The Supportive Care Clinic: A Novel Model of Embedded Pediatric Palliative Oncology Care

Differences in palliative opportunities across diagnosis groups in children with cancer

“…This gap in service could be improved with the provision of outpatient PC access and continuing education for providers around benefits of PC. 41 Although patients in the ST and CNS tumor groups had the highest number of palliative opportunities, they had the lowest rates of PC consultation. Reasons for the lack of PC consultation often include the oncology team's comfort in providing primary PC, challenges accepting subspecialty PC, lack of access to outpatient subspecialty PC and limited inpatient providers, and beliefs about family acceptance of PC.…”

“…At the time of this study, while the inpatient service was robust and readily available, our center did not have outpatient PC. This gap in service could be improved with the provision of outpatient PC access and continuing education for providers around benefits of PC 41 …”

Consultation patterns before and after embedding pediatric palliative care into a pediatric hematology/oncology clinic

“…[2][3][4][5][6][7][8][9][10][11] Pediatric palliative oncology (PPO) is a term used to describe palliative care within pediatric oncology that emphasizes longitudinal therapeutic relationships, symptom management, and shared decision-making with patients, families, and oncologists. 12 Existing models of PPO care seek to increase the availability of palliative care services in pediatric oncology practices.…”

“…However, many PPC practices are weighted toward the inpatient setting. 12 Increasing utilization of PPC in oncology through expansion of outpatient practice and early inclusion of PPC as a multidisciplinary team member is an overarching strategy to improve access to PPC. 13 Unfortunately, there are significant barriers to integration of PPC into pediatric oncology practices, such as resource limitations of outpatient PPC practices, lack of research on how to best integrate care, stigma of palliative care among physicians and families, and limited physician knowledge of palliative care and when to refer.…”

“…[15][16][17][18][19][20][21] Embedded palliative care, defined as a model of care with shared workspace for palliative specialists and oncologists, has emerged as one way to improve access to palliative care in the outpatient oncology setting. 12 Perceived benefits of embedded PPC among multidisciplinary team members include early integration, routinization of care, and accessibility of PPC. 22 There are several notable gaps in the literature surrounding embedded PPC.…”