Oncology Rounds

UVA's 3 keys to building a top outpatient palliative care program

by Deirdre Saulet and Julia Venanzi

This summer, we shared results from UVA's CARE Track program, a multi-year initiative to improve the quality of life for patients with advanced cancer. While that post focused on the reduced odds of ICU admissions for cancer patients at UVA, we received so much interest from organizations around the country that we had a follow-up conversation with Dr. Leslie Blackhall, the palliative care lead at UVA.

Dr. Blackhall shared three lessons that UVA has learned about how to establish a successful outpatient palliative care program.

No. 1: Provide convenient, co-located care

When UVA first began offering outpatient palliative care, they had a high no-show rate, likely because appointments weren't coordinated with patients' other appointments in the cancer center. When patients are sick, another trip to the cancer center is a significant burden, especially if they are traveling long distances.

That experience taught Dr. Blackhall and UVA the importance of making sure that palliative care appointments happen at the same time and in the same place as cancer treatment.

Co-location also enhances palliative care's visibility across the cancer care team, which helps build trust and increase buy-in.

No. 2: Designate a palliative care patient coordinator

The second key element to the program's success is a dedicated coordinator who makes sure palliative care patients don't fall through the cracks. The care coordinator promotes shared decision-making, helps to reduce fragmented care, and improves the overall patient experience. Coordinators utilize electronic health record alerts to flag when palliative care patients are admitted to the hospital or miss an appointment. They work across teams at UVA to coordinate appointments with other teams to ensure all patients have what they need and work to promote palliative care to patients at every turn.

No. 3: Care for the emotional needs of your staff

To ensure coordination across the cancer care teams, UVA started a weekly supportive care tumor board that includes medical, surgical and radiation oncologists, palliative care physicians, pharmacists, anesthesia pain specialists, social workers, and a chaplain.

While the conference initially started as a way to talk about patient needs and identify ways the team could support family and caregivers, it has an unintended second benefit. It serves as a place for the care team to acknowledge the emotional effects and psychosocial impact of caring for patients with advanced cancer. Further, recognizing an unfilled need, the chaplain also started holding afternoon teas every few weeks to create another opportunity for staff to come talk. Dr. Blackhall said these support programs crucially improve the emotional wellbeing of staff and allow the care team to take time to reflect upon each patient and take a holistic look at the disease trajectory.

 

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