Palliative care from cancer diagnosis for all: Memorial Sloan Kettering’s 'One-Two-Three' program
| Autor: | Kelley Anderson, Robin Rawlins-Duell, Kimberly Chow, Peter Justin Wan, Jessica Goldberg, Andrew S. Epstein, Judith E Nelson, Dana Kramer, Anjali V. Desai, Virginia M. Klimek, Coleen Ranghan, Molly Okpako, Debra O'Shea |
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| Rok vydání: | 2017 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 35:111-111 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | 111 Background: Early, universal palliative care is an unmet need for cancer patients. Our new program aims to provide palliative care, by primary oncology teams with support from palliative care specialists, from diagnosis as an institutional standard. Methods: One-Two-Three is a structured program of assessment and response addressing palliative care needs regardless of cancer stage or prognosis starting with the first 3 visits after diagnosis. Assessments include patient physical/emotional/spiritual symptoms (10 symptoms, self-reported 0-10), communication needs (information preferences, illness understanding), and proactive care planning through exploration of core values. As first responders, oncology nurses are guided by “ready responses” in an empathic framework and coaching or direct patient consultation by palliative care specialists. Feasibility, acceptability, and impact on patient, caregiver, and utilization outcomes are evaluated quantitatively and qualitatively. Results: Assessments were piloted with 25 consecutive, newly-diagnosed patients in blood cancer and solid tumor clinics. Symptom and communication assessments each took < 5 minutes and showed high prevalence of moderate/severe distress ( > 50% for 8/10 symptoms, 144 assessments), variation in information preferences (76% wanting detail, 24% broad overview only), and unmet communication needs. All but 1 patient without a health care proxy chose one. Oncology nurses engaged patients in structured discussions ( < 15 minutes) of core values. Clinic workflow was maintained. Patients, families, and oncology clinicians endorsed the initiative. As palliative care skills of oncology teams improved, specialists focused on more complex issues. Conclusions: Routine interprofessional primary palliative care with specialist support from diagnosis is feasible and acceptable in our center’s high-volume outpatient oncology clinics. Ongoing evaluations will assess other outcomes (e.g., quality of life); impact on clinicians/ processes; and utilization (e.g., ED/hospital visits, hospice use). |
| Databáze: | OpenAIRE |
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