Conceptual Models for Integrating Palliative Care at Cancer Centers

Abstract

Palliative care programs are rapidly evolving in acute care facilities. Increased and earlier access has been advocated for patients with life-threatening illnesses. Existing programs would need major growth to accommodate the increased utilization. The objective of this review is to provide an update on the current structures, processes, and outcomes of the Supportive and Palliative Care Program at the University of Texas M.D. Anderson Cancer Center (UTMDACC), and to use the update as a platform to discuss the challenges and opportunities in integrating palliative and supportive services in a tertiary care cancer center. Our interprofessional program consists of a mobile consultation team, an acute palliative care unit, and an outpatient supportive care clinic. We will discuss various metrics including symptom outcomes, quality of end-of-life care, program growth, and financial issues. Despite the growing evidence to support early palliative care involvement, referral to palliative care remains heterogeneous and delayed. To address this issue, we will discuss various conceptual models and practical recommendations to optimize palliative care access.

Patterns of care at end of life for people with primary intracranial tumors: lessons learned

“…First, integration of palliative care within the continuum of cancer care 98 , by involvement of palliative care physicians or nurses early in the management plane, especially for patients with aggressive tumors (e.g. GBM) through participation in tumor board meetings, involvement in the multidisciplinary clinics, etc.…”

Development of a Question Prompt Sheet for Cancer Patients Receiving Outpatient Palliative Care

“…[24][25][26] Also, the development of the prompt sheet was intended for both patient and caregiver use because ambulatory palliative care is provided with strong caregiver involvement. It was, therefore, important to generate one single prompt sheet that could be used by both the patient and the caregiver.…”

The lung cancer patient, the pneumologist and palliative care: a developing alliance

“…Whilst increasing evidence has been published demonstrating successful implementation of palliative care or its elements into standard lung cancer care on the local level [23,62,[176][177][178], a superordinate master plan for better and encompassing delivery of palliative care in lung cancer patients is missing. For that, joint actions by governments and scientific societies are needed.…”

“…Structural requirement figures for comprehensive palliative care in Europe were estimated by EAPC [166], and respiratory societies should create joint initiatives together with other stakeholders to let palliative care become a true and effective partner in routine lung cancer care. Undoubtedly, sufficient palliative care structures do need proper re-allocation of funding, but graded levels of palliative care within coordinated network structures (including trained individuals, general palliative care in hospitals or nursing services, specialist palliative care, and centres of excellence) have already been proposed as cost-saving solutions [165,166,178,179], as have telephone counselling or other formats of telemedicine to overcome geographical gaps [180]. Furthermore, the Asian Oncology Summit from 2012 provided a template for a stratified allocation of palliative care according to national economic resources [181].…”