Models of Integration of Specialized Palliative Care with Oncology

Abstract

Evidence from randomized controlled trials and meta-analyses has shown that early integration of specialized palliative care improves symptoms and quality of life for patients with advanced cancer. There are various models of early integration, which may be classified based on setting of care and method of palliative care referral. Most successful randomized controlled trials of early palliative care have used a model of specialized teams providing in-person palliative care in free-standing or embedded outpatient clinics. During the COVID-19 pandemic, telehealth has become a prominent model for palliative care delivery. This model of care has been well received by patients and palliative care providers, although evidence to date is limited. Despite evidence from trials that routine early integration of palliative care into oncology care improves patient outcomes, referral to palliative care still occurs mostly according to the judgment of individual oncologists. This hinders equitable access to palliative care and to its known benefits for patients and their caregivers. Automated referral based on triggering criteria is being actively explored as an alternative. In particular, routine technology-assisted symptom screening, combined with targeted needs-based automatic referral to outpatient palliative care, may improve integration and ultimately increase quality of life.

Keywords: Integrated healthcare systems; Integration; Models of care; Neoplasms; Oncology; Palliative care; Quality of life; Telemedicine.

Fig. 1

Key elements of early palliative care. The key elements of early palliative care can be divided into two broad areas: principles and domains of care. We identify four key principles on how care should be provided (care that is flexible, attentive, patient-led, and family-centered) and four key domains (support and coping, managing symptoms, assisting with medical decision-making, and planning for the future).