A Quality Improvement Project to Provide Early Referral to Palliative Care Clinic for Advanced Oral Cancer Patients (TH341A)

Abstract

•Identify palliative care needs, referral timings and reasons for delay in referral to palliative care clinic for advanced oral cancer patients.•Develop, test and sustain interventions to provide early referral to palliative care clinic for advanced oral cancer patients. Recent literature affirms the benefits of early palliative care in advanced cancer patients. The prevalence of oral cancer is high in India and often patients present at advanced stages at the time of diagnosis. Bleak scope of curative treatment and high symptomatic burden detracts from the quality of life of these patients. The aim of this study was to provide early referral to a palliative care clinic for advanced oral cancer patients. This initiative was carried out at Dr B. R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, India in collaboration with quality improvement leaders at Stanford University. A multidisciplinary team consisting of oncologists, surgeons, nurses, administrative staff, palliative care physicians and overseas quality improvement mentors was formed. Using A3 methodology, we applied improvement tools to understand the current situation. A cause and effect analysis revealed absence of referral guidelines and misalignment of what was deemed appropriate early referral as the major factors contributing to the practice of late referral. Our interventions were developing a standard, agreed upon, protocol for providing palliative care referral and consultation, creating awareness through pamphlets, educating oncologists and surgeons through weekly departmental meetings and documenting symptom burden in the medical record. The interventions were sustained by soliciting feedback from oncologists and surgeons during periodic departmental meetings, educating new oncologists and surgeons about referral protocols during their orientation program i.e. once in three months and by auditing patient referral data. Number of days from identification of advanced oral cancer to referral to palliative care clinic decreased from an average of 48 days at baseline to 13 days post-interventions. Early referrals to palliative care clinic are possible using a multidisciplinary team approach focusing on aligning expectations between oncologists, surgeons and palliative care professionals, modifying process maps and standardizing and documenting assessment.