Cullen G

Purpose: Palliative care is essential to oncology. The purpose of this project was to characterize the interface between VA oncologists and palliative care specialists in the outpatient setting and to identify barriers to outpatient palliative oncology care in the VA.

Background: The American Society of Clinical Oncology (ASCO) recommends palliative care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. The VA mandates palliative care inpatient consult teams for all medical facilities. It is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. The 2016 VHA Cancer Care Survey was a comprehensive assessment of 140 VA facilities regarding their cancer care infrastructure. On this survey, 23% of sites (N=32) reported that they were not able to provide adequate palliative oncology care in the outpatient setting.

Methods: We contacted clinicians at each of these 32 sites to characterize the outpatient oncology/palliative care interface and identify potential barriers.

Results: Of the 32 sites, 17 reported that they provided limited oncologic care and generally referred patients to other facilities for cancer treatment. The remaining 15 sites reported providing full oncology services. These 15 sites employed a variety of methods to engage palliative care specialists. These included referring patients to a separate outpatient palliative care clinic or a home-based provider; consulting the inpatient palliative care team to evaluate the patient while in the cancer clinic; working with an oncology social worker; or arranging a tele-consult with a remote palliative care specialist. Barriers to providing outpatient palliative care included not enough palliative care staff, not enough clinic space, and patients or oncologists declining a palliative care referral. Clinicians expressed that they would provide more outpatient palliative care if they
had more palliative care staff, more clinic space, and more palliative care training for oncologists.

Conclusions: This project identified that some sites have found creative approaches to providing outpatient palliative oncology care. In addition, clinicians emphasized the ongoing need for additional specialty palliative care staff, primary palliative care training for oncologists, and clinic space in order to provide optimal outpatient palliative oncology care for VA patients.

Purpose: Palliative care is essential to oncology. The purpose of this project was to characterize the interface between VA oncologists and palliative care specialists in the outpatient setting and to identify barriers to outpatient palliative oncology care in the VA.

Background: The American Society of Clinical Oncology (ASCO) recommends palliative care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. The VA mandates palliative care inpatient consult teams for all medical facilities. It is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. The 2016 VHA Cancer Care Survey was a comprehensive assessment of 140 VA facilities regarding their cancer care infrastructure. On this survey, 23% of sites (N=32) reported that they were not able to provide adequate palliative oncology care in the outpatient setting.

Methods: We contacted clinicians at each of these 32 sites to characterize the outpatient oncology/palliative care interface and identify potential barriers.

Results: Of the 32 sites, 17 reported that they provided limited oncologic care and generally referred patients to other facilities for cancer treatment. The remaining 15 sites reported providing full oncology services. These 15 sites employed a variety of methods to engage palliative care specialists. These included referring patients to a separate outpatient palliative care clinic or a home-based provider; consulting the inpatient palliative care team to evaluate the patient while in the cancer clinic; working with an oncology social worker; or arranging a tele-consult with a remote palliative care specialist. Barriers to providing outpatient palliative care included not enough palliative care staff, not enough clinic space, and patients or oncologists declining a palliative care referral. Clinicians expressed that they would provide more outpatient palliative care if they
had more palliative care staff, more clinic space, and more palliative care training for oncologists.

Conclusions: This project identified that some sites have found creative approaches to providing outpatient palliative oncology care. In addition, clinicians emphasized the ongoing need for additional specialty palliative care staff, primary palliative care training for oncologists, and clinic space in order to provide optimal outpatient palliative oncology care for VA patients.

Purpose: Palliative care is essential to oncology. The purpose of this project was to characterize the interface between VA oncologists and palliative care specialists in the outpatient setting and to identify barriers to outpatient palliative oncology care in the VA.

Background: The American Society of Clinical Oncology (ASCO) recommends palliative care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. The VA mandates palliative care inpatient consult teams for all medical facilities. It is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. The 2016 VHA Cancer Care Survey was a comprehensive assessment of 140 VA facilities regarding their cancer care infrastructure. On this survey, 23% of sites (N=32) reported that they were not able to provide adequate palliative oncology care in the outpatient setting.

Methods: We contacted clinicians at each of these 32 sites to characterize the outpatient oncology/palliative care interface and identify potential barriers.

Results: Of the 32 sites, 17 reported that they provided limited oncologic care and generally referred patients to other facilities for cancer treatment. The remaining 15 sites reported providing full oncology services. These 15 sites employed a variety of methods to engage palliative care specialists. These included referring patients to a separate outpatient palliative care clinic or a home-based provider; consulting the inpatient palliative care team to evaluate the patient while in the cancer clinic; working with an oncology social worker; or arranging a tele-consult with a remote palliative care specialist. Barriers to providing outpatient palliative care included not enough palliative care staff, not enough clinic space, and patients or oncologists declining a palliative care referral. Clinicians expressed that they would provide more outpatient palliative care if they
had more palliative care staff, more clinic space, and more palliative care training for oncologists.

Conclusions: This project identified that some sites have found creative approaches to providing outpatient palliative oncology care. In addition, clinicians emphasized the ongoing need for additional specialty palliative care staff, primary palliative care training for oncologists, and clinic space in order to provide optimal outpatient palliative oncology care for VA patients.

Background: Commission on Care (CoC) Standard 3.3 states cancer centers need to focus initial efforts for survivorship care plan (SCP) delivery to patients treated with “curative intent and have completed active therapy (other than long term hormonal therapy).” The criteria on who is
a survivor, includes individuals with cancer from all disease sites. However, patients with metastatic disease, though survivors by some definitions, are not targeted for delivery of comprehensive care summaries and follow-up plans under CoC Standard 3.3.

Methods: The cancer committee at the John D. Dingell VAMC started working on the initial template for SCP in April 2013. The template was available in CPRS for the required survivorship care plan note by October 2013. Two nurse navigators were hired in 2014 to assist with beginning
this process. Review of eligible patients with the oncologist was done on a weekly basis. The nurse navigator then would prepare the note and meet with the patient to summarize the plan with a copy for their reference.

Our cancer committee met again in early 2015 and standard guidelines reviewed with minor adjustments made with the SCP template. Also, training was provided to designated staff of urology, surgery, and radiation oncology services regarding completion of SCP for their oncology patients. Required data elements included in the new survivorship care plans are details regarding treatment summary; contact information; diagnosis; stage of disease; surgery; chemotherapy; radiation therapy; and side effect management. Other information with the SCP includes ongoing adjuvant therapy; clinic visit schedule; cancer surveillance tests for recurrence; cancer screening tests and other periodic testing/exams related to specific diagnosis. Also, stressed with survivors is the importance of reporting any new, unusual and/or persistent symptoms need be brought to the attention of their provider.

Conclusions: The CoC states that the SCP can be completed by physicians; registered nurses; advanced practice nurses; nurse practitioners; physician assistants; and credentialed nurse navigators. As the number of cancer survivors continues to increase, the ongoing evaluation of long-term late effects of cancer treatment is important. The SCP is used to promote wellness and improve quality of life in cancer survivors.

Background: Commission on Care (CoC) Standard 3.3 states cancer centers need to focus initial efforts for survivorship care plan (SCP) delivery to patients treated with “curative intent and have completed active therapy (other than long term hormonal therapy).” The criteria on who is
a survivor, includes individuals with cancer from all disease sites. However, patients with metastatic disease, though survivors by some definitions, are not targeted for delivery of comprehensive care summaries and follow-up plans under CoC Standard 3.3.

Methods: The cancer committee at the John D. Dingell VAMC started working on the initial template for SCP in April 2013. The template was available in CPRS for the required survivorship care plan note by October 2013. Two nurse navigators were hired in 2014 to assist with beginning
this process. Review of eligible patients with the oncologist was done on a weekly basis. The nurse navigator then would prepare the note and meet with the patient to summarize the plan with a copy for their reference.

Our cancer committee met again in early 2015 and standard guidelines reviewed with minor adjustments made with the SCP template. Also, training was provided to designated staff of urology, surgery, and radiation oncology services regarding completion of SCP for their oncology patients. Required data elements included in the new survivorship care plans are details regarding treatment summary; contact information; diagnosis; stage of disease; surgery; chemotherapy; radiation therapy; and side effect management. Other information with the SCP includes ongoing adjuvant therapy; clinic visit schedule; cancer surveillance tests for recurrence; cancer screening tests and other periodic testing/exams related to specific diagnosis. Also, stressed with survivors is the importance of reporting any new, unusual and/or persistent symptoms need be brought to the attention of their provider.

Conclusions: The CoC states that the SCP can be completed by physicians; registered nurses; advanced practice nurses; nurse practitioners; physician assistants; and credentialed nurse navigators. As the number of cancer survivors continues to increase, the ongoing evaluation of long-term late effects of cancer treatment is important. The SCP is used to promote wellness and improve quality of life in cancer survivors.

Background: Commission on Care (CoC) Standard 3.3 states cancer centers need to focus initial efforts for survivorship care plan (SCP) delivery to patients treated with “curative intent and have completed active therapy (other than long term hormonal therapy).” The criteria on who is
a survivor, includes individuals with cancer from all disease sites. However, patients with metastatic disease, though survivors by some definitions, are not targeted for delivery of comprehensive care summaries and follow-up plans under CoC Standard 3.3.

Methods: The cancer committee at the John D. Dingell VAMC started working on the initial template for SCP in April 2013. The template was available in CPRS for the required survivorship care plan note by October 2013. Two nurse navigators were hired in 2014 to assist with beginning
this process. Review of eligible patients with the oncologist was done on a weekly basis. The nurse navigator then would prepare the note and meet with the patient to summarize the plan with a copy for their reference.

Our cancer committee met again in early 2015 and standard guidelines reviewed with minor adjustments made with the SCP template. Also, training was provided to designated staff of urology, surgery, and radiation oncology services regarding completion of SCP for their oncology patients. Required data elements included in the new survivorship care plans are details regarding treatment summary; contact information; diagnosis; stage of disease; surgery; chemotherapy; radiation therapy; and side effect management. Other information with the SCP includes ongoing adjuvant therapy; clinic visit schedule; cancer surveillance tests for recurrence; cancer screening tests and other periodic testing/exams related to specific diagnosis. Also, stressed with survivors is the importance of reporting any new, unusual and/or persistent symptoms need be brought to the attention of their provider.

Conclusions: The CoC states that the SCP can be completed by physicians; registered nurses; advanced practice nurses; nurse practitioners; physician assistants; and credentialed nurse navigators. As the number of cancer survivors continues to increase, the ongoing evaluation of long-term late effects of cancer treatment is important. The SCP is used to promote wellness and improve quality of life in cancer survivors.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.