative Care, Centre Hospitalier Universitaire Grenoble Alpes, Boulevard de la Chantourne, La Tronche, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, Besançon, France.,University of Burgundy Franche-Comté, Besançon, France
| | - Guillaume Economos
- Department of palliative and supportive care, Centre Hospitalier Universitaire de Lyon Sud Hospital, Pierre Bénite, France
| | - Elise Perceau-Chambard
- Department of palliative and supportive care, Centre Hospitalier Universitaire de Lyon Sud Hospital, Pierre Bénite, France
| | - Stéphane Sanchez
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Cécile Barbaret
- Department of Supportive and Palliative Care, Centre Hospitalier Universitaire Grenoble Alpes, Boulevard de la Chantourne, La Tronche, France.,Laboratoire ThEMAS (Techniques pour l'évaluation et la Modélisation des Actions de Santé (TIMC-IMAG: Technique de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications)), La Tronche, France
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12
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Elliott E, Watson T, Singh D, Wong C, Lo SS. Outcomes of Specialty Palliative Care Interventions for Patients With Hematologic Malignancies: A Systematic Review. J Pain Symptom Manage 2021; 62:863-875. [PMID: 33774128 DOI: 10.1016/j.jpainsymman.2021.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
CONTEXT The outcomes of specialty palliative care (PC) interventions for patients with hematologic malignancies (HMs) is under-investigated. OBJECTIVES We performed a systematic review to evaluate the effect of PC interventions on patient- and caregiver- reported outcomes and healthcare utilization among adults with HMs (leukemia, myeloma, and lymphoma). METHODS From database inception through September 10, 2020, we systematically searched PubMed, CINAHL, Embase, Scopus, Web of Science, and Cochrane Reviews using terms representing HMs and PC. Eligible studies investigated adults aged 18 years and older, were published in the English language, and contained original, quantitative, or qualitative data related to patient- and/or caregiver-centered outcomes and healthcare utilization. RESULTS We screened 5345 studies;16 met inclusion criteria and found that specialty PC led to improved symptom management, decreased likelihood of inpatient death, decreased healthcare utilization, decreased cost of healthcare, and improved caregiver-reported outcomes. Patients with HM have a high need for PC which, though increasing over time, is often provided late in the clinical disease course. CONCLUSIONS Specialty PC interventions improve healthcare outcomes for patients with HMs and should be implemented early and often. There remains a need for additional studies investigating PC use exclusively in patients with HMs.
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Affiliation(s)
- Elizabeth Elliott
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
| | - Tracie Watson
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Daulath Singh
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Connie Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Shelly S Lo
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
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13
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Hui D, De La Rosa A, Chen J, Delgado Guay M, Heung Y, Dibaj S, Liu D, Bruera E. Palliative care education and research at US cancer centers: A national survey. Cancer 2021; 127:2139-2147. [PMID: 33662148 DOI: 10.1002/cncr.33474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/14/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Palliative care (PC) education and research are essential to developing a skilled workforce and evidence base to support the delivery of quality cancer care. The current state of PC education and research at US cancer centers is unclear. In this national survey, the education and research programs of the National Cancer Institute (NCI)-designated and nondesignated cancer centers and the changes between 2009 and 2018 are compared. METHODS Between April and August 2018, PC program leaders at all NCI-designated cancer centers and a random sample of nondesignated centers were sent a survey to examine the structure, processes, and outcomes of their programs on the basis of questions from a 2009 national survey. This preplanned analysis focused on education and research. RESULTS There were 52 of 61 (85%) NCI-designated and 27 of 38 (71%) nondesignated cancer centers that responded. NCI-designated centers were more likely than nondesignated centers to have a PC fellowship program (87% vs 30%; P < .001), training for advanced practice providers (71% vs 44%; P = .03), PC research program (58% vs 15%; P < .001), peer-reviewed funding (43% vs 11%; P = .005), and philanthropic grants (41% vs 7%; P = .002). There were few significant improvements in PC education or research between 2009 and 2018 for both groups, notable exceptions include an increase in PC fellowships (38% vs 87%; P < .001) and mandatory PC rotations for medical oncology fellows (29% vs 55%; P = .02) at NCI-designated cancer centers. CONCLUSIONS PC education and research are more developed at NCI-designated cancer centers. Despite some progress over the past decade, it is relatively slow and suboptimal.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Allison De La Rosa
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph Chen
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marvin Delgado Guay
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yvonne Heung
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seyedeh Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Cheng HWB, Lam KO. Supportive and palliative care in hemato-oncology: how best to achieve seamless integration and subspecialty development? Ann Hematol 2021; 100:601-606. [PMID: 33388859 DOI: 10.1007/s00277-020-04386-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022]
Abstract
While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and frequently are associated with significant symptom and quality of life burden for patients and families. Patients with hematological cancer are referred to palliative care (PC) services less often than those with solid tumors, despite higher inpatient mortality and shorter interval between first consultation and death. The complexity of individual prognostication, ongoing therapeutic goals of cure, the technical nature and complications of treatment, the intensity of medical care even when approaching end of life, and the speed of change to a terminal event all pose difficulties and hinder referral. A modified palliative care model is an unmet need in hemato-oncology, where PC is introduced early from the diagnosis of hematological malignancy, provided alongside care of curative or life-prolonging intent, and subsequently leads to death and bereavement care or cure and survivorship care depending on disease course. From current evidence, the historical prioritization of cancer care at the center of palliative medicine did not guarantee that those diagnosed with a hematological malignancy were assured of referral, timely or otherwise. Hopefully, this article can be a catalyst for debate that will foster a new direction in integration of clinical service and research, and subspecialty development at the interface of hemato-oncology and palliative care.
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Affiliation(s)
- Hon Wai Benjamin Cheng
- Medical Palliative Care Team, Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong.
| | - Ka On Lam
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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15
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Sedhom R, Gupta A, Kamal AH. Case for Dual Training in Medical Oncology and Palliative Care. JCO Oncol Pract 2020; 16:537-539. [PMID: 32427538 PMCID: PMC7489489 DOI: 10.1200/op.20.00137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ramy Sedhom
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Arjun Gupta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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16
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End-of-life and goals of care discussions with cancer patients in the coronavirus pandemic. Palliat Support Care 2020; 19:384-385. [PMID: 32814600 DOI: 10.1017/s1478951520000668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Paulsen K, Wu DS, Mehta AK. Primary Palliative Care Education for Trainees in U.S. Medical Residencies and Fellowships: A Scoping Review. J Palliat Med 2020; 24:354-375. [PMID: 32640863 DOI: 10.1089/jpm.2020.0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The medical profession increasingly recognizes the growing need to educate nonpalliative physicians in palliative care. Objective: This study aims to provide a scoping review of the primary palliative care (PPC) education currently available to graduate medical trainees in primary and specialty tracks. Design: Studies of PPC interventions in U.S. residency or fellowship programs of all subspecialties published in English and listed on MEDLINE, CINAHL, and EMBASE through January 2020 were included. To meet admission criteria, studies had to describe the content, delivery methods, and evaluation instruments of a PPC educational intervention. Results: Of 233 eligible full texts, 85 studies were included for assessment, of which 66 were novel PPC educational interventions and 19 were standard education. Total number of publications evaluating PPC education increased from 8 (2000-2004) to 36 (2015-2019), across 11 residency and 10 fellowship specialties. Residency specialties representing the majority of publications were emergency medicine, general surgery, internal medicine, and pediatric/medicine-pediatrics. PPC content domains most taught in residencies were communication and symptom management; the primary delivery method was didactics, and the outcome assessed was attitudes. Fellowship specialties representing the majority of publications were pediatric subspecialties, nephrology, and oncology. The PPC content domain most taught in fellowships was communication; the primary delivery method was didactics and the outcome evaluated was attitudes. Conclusions: While PPC education has increased, it remains varied in content, delivery method, and intervention evaluations. Future studies should include more widespread evaluation of behavioral outcomes, longitudinal persistence of use, and clinical impact.
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Affiliation(s)
- Kate Paulsen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - David S Wu
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles Medical Center, Santa Monica, California, USA
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18
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Reddy SK, Yennu S, Tanco K, Anderson AE, Guzman D, Ali Naqvi SM, Sadaf H, Williams J, Liu DD, Bruera E. Frequency of Burnout Among Palliative Care Physicians Participating in a Continuing Medical Education Course. J Pain Symptom Manage 2020; 60:80-86.e2. [PMID: 32105789 DOI: 10.1016/j.jpainsymman.2020.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 02/03/2023]
Abstract
CONTEXT Palliative care (PC) physicians are vulnerable for burnout given the nature of practice. The burnout frequency may be variable and reported between 24% and 38% across different countries. OBJECTIVE The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC continuing medical education course. METHODS A survey including the Maslach Burnout Inventory-General along with 41 custom questions were administered to determine the frequency of burnout among physicians attending the 2018 Hospice and Palliative Medicine Board review course. RESULTS Of 110 physicians, 91 (83%) completed the survey. The median age was 48 years with 65% being females, 81% married, 46% in community practice, 38% in practice for 6-15 years. PC was practiced ≥50% of the time by 62%, and 76% were doing clinical work. About 73 (80%) reported that PC is appreciated at their work, 58 (64%) reported insurance to be a burden, and 58 (64%) reported that the electronic medical record was a burden. About 82 (90%) felt optimistic about continuing PC in future. Maslach Burnout Inventory results suggest that 35 (38%) participants reported at least one symptom of burnout. Only being single/separated showed trend toward significance with burnout (P = 0.056). CONCLUSION Burnout among PC physicians who attended a board review course was 38%. Being single/separated showed trend toward association with burnout. Physicians who choose to attend continuing medical education may have unique motivating characteristics allowing them to better cope with stress and avoid burnout.
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Affiliation(s)
- Suresh K Reddy
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
| | - Sriram Yennu
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberson Tanco
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Aimee E Anderson
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Guzman
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed M Ali Naqvi
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Humaira Sadaf
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Integrative and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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19
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Andreev-Drakhlin AY, Epner DE. Chemistry of Caring: Timeless Lessons From Oncology Fellowship. J Clin Oncol 2020; 38:2107-2109. [PMID: 32315277 DOI: 10.1200/jco.19.03354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Daniel E Epner
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Sedhom R, Gupta A, Shah M, Hsu M, Messmer M, Murray J, Browner I, Smith TJ, Marrone K. Oncology Fellow-Led Quality Improvement Project to Improve Rates of Palliative Care Utilization in Patients With Advanced Cancer. JCO Oncol Pract 2020; 16:e814-e822. [PMID: 32339469 DOI: 10.1200/jop.19.00714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE ASCO guidelines recommend palliative care (PC) referral for patients with advanced or metastatic cancer. Despite this, implementation has considerable hurdles. First-year oncology fellows at our institution identified low rates of PC utilization in their longitudinal clinic as a metric needing improvement. METHODS A fellow-led multidisciplinary team aimed to increase PC utilization for patients with advanced cancer followed in he first-year fellows' clinic from a baseline of 11.5% (5 of 43 patients, July to December of 2018) to 30% over a 6-month period. Utilization was defined as evaluation in the outpatient PC clinic hosted in the cancer center. The team identified the following barriers to referral: orders difficult to find in the electronic medical record (EMR), multiple consulting mechanisms (EMR, by phone, or in person), EMR request not activating formal consult, no centralized scheduler to contact or confirm appointment, and poor awareness of team structure. Plan-Do-Study-Act (PDSA) cycles were implemented based on identified opportunities. Data were obtained from the EMR. RESULTS The first PDSA cycle included focus groups with stakeholders, standardizing referral process via single order set, identifying a single scheduler with bidirectional communication, and disseminating process changes. PDSA cycles were implemented from January to June of 2019. Rates of PC use increased from 11.5% before the intervention to 48.4% (48 of 99 patients) after the intervention. CONCLUSION A multidisciplinary approach and classic quality improvement methodology improved PC use in patients with advanced cancer. The pilot succeeded given the small number of fellows, buy-in from stakeholders, and institutional and leadership support. Straightforward EMR interventions and ancillary staff use are effective in addressing underreferrals.
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Affiliation(s)
- Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Mirat Shah
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Melinda Hsu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Marcus Messmer
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Joseph Murray
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Ilene Browner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Kristen Marrone
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
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