Guidance on delivering high-quality primary palliative care in oncology

Last Updated: 2015-10-12

By Megan Brooks

NEW YORK (Reuters Health) - The first formal consensus-based statement on delivering high-quality primary palliative care in oncology practice has been issued by the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM).

"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 Dr. Kathleen Bickel said in an ASCO statement from the 2015 Palliative Care in Oncology Symposium.

"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," added Dr. Bickel, of White River Junction Veterans Affairs Medical Center and the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire.

The guidance statement was developed by a 31-member panel of physicians, patient advocates, social workers, nurses and nurse practitioners. The panel ranked 966 different palliative care services according to their importance, feasibility, and whether or not the services were within the scope of medical oncology practice. Only services ranked highly in all three areas were included in the panel's definition of high-quality primary palliative care in oncology.

Most palliative care services included in the definition relate to symptom assessment and management, communication and shared decision-making, and advance care planning, for example: manage nausea and vomiting resistant to second-line treatment, gauge the patient's and family's understanding of prognosis, and assess the need for hospice referral at the time of diagnosis of an incurable cancer.

"The full publication will be coming soon with more details about the specific service items included in this definition project," Dr. Bickel noted during a presscast. "It is still an early-stage definition project, but this is necessary because in order to improve palliative care delivery and access for patients with cancer, we must first define and agree on what oncology practices should be providing."

"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," she said.

These efforts represent an important collaboration and characterize a new concept of primary palliative care," said Dr. Don Dizon, presscast moderator and designated ASCO expert for the symposium.

"Given the importance of assessing symptom burden for our patients, particularly with advanced malignancy, these guidelines will be helpful to delineate what palliative services should be reasonably expected as part of usual medical oncology versus what should be referred to a specialist within palliative care," added Dr. Dizon, co-director of gynecologic oncology at Massachusetts General Hospital in Boston.

The 2015 Palliative Care in Oncology Symposium, held October 9-10 in Boston, was co-sponsored by ASCO, AAHPM, the American Society for Radiation Oncology, and the Multinational Association of Supportive Care in Cancer.

SOURCE: http://bit.ly/1OxessP

ASCO 2015 Palliative Care in Oncology Symposium.