Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.
Brigham and Women's Hospital, Boston, MA.
JCO Oncol Pract. 2021 Feb;17(2):107-110. doi: 10.1200/OP.20.00469. Epub 2020 Nov 16.
As part of a larger effort to integrate palliative care into a cancer center, we identified barriers to palliative care referral for patients with breast or gynecologic cancer and developed a pilot program to improve access to palliative care services.
We developed a multidisciplinary steering committee to uncover barriers to palliative care referral and developed a pilot program, called the Warm Handoff. Through ongoing collaboration and midpilot feedback sessions, we identified several additional barriers and opportunities to increase access to palliative care.
Clinicians used the initial Warm Handoff process only 20 times over a period of 7 months. Of those calls, 10 were for issues outside of those that the Warm Handoff pilot was intended to address. During the pilot, we identified lack of access to urgent visits and clinician telephone availability for clinical case discussion as additional barriers to access. Increased collaboration led to the creation of a clinical provider of the day (CPOD) care model, which allowed for a notable increase in the capacity to see urgent consults. After this intervention, we observed an average of 19 patients seen urgently per month. In addition, there was a trend toward increasing referrals from breast oncology after the initiation of the CPOD.
A CPOD model, developed via close oncology/palliative care collaboration, resulted in increased utilization of palliative care services.
作为将姑息治疗纳入癌症中心的更大努力的一部分，我们确定了向患有乳腺癌或妇科癌症的患者转介姑息治疗的障碍，并制定了一项试点计划以改善姑息治疗服务的可及性。
我们成立了一个多学科指导委员会，以发现向姑息治疗转介的障碍，并制定了一个试点计划，称为“温馨交接”。通过持续的合作和中期试点反馈会议，我们确定了增加姑息治疗可及性的其他一些障碍和机会。
在 7 个月的时间里，临床医生仅使用了最初的“温馨交接”过程 20 次。在这些电话中，有 10 个是针对“温馨交接”试点计划旨在解决的问题以外的问题。在试点期间，我们发现无法获得紧急就诊和临床医生的电话可用性以进行临床病例讨论是增加可及性的另外两个障碍。增加合作导致创建了一个临床值班医生（CPOD）护理模式，这显著增加了紧急咨询的能力。在这一干预措施之后，我们观察到每月平均有 19 名患者接受紧急就诊。此外，在启动 CPOD 后，从乳腺癌肿瘤学开始，转介的人数呈上升趋势。
通过密切的肿瘤学/姑息治疗合作制定的 CPOD 模式，导致姑息治疗服务的利用率增加。
