Integrating Palliative Care at the Point of Care: Development of Electronic Interdisciplinary Plans of Care for Oncology Inpatients.

Abstract

Integration of palliative care (PC) in oncology requires changes in delivery and processes of care, such as implementation of comprehensive, evidence-based interdisciplinary plans of care (IPOCs). A multidisciplinary design team partnered with an electronic health record company and an information analytics company that specializes in online clinical practice guidelines. The team sought to develop electronic IPOCs that address the unique needs of oncology inpatients, attend to PC needs, and reflect the interdisciplinary team's contribution to quality patient outcomes. Our cancer center had paper-based care plans that were not well integrated into workflow, did not represent comprehensive PC, did not reflect interdisciplinary care, and did not guide evidence-based practice at point of care. The team designed IPOCs to be incorporated into each discipline's workflow and unique documentation and established clinical decision support tools to suggest appropriate IPOCs. Thirty-five IPOCs were developed and included all domains of quality PC. Evaluation of IPOC use indicated incomplete, but improving, adoption of PC-specific IPOCs with engagement in collaborative care planning by a variety of disciplines and across oncology nursing subspecialties.