An Interdisciplinary Outpatient Palliative Care Model for Cancer Patients: Successful and Reproducible (TH307)

Abstract

•Identify key attributes that an integrated interdisciplinary care team model brings to the palliative care clinic, the delivery of care and patient outcomes.•Identify key components of a successful outpatient palliative care model that integrates interdisciplinary palliative care with oncology in a cancer center.•Identify benefits and opportunities to influence institutional leaders, initiate, maintain, and advance outpatient palliative care programs, while recognizing some of the challenges and pitfalls of initiating, sustaining, and expanding an outpatient program within academic institutions and in the community cancer center. Only 59% of NCI centers have outpatient palliative care clinics. Clinics are crucial for the integration of palliative care into oncology and improve outcomes, including caregiver satisfaction, symptoms, and survival. ASCO’s recommendation for comprehensive cancer care by 2020 includes “dissemination of effective models of cancer care that incorporate palliative care.” They recognize MD Anderson Cancer Center (MDACC) as an innovative model for integration of palliative care into oncology. We will describe the MDACC model and exponential growth of the outpatient program, including improved clinical outcomes supported by published research. We will discuss the necessary ingredients for a successful program, including the importance of changing an institutional culture; how an interdisciplinary team brings an additive role to palliative care; the use of routine screenings for symptom distress and chemical coping; the use of family conferences and split visits (parallel meetings with patient and accompanying family for counseling); and unique methods of follow-up such as phone care programs and same-day consults. And, in spite of some institution-specific characteristics unique to MDACC, the clinical model, including an interdisciplinary palliative care team and a simultaneous cancer care approach, is reproducible. To demonstrate this, we will describe the Virginia Commonwealth University palliative care program that implemented core features of the MDACC model into their supportive care clinic, producing an eight-fold increase in patient contacts and clinic availability. We will conclude with discussing the opportunities and benefits for adapting this model into cancer centers to advance delivery of care, as well as the challenges and pitfalls encountered. Ultimately, the information delivered will provide concrete experiences for both academic institutions as well as community cancer centers to apply effective strategies to implement a dynamic interdisciplinary model of palliative care.