Palliative care services are an important element of comprehensive cancer care. However, patients are not usually introduced to palliative care providers until their services are needed. Read how Cancer Care Associates of York—a community-based private practice in York, Penn.—is changing this by identifying high-risk patients suitable for palliative interventions up front and allowing patients to access palliative care services as early as possible.
This blog post is the last of a seven-part series highlighting the achievements of the 2021 ACCC Innovator Award Winners before their in-depth sessions at the ACCC 38th [Virtual] National Oncology Conference. You can learn more about the innovations being recognized this year and the people who pioneered them by joining us live on November 9-10, 2021.
Palliative care services are an important element of comprehensive cancer care. However, patients are not usually introduced to palliative care providers until their services are needed. Cancer Care Associates of York—a community-based private practice in York, Penn.—is changing this by identifying high-risk patients suitable for palliative interventions up front and allowing patients to access palliative care services as early as possible.
“Given that we practice in oncology, we know that palliative care issues are not new," says Jia Conway, DNP, CRNP, AOCNP, a nurse practitioner at Cancer Care Associates of York. “The issues that were arising in our practice were fragmentation of care and identification of high-risk patients—those who are sick before they start treatment or those who have complications during treatment.”
To better keep patients in treatment out of the hospital and prevent treatment delays due to adverse reactions, Conway spearheaded the development and implementation of a comprehensive community-based palliative care program at her practice. Through this program, staff identify high-risk patients and introduce them before the start of treatment to an advanced practice provider (APP) who teaches patients and family members about palliative care and its benefits.
“We were facing gaps in care when trying to get our patients seen in a reasonable amount of time, especially if pain, dyspnea [difficult of labored breathing], dysphagia [swallowing difficulties], eating, weakness, or anorexia was an issue,” Conway explains. “Our thought process as a practice was that we're already here, we know these patients and their issues, so why not prevent those delays or complications in portions of their care and deliver services in a timely and appropriate fashion?”
Determining and Responding to Need
In 2017, Conway and her team of APPs, oncologists, and nurses first targeted patients with specific diagnoses that usually put them at high risk of recurrent hospitalizations and increased sensitivity to treatment or its side-effects at time of presentations and may require palliative care interventions at some point in the cancer care continuum. They identified patients with head and neck, gastrointestinal, genitourinary, pancreatic, stage IV non-small cell lung cancer, and extensive stage lung cancers as the initial focus of the intervention. Patients with these high-risk oncology malignancies are most likely to need palliative care interventions soon after diagnosis. As the program grew, the team added to its list of specific diagnoses other factors that contribute to an increased need for palliative care services, including specific chemotherapy and treatment regimens that create significant toxicities in patients. As a result, diagnosis, symptoms related to diagnosis and treatment, and treatment response are now the benchmarks clinicians at Cancer Care Associates of York use to identify and stratify patients in terms of their risk of adverse reactions and hospitalizations during treatment.
Using this risk stratification assessment, qualifying patients are scheduled to meet with one of the practice’s five APPs to learn more about palliative care and the practice’s available services and receive symptom monitoring and appropriate interventions. Conway likes to invite the members of patients’ support systems to these appointments and uses the opportunity to initiate potentially difficult conversations early in their care. Conway’s team relies on nursing staff to identify and triage patients with treatment-related symptoms and on the practice’s physician leader to help determine the direction of the palliative care program.
The team uses its electronic health record (EHR) to schedule patients’ 45-minute palliative care visits. “An advanced practitioner goes over with the patient everything possible that is important, including difficult conversations and helping families understand how to have those conversations,” Conway says. “It's become a dynamic team where everybody's doing their part.” Conway explains that nursing staff is key to the program’s success because they are trained in palliative care assessment, documenting results in the EHR, and scheduling visits with key resources (i.e., Conway, other APPs, nutritionists, etc.). Nurses track patient results with custom tools integrated into the EHR after assessments are complete. Patients’ risk scores are calculated and recorded in their EHR and made available to APPs working with patients.
Starting Early is Crucial
As the palliative care program at Cancer Care Associates of York continues to grow, Conway hopes it will become standard of practice to incorporate this type of care into the start of patients’ cancer journeys. “I can tell when patients aren't doing well because you start seeing family members who you never saw before,” says Conway. “We do not want to wait until that happens. We want to get patients and their families in this conversation early on because there are some things that we can prevent sooner rather than later when we understand what is happening globally with our patients.”
Conway says that a key part of her program’s success is teaching everyone in her practice about palliative care and why it is important to offer this care to patients early in their treatment. For others looking to start a similar program, Conway suggests educating yourself on all aspects of palliative care and allowing your program to adapt to meet the needs of your patients. “We’re a private community practice, so our resources are not always the same as an academic center,” she says. “But we do an amazing job with what we have. There are so many moving parts that you need to find out what works and what's going to be reasonable for all the team players who you're going to need to help you make this come to fruition.”
Attend the ACCC 38th [Virtual] National Oncology Conference to learn more about Cancer Care Associates of York’s community-based comprehensive palliative care program, including the creation and implementation of its patient assessment, EHR integration, and interdisciplinary collaboration that allows the palliative care program to adapt to patients’ needs as they grow.
