Goals Defined for Palliative Care in Oncology Practices

Kathleen Bickel, MD, MPhil

Kathleen Bickel, MD, MPhil

The American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM) have partnered to create a consensus definition of high-quality palliative care incorporated into oncology practices.

Palliative care integrated into routine oncology care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, the small workforce of palliative care specialists is insufficient to meet the needs of all patients with cancer.

The guidance statement is intended to define goals that can help improve the palliative care that is already being delivered by medical oncology practices.

“Oncologists can and already do provide many palliative services, but until now, no comprehensive guidance existed on what practices should be aiming for,” lead author Kathleen Bickel, MD, MPhil, assistant professor of medicine, White River Junction Veterans Affairs Medical Center and the Geisel School of Medicine at Dartmouth, said in a statement.

“For the first time, we’ve set some reasonable and achievable goals for high-quality primary palliative care delivery for oncology practices in the everyday care of patients, which we hope will improve patient comfort and quality of life.”

The recommendations were previewed in a presscast October 5 in advance of the 2015 Palliative Care in Oncology Symposium to be held October 9-10 in Boston.

For the project, researchers developed a list of 966 palliative care service items, divided into nine domains, each describing an aspect of palliative care for patients with advanced cancer.

Thirty-one multidisciplinary panelists—including physicians, nurses, nurse practitioners, social workers, and patient advocates—used a modified Delphi methodology to rank each item according to importance, feasibility, and scope.

The highest consensus among panelists was in favor of including end-of-life care (81%), communication and shared decision making (79%), and care planning (78%).

Under the appropriate palliative care and hospice referral domain (69% consensus), panelists agreed that oncology practices should be able to explain the difference between palliative care and hospice care to patients. They also agreed that oncologists should refer patients with an expected survival of under 3 months to hospice.

In the largest domain with 259 items, symptom assessment and management (66%), there was a consensus that symptoms should be assessed and managed at a basic level with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, and pain.

Other domains were carer support (56%), coordination/continuity of care (48%), psychosocial assessment and management (39%), and spiritual and cultural assessment and management (35%).

“This is necessary because in order to improve palliative care delivery and access to patients with cancer, we must first define and agree on what oncology practices should be providing,” Bickel said during the press. “These goals may adapt and change over time, but we hope this work will serve as a foundation for future palliative care—related quality measures, quality improvement initiatives, and educational activities and will help oncology practices improve their delivery of primary palliative care.”

Bickel added that it will take time for the guidelines to be implemented in oncology practices, but concluded that they may be useful for providers looking to improve palliative care delivery.

“This collaboration between professional organizations is a significant step toward accessible, high-quality palliative care for all patients,” said Don S. Dizon, MD, ASCO Expert and presscast moderator, in a statement. “The recommendations will help us identify essential palliative care services and set achievable goals for medical oncology practices across the country.”

Bickel, KE, McNiff, KK, Buss, MK, et al. Defining high-quality palliative care in oncology practice: An ASCO/AAHPM Guidance Statement. J Clin Oncol. 2015;(suppl; abstr 108).