Measuring the impact of integrating palliative care into a multidisciplinary brain and spine oncology clinic.

Abstract

163 Background: Recent literature indicates that palliative care (PC) improves the outcomes of patients with cancer. Integration of PC providers into cancer centers is increasingly recognized to enhance symptom management with a beneficial effect on patient survival. In order to predict the impact of widespread PC integration, we hypothesized that a small pilot program may provide evidence supporting broader implementation. The current study endeavors to measure the result of adding a dedicated PC provider to a multidisciplinary brain and spine oncology program. Methods: Over the six month study period, a PC nurse practitioner was integrated into an existing weekly multidisciplinary brain and spine oncology conference and clinic. The provider participated in the multidisciplinary conference reviewing recent MRIs and discussing current disease status and treatment options. Following conference, the PC provider would consult on up to four of the clinic patients. Data were recorded regarding patient characteristics, goals of care, and changes in therapy. Results: The PC provider participated in 14 multidisciplinary clinics with a total of 180 subjects. Of those, 24 subjects met with the PC provider in formal consultation. The most common diagnoses were 41.6% with metastatic lung cancer and 25% with glioblastoma. For goals of care, an Advanced Directive discussion was documented in 100%. Do Not Resuscitate (DNR) orders were activated in 37.5% and documented in 54%. Medical Orders for Scope of Treatment (MOST) forms were introduced in 87.5% and completed in 25%. For changes in therapy, enrollment in hospice occurred in 33.3%. Pain medication was changed in 33.3%. Other symptoms including fatigue, weakness, anorexia, constipation, anxiety, lymphedema, dysphagia, depression, insomnia, and alopecia were managed in 87.5%. Conclusions: This study suggests that the integration of a PC provider into an existing multidisciplinary cancer program can produce a high rate of establishing goals of care and result in changes in treatment in a significant number of cases. Further study on the impact of integrating PC in cancer centers seems to be warranted.