Embedding Palliative Care in Treatment Clinics Improves Access to Care

An embedded palliative care program results in earlier and prolonged access to palliative care, according to research published in the Journal of Oncology Practice (published online June 2017; doi:10.1200/JOP.2016.020396).


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Previous research has confirmed that patients with advanced cancer benefit from early involvement of palliative care. However, the optimal method of integrating palliative care remains to be determined, especially for patients treated in clinics that specialize in targeted and immune-based therapies.

David J Einstein, MD, Beth Israel Deaconess Medical Center (Boston, MA), and colleagues conducted a study to assess the impact of an embedded palliative care team that assisted patients in an academic oncology clinic specializing in targeted and immune-based therapies. Researchers examined data from 114 patients who died within the three years after implementation of the embedded model. Patients seen on a specific day (n = 26) had access to the embedded model based on automatic criteria: diagnosis of stage IV metastatic renal cancer or melanoma, receipt of active anticancer therapy, or a self-assessed Edmonton Symptom Assessment Scale score greater than 5 on one or more individual symptoms. Patients assisted on other days (n = 88) could be referred to a separate palliative care clinic (usual care).

Researchers found that the patients assisted in the embedded model accessed palliative care as outpatients more often than those receiving usual care (90% vs 73%, respectively). While hospice enrollment rates were similar (58% vs 51%), the mean duration of hospice was increased (57 days vs 25 days) as well as enrollment in hospice more than seven days before death (50% vs 28%).

Researchers noted that place of death and chemotherapy use within two weeks of death did not differ significantly between the groups.

Authors of the study concluded that, ““A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.”—Zachary Bessette