Recognizing the importance of early referrals for palliative care is critical to patient care

In conversation with pharmacy hours At the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Ajeet Gajra, MD, MBBS, FACP, discussed research finding that the use of an augmented intelligence-based system improves the timeliness of referrals to palliative care and hospice services in community oncology can improve environments.

Can you discuss the importance of timely referrals to palliative care and hospice services?

Ajeet Gajra, MD, MBBS, FACP: Timely referrals to palliative and hospice care near the end of life are considered quality benchmarks in oncology. So our own society, ASCO, through their QOPI program, has identified that there are ASCO guidelines, NCCN guidelines, for the early integration of palliative care into the course of patients battling cancer. And what leads to that is better expectation, you know, a better set of patient and family expectations, number 1. Number 2, it often avoids traumatic end-of-life treatments.

So what we do know is whether patients with advanced cancer are receiving chemotherapy or radiation therapy, if they have to go to the emergency room repeatedly, receive hospital admissions, or are admitted to the intensive care unit, these are all bad outcomes. Indeed, these results indicate poor quality of oncological care and should therefore be avoided and prevented at all costs. The way to avoid and prevent these is therefore to integrate palliative care into the course at an early stage. And when the time comes, this palliative care can then, if necessary, be transferred to hospice care. And I think that’s a critical piece. And unfortunately there is still sometimes confusion about equating palliative care with hospice care. And again, I want to emphasize that hospice care is just a small segment of palliative care, which is a much broader term on something so much longer continuum, and towards the end of that, you know, we use hospice care.

What are the barriers to timely referrals for patients with advanced cancer?

Ajeet Gajra, MD, MBBS, FACP: So I would break these obstacles into really 3 buckets. So there are obstacles or barriers from the perspective of the patient or caregiver. There are obstacles from the perspective of the provider or the clinician. And then there are obstacles that are inherent obstacles. So when we first talk about patients and carers, there’s always the concern that if palliative care isn’t mentioned or conveyed in the right context, there’s a fear that my doctor will give up on me. So, you know, that’s still a common thought process, unfortunately. I think through our outreach and patient-centred education, we need to eliminate that and reduce that kind of mindset. I think we need to make it very clear to patients and families that when their clinical team recommends palliative care, alongside other therapies they are receiving, the goal is really to help them manage their symptoms more effectively and actually improve the quality improve care. And that doesn’t mean her oncology care is going away.

So, I think there’s a downside. So, I said, you know, there’s also the clinician or provider aspect. Therefore, providers must also be convinced that palliative care is an essential part of the cancer continuum. And if we integrated early, we have a lot of studies, you know, first came the groundbreaking work in patients with advanced lung cancer, and that’s 10 years ago now. And since then we’ve had many other studies showing that integrating palliative care earlier improves outcomes, both in terms of quality of life and survival in these patients. So I think we have to do that.

In another work Cardinal Health has done with local oncology clinicians, there is still a gap where people are not incorporating palliative care early. They wait until, you know, really later stages and near the end of life before initiating such care. And these are still clinicians and providers, perhaps a specialty in a community setting. And, you know, the United States is a big country and there’s a lot of practices, and especially in the rural areas where these are busy practices and these clinicians are busy taking care of all kinds of cancer patients, and that’s maybe not the best mind for her. So education feels critical.

And the third, as I said, is a system-based problem. Do we have enough palliative care workers? You know, they don’t have to be doctors, they can be advanced practice providers. It can be a team, you know, that includes an APP and the social worker and other components. However, it must be recognized that this is a critical component in patient care.

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