A new guidance statement from the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM) provides the first formal, consensus-based recommendations regarding high-quality primary palliative care in oncology, according to Kathleen E. Bickel, MD, MPhil, Assistant Professor of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH. The statement could potentially standardize primary palliative care delivery across oncology settings. Dr Bickel participated in the panel that developed the guidance statement and presented its goals at the 2015 Palliative Care in Oncology Symposium. When integrated into routine oncology care, palliative care improves symptom burden, quality of life, and patient and caregiver satisfaction. However, not all patients with cancer have access to specialist palliative medicine. “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,” said Dr Bickel. “Serious illness is hard, and there’s a lot we want our medical team to do for us,” said Dr Bickel. “This guidance statement is intended to represent what oncology clinic stakeholders feel right now is reasonable, important, and feasible to implement in current practice.” According to her, consistent access to at least basic palliative care services would be improved if the delivery of high-quality primary palliative care services were incorporated in all medical oncology practices. Therefore, investigators sought to determine which palliative care elements constitute high-quality palliative care delivery in US medical oncology practices, for adult patients with advanced cancer or high symptom burden.
Palliative Care Domains for Oncology PracticesIn developing the guidance statement, the investigators focused on what could be delivered solely by oncology practices versus what should be delivered by palliative care specialists. “The purpose of this project is to give oncology practice real tools to improve their delivery of primary palliative care,” said Dr Bickel. An expert steering group of committee members from AAHPM and ASCO developed a list of 966 potential palliative care service items, which were divided into 9 domains of palliative care categories relevant to oncology practice. Each of the domains reflects an aspect of palliative care delivery for patients with advanced cancer. The 9 domains include:
- Symptom assessment and management
- Psychosocial assessment and management
- Spiritual and cultural assessment and management
- Communication and shared decision-making
- Advance care planning, including ethical and legal issues
- Coordination and continuity of care
- Appropriate palliative care and hospice referral
- Caregiver support (family/caregiver and staff)
- End-of-life care.