With its longstanding emphasis on whole-person care and complex symptom management, oncology may be uniquely positioned to lead the next evolution of palliative care integration.
Kim Slusser, PhD, RN, chief nursing officer at Houston-based University of Texas MD Anderson conducted a systematic review, published Sept. 27 in Global Qualitative Nursing Research, and identified key strategies for improving palliative care access for cancer patients.
Dr. Slusser spoke to Becker’s about her review and what health systems can learn about effectively embedding palliative care pathways into oncology.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Your study outlines a conceptual framework for improving early palliative care integration. Where are the most immediate opportunities for health systems to apply this framework?
Dr. Kim Slusser: The conceptual framework came out of our systematic review. It was pulling those themes out that either facilitate or were barriers to earlier integration of palliative care. Healthcare organizations can look at this conceptual framework as a road map for their own assessment because it’s not an all or nothing.
Organizations can really focus on: When do we talk to patients about palliative care? What are the resources that we make available to them?
One of the things we found in the review is that patients and care partners really rely on their oncology clinical team members to tell them about available resources, including palliative care. They might not even know what palliative care is. That’s one of the areas that clinical team members need to be real intentional about and not assume that patients or care partners will ask for this. We have a responsibility to make sure that they understand what it is and when it can be meaningfully integrated into their cancer care journey.
Question: Your work offers a road map for redesigning cancer care with earlier palliative integration. Can you walk through the most actionable steps health system leaders can take to operationalize that framework?
KS: Pieces that organizations can look at — especially in outpatient oncology — is how they assess their patients’ needs, and how they can embed palliative care pathways and needs assessments into their clinical workflows. The last thing you want to do is ask busy clinical team members to do additional tasks that take more time.
A lot of oncology clinics already assess patients for distress and symptom burden. We can take those already existing tools and enhance them with palliative care-validated instruments, and then have clear pathways for either palliative care provided by the oncology team or a specialty palliative care referral.
They could also use the roadmap to ask: Do we have palliative care referral pathways? What are the opinions of our patients and our clinicians about palliative care? What do they know about palliative care? They can then identify the areas where they have opportunity to improve access and early integration.
Q: Where in the cancer care continuum are you seeing the most persistent breakdowns in palliative care integration?
KS: This review really focused on the outpatient setting because that’s where oncology patients receive the majority of their care and that’s really where that early integration can happen.
Obviously, hospitals also need palliative care but we’re really trying to move it further up in the individual’s journey.
There is a balance. One of the things we found in the review is that patients and care partners are more accepting of palliative care when they actually have palliative care needs. A lot of times patients are overwhelmed with all the information they receive in the beginning. If something doesn’t really pertain to them, they’re not going to really retain it.
Having that palliative care needs assessment can be helpful to individualize the conversation to the patient and their care partners. It is more effective to integrate those conversations earlier, because patients and care partners will be more accepting of palliative care when it is connected with their actual needs.
We know that time is limited in clinic visits, both for the patients and for the clinical team members. Making sure we’re having individualized, purposeful conversations, and using those assessment tools to drive those conversations, can be helpful.
Q: How do emerging technologies like telehealth or AI address potential friction points?
KS: One of the things that can really improve access in all settings, but especially in rural settings, is the use of telehealth. That was a theme we saw in the review over and over again. It was an effective strategy, especially when you think about the shortage of palliative care workforce members, whether that be physicians, nurses, social work or chaplains that have that specialty.
We’re really looking forward to the use of AI in this space.
Right now, we rely on clinical team members to go through very complex electronic health records to find the necessary information to individualize that care for one patient. AI could synthesize all of the data points in the electronic record, help bring those palliative care needs to the surface and personalize those conversations, to ensure palliative care is integrated early in the cancer care journey. I am really looking forward to that. It’s really not replacing anything; it’s giving our clinical team members more time for meaningful conversations.
Q: What about oncology makes it primed to lead the next evolution of palliative care integration?
KS: Palliative care integration really works well when we increase collaboration between palliative care and oncology team members. Building trust and interprofessional collaboration in cancer care is so beneficial — not just with physicians, but with nurses, pharmacists, social workers, chaplains and all the interdisciplinary team members. The more that we can foster that collaboration, it will benefit our patients and our care partners.
Any clinicians that deal with chronic illness — including oncology clinicians — understand the importance of holistic care.
A cancer diagnosis affects not only the individual going through the cancer, but their family, friends, how they show up at work, whether they can work. Focusing on the whole person has always been an important aspect of cancer care.
Palliative care just makes sense. It makes sense to have that type of approach in caring for cancer patients, and that can really help with the acceptability of palliative care in cancer care.
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