Integrating Palliative Care in Oncology Practice to Ensure Better Quality of Life
Rebecca Kirch, JD, executive vice president, Healthcare Quality & Value, National Patient Advocate Foundation, explained the value of palliative care in the context of the triple aim during her presentation at the 2018 Community Oncology Alliance (COA) Conference (April 13, 2018; National Harbor, MD).
Dr Kirch began her presentation by noting the points of emphasis to come: the science behind palliative care integration, the words used and integration approaches in practice, communication resources available, and advocacy steps to pursue. “The importance of integrating palliative care into value-based care is that we emphasize the quality of care for the patient,” she said.
The demand for value-based care is growing, she continued, and success depends on both the attention on the patient experience as well as efficient health services utilization. In this regard, palliative care helps render better quality care. Provided along with curative treatment, palliative care offers an added layer of support, she argued.
Health system leaders have addressed both challenges and benefits of having a palliative care program. Among the noted challenges are insurance reimbursement, patient satisfaction, and hiring and maintaining staff. On the contrary, palliative care programs help to improve quality of life and support for patients and their families, as well as improve doctor and staff satisfaction. Dr Kirch stressed that education and resources are needed from the top down; hospital executives need to understand the value and benefits of palliative care for their institution, providers need palliative care training and a better understanding that people benefit from palliative care earlier in treatment than they might think, and patients need to be made aware that palliative care exists as an option.
“Palliative care has improved tremendously in the past decade,” Dr Kirch commented, referring specifically to how this type of care offers a triple aim solution. Palliative care improves quality of life, strengthens communication and decision-making between providers and patients and their families, coordinates medical and practical needs across care settings and care transitions, and reduces resource utilization and costs by matching treatment to patient and family goals.
Three elements of palliative care visit focus are associated with improved patient outcomes: coping (improved quality of life and reduced depression symptoms), treatment decisions (reduced chemotherapy initiation and hospitalization in 60 days before death), and advance care planning (increased likelihood of using hospice). All of these are crucial elements of early palliative care that enable dissemination of the integrated care model, Dr Kirch noted.
Additionally, she disclosed that early palliative care shift expenditures from the inpatient to outpatient and hospice settings, which accounts for over $2500 saved per patient case.
“Palliative care has an identity problem,” Dr Kirch shared, referring to the common belief among clinicians that palliative care is its own specialty and therefore should be confined to specific caregivers. Dr Kirch set this misconception straight by reminding the audience that while there are palliative care specialists who manage complex cases and challenging symptoms, all clinicians are responsible for general palliative care, which includes basic symptom management, communication, and coordination to align treatment with goals.
Furthermore, Dr Kirch alluded to requirements of the Oncology Care Model (OCM), which asks its participants to engage in expert and effective pain management, skilled communication, and patient care coordination. The OCM “enhanced services” require a 13-point care plan that communicates treatment benefits and short/long-term effects, quality of life and likely experience with treatment, and who will take responsibility for specific aspects of patient care.
As the most important and take-home message of the presentation, Dr Kirch reminded the audience that the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM) released a joint statement in 2016 for guidance on defining and providing high-quality palliative care services in oncology. The statement offers specific instruction for oncologists who see all patients receiving palliative care, the consultants who see complex patients, and for hospice referral.
In her concluding remarks, Dr Kirch spoke about the national strategy for boosting palliative care access. Among the necessary components are increased awareness, expanded education, adequate training, reimbursement alignment, improved accountability, and boosted research investment.—Zachary Bessette