Although the physicians were familiar with the palliative care advanced practice registered nurse (APRN) from the inpatient service, they still expressed concern and had some misunderstanding regarding the role of palliative care.
There was concern that the palliative care team would tell patients they were dying before the patients were ready to discuss death.
The APRN also attended lung and gastrointestinal (GI) tumor boards and completed a palliative care screening on newly diagnosed patients, with the goal being able to identify appropriate patients and see them soon after diagnosis.
The focus of this pilot was on diagnoses that were stage IIIb and above, recurrent or metastatic disease, and solid organ tumors.
The benefits and challenges will be explored, as well as evidence for why palliative care clinicians are an integral part of the outpatient oncology care team.
The first step in successful integration should be defining what palliative care is and is not.
Further, it was collaboratively decided that the best way to fully integrate the palliative program was to have the APRN meet the patient with the oncologist on their initial consult visit in the outpatient oncology office.
The palliative care APRN introduced herself as “another member of the oncology team to provide you with an extra layer of support.” The benefit of this model was the oncologist got to experience exactly how the APRN introduced the topic of palliative care to a newly diagnosed patient prior to treatment initiation.
Initially, patients were seen bythe palliative care service while they were an inpatient and were subsequently seen in the outpatient oncology office for follow-up care.
This was a good way to start to get to know the practice and team members and begin to gain trust.