Case for Dual Training in Medical Oncology and Palliative Care

Sedhom, Ramy; Gupta, Arjun; Kamal, Arif H.

doi:10.1200/op.20.00137

Cited by 12 publications

(6 citation statements)

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“…Oncologists reported underconfidence in counseling as a key issue; unfortunately, fertility preservation principles remain undertaught in oncology curriculum. [9][10][11] Similar to our diagnostic data, previous qualitative data from Canadian oncofertility clinicians demonstrated that a major barrier to appropriate counseling is clinician unfamiliarity (with infertility risks and referral processes). 12 In another report, oncologists across practice settings rated fertility preservation as the most difficult QOPI measure to influence.…”

Section: Discussionsupporting

confidence: 80%

Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

Sena

Sedhom

Scott

et al. 2022

JCO Oncology Practice

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PURPOSE: Oncofertility counseling regarding the reproductive risks associated with cancer therapy is essential for quality cancer care. We aimed to increase the rate of oncofertility counseling for patients of reproductive age (18-40 years) with cancer who were initiating systemic therapy at the Johns Hopkins Cancer Center from a baseline rate of 37% (25 of 68, June 2019-January 2020) to 70% by February 2021. METHODS: We formed an interprofessional, multidisciplinary team as part of the ASCO Quality Training Program. We obtained data from the electronic medical record and verified data with patients by phone. We surveyed patients, oncologists, and fertility specialists to identify barriers. After considering a prioritization matrix, we implemented Plan-Do-Study-Act (PDSA) cycles. RESULTS: We identified the following improvement opportunities: (1) oncologist self-reported lack of knowledge about counseling and local fertility preservation options and (2) lack of a standardized referral mechanism to fertility services. During the first PDSA cycle (February 2020-August 2020, disrupted by COVID-19), we introduced the initiative to increase oncofertility counseling at faculty meetings. From September 2020 to November 2020, we implemented a second PDSA cycle: (1) educating and presenting the initiative at Oncology Grand Rounds, (2) distributing informative pamphlets to oncologists and patients, and (3) implementing an electronic medical record order set. In the third PDSA cycle (December 2020-February 2021), we redesigned the order set to add information (eg, contact information for fertility coordinator) to the patient after-visit summary. Postimplementation (September 2020-February 2021), counseling rates increased from 37% to 81% (38 of 47). CONCLUSION: We demonstrate how a trainee-led, patient-centered initiative improved oncofertility care. Ongoing work focuses on ensuring sustainability and assessing the quality of counseling.

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Section: Discussionsupporting

confidence: 80%

Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

Sena

Sedhom

Scott

et al. 2022

JCO Oncology Practice

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“…24,25 For example, there could be novel ways of integration between oncologists and specialist palliative care providers to utilise limited resources more efficiently and deliver more coordinated palliative care support to advanced cancer patients. [26][27][28][29] This may involve oncologists providing generalist palliative care for those without complex needs who may not require specialist palliative care. 30,31 The second main reason for delayed access to specialist palliative care is the dependence on the referring practices of primary oncologists which vary widelysome refer all patients with advanced cancer while others refer only in the terminal phase of life.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and timing of specialist palliative care access among advanced cancer patients and association with hospital death

Yang

Lim

Zhuang

et al. 2021

Proceedings of Singapore Healthcare

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Background Patients with advanced cancer have poor quality of life and high utilisation of acute healthcare services. Early access to palliative care has been shown to improve quality of life as well as reduce acute healthcare utilisation and costs. Objectives To determine the prevalence and timing of hospital-based specialist palliative care reviews for patients with advanced cancer known to National Cancer Centre Singapore. We also explored the association between specialist palliative care review and place of death. Methods A retrospective study of patients with Stage 4 cancer who died in a 2-year period from 1 January 2016 to 31 December 2017 (regardless of their date of diagnosis) and who received treatment in National Cancer Centre Singapore (NCCS). Results A total of 2572 patients were included, of which 1226 (47.7%) had at least one inpatient or outpatient specialist palliative care consultation. Those who had their first specialist palliative care review 30 days or less before death had a 2.01 (95% CI 1.62 to 2.49, p < 0.001) increased odds of hospital death while those who had the first hospital-based palliative care review more than 30 days before death a 0.76 (95% CI 0.62 to 0.93, p = 0.009) reduced odds of hospital death. Conclusions Our study found inadequate and late access to specialist palliative care among advanced cancer patients. Furthermore, late access to specialist palliative care was associated with hospital death. There is an urgent need to improve access to specialist palliative care in order to improve patient outcomes.

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“…Yes, better investments can be made in the time dedicated to an oncologist's palliative care training. 8,9 Still, it would be alarming if 100% of patients with cancer were seen by palliative care, which begs the question, what is the optimal penetration rate for palliative care among patients with advanced cancer?…”

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confidence: 99%

Is Improving the Penetration Rate of Palliative Care the Right Measure?

Sedhom

Kamal

2022

JCO Oncology Practice

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Case for Dual Training in Medical Oncology and Palliative Care

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 12 publications

References 11 publications

Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

Prevalence and timing of specialist palliative care access among advanced cancer patients and association with hospital death

Is Improving the Penetration Rate of Palliative Care the Right Measure?

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