In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 29_suppl ( 2015-10-10), p. 156-156
Abstract:
156 Background: Patients with incurable cancer often have problematic symptoms and functional impairment despite active cancer care. Opportunities to assess and address these unmet needs exist at every care point. Methods: In 2007, we piloted a holistic model of care in an outpatient Palliative Radiation Oncology clinic. Twin goals (timely access to radiotherapy (RT) and multidisciplinary (MDT) symptom assessment/management) were met: a one-stop-shop to see a radiation oncologist (RO), nurse (RN), radiation therapist (MRT(T)) and pharmacist, with Social Work, Nutrition and Rehabilitation as needed. The model has since evolved, adapting to shifting system-level barriers, with continued attention to patient-reported outcomes. We discuss our team’s 8-year effort to integrate symptom management and palliative RT in a tertiary cancer center. Results: Despite challenges (patient-, provider-, facility-, service- or logistics-related), our target RT population grew from initially only those with bone metastases (served by 1 RO once weekly), to include brain or chest disease (seeing any local RO, any day). Priorities were complex, even at odds, to cater to broadly defined stakeholders: access to RT, systematic basic supportive care (BSC), operational efficiency, care transitions. From strong interdisciplinary focus and task-shifting emerged a critical patient navigation piece. Informal, then formal quality improvement work recast key functions by person/time/place, recently streamlining (e.g. intake/triage/referral pathways) and upgrading (e.g. shared RN/MRT(T) navigator role). Interfaces are layered, broad now between BSC (e.g. horizontal pre-/post-visit telephone symptom screening and goal-setting) and RT processes (e.g. more consistently vertical, less disruptive to technical workflows), enabling scale-up and alignment by design with quality dimensions. Operational and patient outcome metrics remain under periodic review. Conclusions: Integrating MDT BSC with outpatient palliative RT is feasible and scalable, when incrementally tailored to context. Further work, to formally assess patient satisfaction and downstream care needs, will inform PRISM as our local standard.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2015.33.29_suppl.156
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2015
detail.hit.zdb_id:
2005181-5
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