Earlier access to palliative medicine: An experience of integration into a community oncology practice.

Abstract

92 Background: A growing body of evidence supports the integration of palliative care as a standard for comprehensive cancer care. Through our experience as an inpatient palliative care provider, with 50% of our population having advanced cancer, we recognized the value proposition to provide continuity in the outpatient setting. Innovative Care Solutions developed a partnership with a large, community oncology program late 2015 for a palliative care multidisciplinary team to be embedded into one location of their practice. Methods: A full-time palliative licensed independent social worker (LISW) was dedicated to educate and engage screening process development. Utilizing the NCCN Distress Thermometer, referrals for care provision were then directed by the LISW to the most appropriate palliative care provider. The LISW addressed communication, goals of care discussions and advance directives. Identification of symptoms, including high level distress or mental health needs, were scheduled to see the palliative physician or advanced practice nurse, available two half days per week within the cancer center. Results: In the first quarter of service, the LISW screened a total of 85 patients, with 54 requiring PC interventions. Complex symptom needs were identified in seventeen percent, thirty percent were seen for psychosocial needs, and twenty percent were seen for completion of an advance directive. Thirty-six percent were seen for medical decision making. Conclusions: Integrating palliative care services in a community-based oncology practice has realized numerous positive patient outcomes and opportunities for further design. Using an evidenced based screening tool, identification of needs in an early access model appear to enable the patient to improve adherence to the medical plan care and avoid ER utilization. Symptom management has shown improved quality of life scores and PPS, and patient’s seen for psychosocial needs are able to explore aspects of person, as opposed to illness, that has improved overall well-being. Further program design will focus on integration of screening for all patients with advanced solid tumor, recurrent/refractory, and formalization of quality data tracking benchmarked to a web-based registry.