Barriers and Approaches to the Successful Integration of Palliative Care and Oncology Practice

Abstract

As management of patients with cancer is evolving, an increased focus is being placed on individualized patient-centered care. Early integration of palliative care into the overall management of patients with cancer can help achieve this paradigm shift. Despite recommendations for earlier integration of palliative care by national and international societies, several barriers remain to achieving this goal. Survey studies have indicated a significant need for increased education regarding palliative care for both medical undergraduates and postgraduate physicians. Key issues in the early integration of palliative care include relationship-building across multiple health systems and specialties; development of a standardized definition of palliative care, making clear that it should be fully integrated with cancer-directed therapy; identification of physician and nonphysician champions; standardization of tools for patient assessment; education programs designed to meet the needs of health care professionals; and ongoing evaluation to assess program benefits and limitations.

MASCC/ESMO/EAPC survey of palliative programs

“…This survey did not include administration time, local meetings, and national or international organization responsibilities. Standardized definitions of palliative care are lacking and the term palliative care has little or no meaning to patients [1]. The use of the term palliative care may put patients off from accepting services as discussed in recent publications from the USA [9,10].…”

“…Integration of palliative care into cancer care is highly endorsed by the World Health Organization, the Institute of Medicine, the European Society of Medical Oncology, and the American Society of Clinical Oncology [1,2]. Palliative Care has increasing relevance for the care of advanced cancer patients [3,4].…”

Strategies for Promoting High-Quality Care and Personal Resilience in Palliative Care

“…Currently, physicians and medical residents report that palliative care training is inadequate [9], and there is a common view among practicing clinicians that palliative care is only appropriate for patients who have stopped curative treatment, which prevents many patients who would benefit from PC from receiving it [10]. The nursing profession has made an effort to provide nurses with palliative care training through the End-of-Life Nursing Education Consortium (ELNEC), which has resulted in over 550,000 nurses receiving education in PC in 88 countries [11].…”

“…Despite the impact of the ELNEC program, there is still a need for more nurses with PC expertise, as suggested by the American Association of Colleges of Nursing recently releasing specific PC competencies for undergraduate nursing education [11]. Increasing palliative care knowledge across the health care workforce can improve communication between clinicians and patients, expand the number of patients who receive the range of PC services-such as control of pain and other distressing symptoms and goal settingand decrease both misinformation about PC and prominent sources of moral distress associated with end-of-life care [4,10].…”

“…Better understanding of these core components and the outcomes associated with them may lead to the incorporation of palliative care into routine treatment of serious illnesses as a matter of protocol, which could be particularly useful in the cancer setting [10,11]. Oncology clinicians commonly use treatment protocols that map a course of treatment but allow for changes based on each patient's clinical course.…”