Delays in access to palliative care services among cancer patients in South Texas.

Abstract

215 Background: The growing support for integrated palliative and cancer care resulted in the American Society of Clinical Oncology’s new recommendation which states patients “with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment.” Unfortunately, timely access to palliative services remains an issue for cancer patients and centers. The aim of this project is to evaluate how socioeconomic factors impact palliative access for patients in South Texas. Methods: During a 6-month period, patients in oncology clinics completed the Edmonton Symptom Assessment System questionnaire. Scores reaching a predetermined threshold resulted in a provider alert to consider referral to palliative services. We examine time to initial palliative appointment after referral and compare time to visit based on location of palliative services determined by insurance coverage. Results: During our study period, providers referred 47 unique patients with 27 patients eligible to receive care at the University of Texas Medicine System (Group A) and 20 patients qualified for care at the University Hospital System providing services to under-insured and safety net patients (Group B). Of the 47 referred patients, 27 (57%) patients were offered an appointment and only 17 patients (36%) actually had a palliative care visit (13/27 (48%) Group A patients and 4/20 (20%) Group B patients). On average, Group B patients had 25.2 days longer wait times to palliative visits compared to Group A patients. Conclusions: This investigation revealed a discrepancy between referral and actual receipt of care. While this study is limited by a small sample, data suggests that under-insured oncology patients may have significantly different access to palliative services which may impact the quality of cancer care. [Table: see text]

Root Cause Analysis of Oncology Adverse Events in the Veterans Health Administration

“…[1][2][3] Medical errors may include a variety of systemderived missteps, including treatment and medication mistakes, missed or delayed diagnoses, and miscommunications during transitions in care. [3][4][5][6][7][8][9][10][11][12][13][14] These errors may result in a wide range of effects to the patients, from no harm to death, and some errors never reach the patient. [3][4][5][6][7][8][9][10][11][12][13][14] The Institute of Medicine maintains patient safety and medical errors to be an urgent public health issue, especially in oncologic care.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14] These errors may result in a wide range of effects to the patients, from no harm to death, and some errors never reach the patient. [3][4][5][6][7][8][9][10][11][12][13][14] The Institute of Medicine maintains patient safety and medical errors to be an urgent public health issue, especially in oncologic care. 1,15 In response to the Institute of Medicine's report highlighting areas of safety concern, ASCO developed the Quality Oncology Practice Initiative in an attempt to standardize care assessment and inform safe practices.…”

“…16 However, safety concerns and the ability to determine the root cause of an adverse event in oncology are often complicated by the interprofessional and interdisciplinary nature of the field, as well as by the complexity of the disease and treatment. 1,2,10,14,17,18 Although these initiatives and collaborative practices are intended to result in safer practices, adverse events still occur in the course of cancer treatment. 1,10,[17][18][19][20] Most current literature pertaining to oncologic errors and adverse events has been based on closed claims malpractice data.…”

“…1,2,10,14,17,18 Although these initiatives and collaborative practices are intended to result in safer practices, adverse events still occur in the course of cancer treatment. 1,10,[17][18][19][20] Most current literature pertaining to oncologic errors and adverse events has been based on closed claims malpractice data. 10,21,22 In those data, the primary reasons for litigation include failure to diagnose and treat, patient injuries, and failure to adhere to safety protocol.…”

“…1,10,[17][18][19][20] Most current literature pertaining to oncologic errors and adverse events has been based on closed claims malpractice data. 10,21,22 In those data, the primary reasons for litigation include failure to diagnose and treat, patient injuries, and failure to adhere to safety protocol. 10,21,22 Existing literature reports oncologic errors and adverse events in specific areas of oncology, including errors in chemotherapy and radiation.…”