Models of Palliative Care Delivery for Patients With Cancer

Abstract

Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. Existing evidence supports that timely involvement of specialist palliative care teams can enhance the care delivered by oncology teams. This review provides a state-of-the-science synopsis of the literature that supports each of the five clinical models of specialist palliative care delivery, including outpatient clinics, inpatient consultation teams, acute palliative care units, community-based palliative care, and hospice care. The roles of embedded clinics, nurse-led models, telehealth interventions, and primary palliative care also will be discussed. Outpatient clinics represent the key point of entry for timely access to palliative care. In this setting, patient care can be enhanced longitudinally through impeccable symptom management, monitoring, education, and advance care planning. Inpatient consultation teams provide expert symptom management and facilitate discharge planning for acutely symptomatic hospitalized patients. Patients with the highest level of distress and complexity may benefit from an admission to acute palliative care units. In contrast, community-based palliative care and hospice care are more appropriate for patients with a poor performance status and low to moderate symptom burden. Each of these five models of specialist palliative care serve a different patient population along the disease continuum and complement one another to provide comprehensive supportive care. Additional research is needed to define the standards for palliative care interventions and to refine the models to further improve access to quality palliative care.

FIG 1.

Service models of specialist palliative care (PC). (A) Care anywhere. Outpatient clinics facilitate access to palliative care in the ambulatory setting while coordinating care with the other models of PC. Inpatient consultation teams and PC units (PCUs) are available at acute care facilities, whereas community-based PC and hospice care allow patients to be cared for in the ambulatory and community setting. The smartphone icon indicates telehealth outreach. (B) Care anytime. This figure highlights how the five service models complement one another to provide comprehensive PC along the entire disease continuum for patients and their families. The arrows indicate the general time frame of patient engagement.