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A Workflow Initiative to Increase the Early Palliative Care Referral Rate in Patients With Advanced Cancer
Background
Early palliative care (PC) has been shown to improve cancer patients’ quality of life, symptom control, disease knowledge, psychological and spiritual health, end-of-life care, and survival, as well as reduce hospital admissions and emergency visits. The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice.
Results
Through a retrospective data review from July, August, and September 2023, a low percentage of early PC referrals were identified among Veterans with pancreatic, head and neck, and stage IV lung cancer in the Infusion Clinic. Only 48.5% had an early PC referral, which is a referral made within 8 weeks from the time of diagnosis and 3 or more months before death. A survey conducted among oncology providers suggests that the lack of provider knowledge about the scope of PC, the lack of set criteria/protocol to initiate a referral, and provider discomfort in referring patients were thought to hinder early referrals or cause late or/lack of referrals.
Discussion
This quality improvement project aimed to increase the early PC referral rate among advanced cancer patients in the infusion clinic to improve patient outcomes. An early PC referral toolkit was implemented consisting of (a) provider education about the scope of PC, (b) a script to help providers introduce PC as part of the comprehensive care team, (c) a PC brochure for reference, and (d) an Evidence-Based Five-item Screening Checklist to identify patients needing PC.
Conclusions
Nine months of data monitoring and analysis post-implementation revealed a 100% (n=12) early PC referral rate, and 80% (n=12) of providers reported feeling comfortable referring their patients. The project fostered a culture of comprehensive cancer care while empowering providers to make early referrals that improve patients’ multidimensional outcomes. The toolkit remains available to oncology providers and is shared upon request with other VA centers, as it is replicable in most VA settings that offer PC.
Background
Early palliative care (PC) has been shown to improve cancer patients’ quality of life, symptom control, disease knowledge, psychological and spiritual health, end-of-life care, and survival, as well as reduce hospital admissions and emergency visits. The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice.
Results
Through a retrospective data review from July, August, and September 2023, a low percentage of early PC referrals were identified among Veterans with pancreatic, head and neck, and stage IV lung cancer in the Infusion Clinic. Only 48.5% had an early PC referral, which is a referral made within 8 weeks from the time of diagnosis and 3 or more months before death. A survey conducted among oncology providers suggests that the lack of provider knowledge about the scope of PC, the lack of set criteria/protocol to initiate a referral, and provider discomfort in referring patients were thought to hinder early referrals or cause late or/lack of referrals.
Discussion
This quality improvement project aimed to increase the early PC referral rate among advanced cancer patients in the infusion clinic to improve patient outcomes. An early PC referral toolkit was implemented consisting of (a) provider education about the scope of PC, (b) a script to help providers introduce PC as part of the comprehensive care team, (c) a PC brochure for reference, and (d) an Evidence-Based Five-item Screening Checklist to identify patients needing PC.
Conclusions
Nine months of data monitoring and analysis post-implementation revealed a 100% (n=12) early PC referral rate, and 80% (n=12) of providers reported feeling comfortable referring their patients. The project fostered a culture of comprehensive cancer care while empowering providers to make early referrals that improve patients’ multidimensional outcomes. The toolkit remains available to oncology providers and is shared upon request with other VA centers, as it is replicable in most VA settings that offer PC.
Background
Early palliative care (PC) has been shown to improve cancer patients’ quality of life, symptom control, disease knowledge, psychological and spiritual health, end-of-life care, and survival, as well as reduce hospital admissions and emergency visits. The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice.
Results
Through a retrospective data review from July, August, and September 2023, a low percentage of early PC referrals were identified among Veterans with pancreatic, head and neck, and stage IV lung cancer in the Infusion Clinic. Only 48.5% had an early PC referral, which is a referral made within 8 weeks from the time of diagnosis and 3 or more months before death. A survey conducted among oncology providers suggests that the lack of provider knowledge about the scope of PC, the lack of set criteria/protocol to initiate a referral, and provider discomfort in referring patients were thought to hinder early referrals or cause late or/lack of referrals.
Discussion
This quality improvement project aimed to increase the early PC referral rate among advanced cancer patients in the infusion clinic to improve patient outcomes. An early PC referral toolkit was implemented consisting of (a) provider education about the scope of PC, (b) a script to help providers introduce PC as part of the comprehensive care team, (c) a PC brochure for reference, and (d) an Evidence-Based Five-item Screening Checklist to identify patients needing PC.
Conclusions
Nine months of data monitoring and analysis post-implementation revealed a 100% (n=12) early PC referral rate, and 80% (n=12) of providers reported feeling comfortable referring their patients. The project fostered a culture of comprehensive cancer care while empowering providers to make early referrals that improve patients’ multidimensional outcomes. The toolkit remains available to oncology providers and is shared upon request with other VA centers, as it is replicable in most VA settings that offer PC.
Centralized Psychosocial Distress Screening Led by RN Care Coordinator
Background
Unmet psychosocial health needs negatively impact cancer care and outcomes. The American College of Surgeons’ Commission on Cancer (CoC) accreditation requirements include Psychosocial Distress Screening (PDS) for all newly diagnosed patients. To enhance cancer care and meet CoC standards, the Tibor Rubin Veterans Affairs Medical Center (TRVAMC) developed and implemented a closed-loop, centralized PDS pathway.
Objectives
Develop processes/methods to: (1) identify all newly diagnosed cancer patients; (2) track initiation of first course of treatment; (3) offer and complete PDS at initiation of first course of treatment; and (4) ensure placement of appropriate referrals.
Methods
All staff members were trained in PDS and competency completed. A standard operating procedure (SOP) was created to identify patients meeting criteria for PDS. Newly diagnosed patients were identified from cancer registry lists, tumor boards, radiology and pathology reports. Patients were placed on a tracking tool by the nurse care coordinator (NCC) and monitored to facilitate timely workup and initiation of treatment. Nurses in the cancer program offered and completed PDS and placed all necessary referrals (to > 11 services). Patients were removed from the tracker only after confirmation of PDS and referrals.
Results
Prior to implementation of PDS, no patients received comprehensive screening and referrals. After implementation, data were collected over a 2 year period. In 2023 and 2024, 277/565 (49%) and 256/526 (48.7%) newly diagnosed patients were eligible for PDS, respectively. All eligible patients were offered PDS (100%). Of patients who underwent PDS, 37% scored their distress at a level of 4/10 or higher, underscoring the severity of distress and unmet need. Referrals to various services were indicated and made in 43.8% patients, most frequently to Social Work, Primary Care or Psychology/Mental Health. More recently, nurses in the Infusion Clinic and Radiation Oncology were trained in and also started conducting PDS on patients coming for treatment.
Conclusions
Implementation of comprehensive and timely PDS resulted in early identification and interventions to address diverse facets of distress that are known to interfere with quality of life, compliance with cancer treatments and outcomes. The program also met the CoC standard for accreditation of TRVAMC in 2024.
Background
Unmet psychosocial health needs negatively impact cancer care and outcomes. The American College of Surgeons’ Commission on Cancer (CoC) accreditation requirements include Psychosocial Distress Screening (PDS) for all newly diagnosed patients. To enhance cancer care and meet CoC standards, the Tibor Rubin Veterans Affairs Medical Center (TRVAMC) developed and implemented a closed-loop, centralized PDS pathway.
Objectives
Develop processes/methods to: (1) identify all newly diagnosed cancer patients; (2) track initiation of first course of treatment; (3) offer and complete PDS at initiation of first course of treatment; and (4) ensure placement of appropriate referrals.
Methods
All staff members were trained in PDS and competency completed. A standard operating procedure (SOP) was created to identify patients meeting criteria for PDS. Newly diagnosed patients were identified from cancer registry lists, tumor boards, radiology and pathology reports. Patients were placed on a tracking tool by the nurse care coordinator (NCC) and monitored to facilitate timely workup and initiation of treatment. Nurses in the cancer program offered and completed PDS and placed all necessary referrals (to > 11 services). Patients were removed from the tracker only after confirmation of PDS and referrals.
Results
Prior to implementation of PDS, no patients received comprehensive screening and referrals. After implementation, data were collected over a 2 year period. In 2023 and 2024, 277/565 (49%) and 256/526 (48.7%) newly diagnosed patients were eligible for PDS, respectively. All eligible patients were offered PDS (100%). Of patients who underwent PDS, 37% scored their distress at a level of 4/10 or higher, underscoring the severity of distress and unmet need. Referrals to various services were indicated and made in 43.8% patients, most frequently to Social Work, Primary Care or Psychology/Mental Health. More recently, nurses in the Infusion Clinic and Radiation Oncology were trained in and also started conducting PDS on patients coming for treatment.
Conclusions
Implementation of comprehensive and timely PDS resulted in early identification and interventions to address diverse facets of distress that are known to interfere with quality of life, compliance with cancer treatments and outcomes. The program also met the CoC standard for accreditation of TRVAMC in 2024.
Background
Unmet psychosocial health needs negatively impact cancer care and outcomes. The American College of Surgeons’ Commission on Cancer (CoC) accreditation requirements include Psychosocial Distress Screening (PDS) for all newly diagnosed patients. To enhance cancer care and meet CoC standards, the Tibor Rubin Veterans Affairs Medical Center (TRVAMC) developed and implemented a closed-loop, centralized PDS pathway.
Objectives
Develop processes/methods to: (1) identify all newly diagnosed cancer patients; (2) track initiation of first course of treatment; (3) offer and complete PDS at initiation of first course of treatment; and (4) ensure placement of appropriate referrals.
Methods
All staff members were trained in PDS and competency completed. A standard operating procedure (SOP) was created to identify patients meeting criteria for PDS. Newly diagnosed patients were identified from cancer registry lists, tumor boards, radiology and pathology reports. Patients were placed on a tracking tool by the nurse care coordinator (NCC) and monitored to facilitate timely workup and initiation of treatment. Nurses in the cancer program offered and completed PDS and placed all necessary referrals (to > 11 services). Patients were removed from the tracker only after confirmation of PDS and referrals.
Results
Prior to implementation of PDS, no patients received comprehensive screening and referrals. After implementation, data were collected over a 2 year period. In 2023 and 2024, 277/565 (49%) and 256/526 (48.7%) newly diagnosed patients were eligible for PDS, respectively. All eligible patients were offered PDS (100%). Of patients who underwent PDS, 37% scored their distress at a level of 4/10 or higher, underscoring the severity of distress and unmet need. Referrals to various services were indicated and made in 43.8% patients, most frequently to Social Work, Primary Care or Psychology/Mental Health. More recently, nurses in the Infusion Clinic and Radiation Oncology were trained in and also started conducting PDS on patients coming for treatment.
Conclusions
Implementation of comprehensive and timely PDS resulted in early identification and interventions to address diverse facets of distress that are known to interfere with quality of life, compliance with cancer treatments and outcomes. The program also met the CoC standard for accreditation of TRVAMC in 2024.