Blakowski S

Background: Tele-palliative care is an effective method of providing care for patients who wish to receive their care locally. In an effort to provide care to veterans that live remotely the Palliative Care program at the Pittsburgh VAMC created a Palliative Care Telemedicine clinic. The clinic provides a patient centered approach by working with primary care and subspecialists to manage symptoms, establish patient’s expectations with treatment and to determine what the patient is willing to endure to reach his/her goals. Patient focused care provides better quality of care and may result in a decrease in unwanted and inappropriate admissions, readmissions, tests, procedures and transfers to a higher level of care that may not align with the patient’s goals of care.

Methods: In 2018 the Palliative Care program partnered with Oncology to provide comprehensive patient care by CVT. Patients who requested that their chemotherapy/ immunotherapy be done at the local VA were seen by Oncology in Pittsburgh with subsequent visits and treatment done in the infusion clinic at the local VA. Patients were seen by Oncology by CVT prior to each treatment, Patients with stage IV disease or who had extensive symptom burden were referred for telepalliative care and were seen on the same day that they were seen by their Oncologist.

Results: Since 2018, 51 patients with the diagnosis of cancer were referred for both Oncology and Palliative Care CVT. There were a total of 211 clinic visits. Patents were primarily referred for symptom management and goals of care. Since January 2018, 22 patients are alive, 24 patients have died and 5 patients are currently receiving hospice care. 21 patients died at home or in a CLC—1 died in the hospital and 2 sites of death are unknown.

Conclusion: Preliminary data suggests that tele-palliative care can provide effective symptom management and may reduce deaths in an acute care setting. The palliative care program plans to expand tele-palliative care by offering this service to other facilities in the VISN as well as partnering with home hospice agencies to provide VVC for patients that are on hospice.

Background: Tele-palliative care is an effective method of providing care for patients who wish to receive their care locally. In an effort to provide care to veterans that live remotely the Palliative Care program at the Pittsburgh VAMC created a Palliative Care Telemedicine clinic. The clinic provides a patient centered approach by working with primary care and subspecialists to manage symptoms, establish patient’s expectations with treatment and to determine what the patient is willing to endure to reach his/her goals. Patient focused care provides better quality of care and may result in a decrease in unwanted and inappropriate admissions, readmissions, tests, procedures and transfers to a higher level of care that may not align with the patient’s goals of care.

Methods: In 2018 the Palliative Care program partnered with Oncology to provide comprehensive patient care by CVT. Patients who requested that their chemotherapy/ immunotherapy be done at the local VA were seen by Oncology in Pittsburgh with subsequent visits and treatment done in the infusion clinic at the local VA. Patients were seen by Oncology by CVT prior to each treatment, Patients with stage IV disease or who had extensive symptom burden were referred for telepalliative care and were seen on the same day that they were seen by their Oncologist.

Results: Since 2018, 51 patients with the diagnosis of cancer were referred for both Oncology and Palliative Care CVT. There were a total of 211 clinic visits. Patents were primarily referred for symptom management and goals of care. Since January 2018, 22 patients are alive, 24 patients have died and 5 patients are currently receiving hospice care. 21 patients died at home or in a CLC—1 died in the hospital and 2 sites of death are unknown.

Conclusion: Preliminary data suggests that tele-palliative care can provide effective symptom management and may reduce deaths in an acute care setting. The palliative care program plans to expand tele-palliative care by offering this service to other facilities in the VISN as well as partnering with home hospice agencies to provide VVC for patients that are on hospice.

Background: Tele-palliative care is an effective method of providing care for patients who wish to receive their care locally. In an effort to provide care to veterans that live remotely the Palliative Care program at the Pittsburgh VAMC created a Palliative Care Telemedicine clinic. The clinic provides a patient centered approach by working with primary care and subspecialists to manage symptoms, establish patient’s expectations with treatment and to determine what the patient is willing to endure to reach his/her goals. Patient focused care provides better quality of care and may result in a decrease in unwanted and inappropriate admissions, readmissions, tests, procedures and transfers to a higher level of care that may not align with the patient’s goals of care.

Methods: In 2018 the Palliative Care program partnered with Oncology to provide comprehensive patient care by CVT. Patients who requested that their chemotherapy/ immunotherapy be done at the local VA were seen by Oncology in Pittsburgh with subsequent visits and treatment done in the infusion clinic at the local VA. Patients were seen by Oncology by CVT prior to each treatment, Patients with stage IV disease or who had extensive symptom burden were referred for telepalliative care and were seen on the same day that they were seen by their Oncologist.

Results: Since 2018, 51 patients with the diagnosis of cancer were referred for both Oncology and Palliative Care CVT. There were a total of 211 clinic visits. Patents were primarily referred for symptom management and goals of care. Since January 2018, 22 patients are alive, 24 patients have died and 5 patients are currently receiving hospice care. 21 patients died at home or in a CLC—1 died in the hospital and 2 sites of death are unknown.

Conclusion: Preliminary data suggests that tele-palliative care can provide effective symptom management and may reduce deaths in an acute care setting. The palliative care program plans to expand tele-palliative care by offering this service to other facilities in the VISN as well as partnering with home hospice agencies to provide VVC for patients that are on hospice.

Purpose: Palliative care is essential to oncology. The purpose of this project was to characterize the interface between VA oncologists and palliative care specialists in the outpatient setting and to identify barriers to outpatient palliative oncology care in the VA.

Background: The American Society of Clinical Oncology (ASCO) recommends palliative care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. The VA mandates palliative care inpatient consult teams for all medical facilities. It is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. The 2016 VHA Cancer Care Survey was a comprehensive assessment of 140 VA facilities regarding their cancer care infrastructure. On this survey, 23% of sites (N=32) reported that they were not able to provide adequate palliative oncology care in the outpatient setting.

Methods: We contacted clinicians at each of these 32 sites to characterize the outpatient oncology/palliative care interface and identify potential barriers.

Results: Of the 32 sites, 17 reported that they provided limited oncologic care and generally referred patients to other facilities for cancer treatment. The remaining 15 sites reported providing full oncology services. These 15 sites employed a variety of methods to engage palliative care specialists. These included referring patients to a separate outpatient palliative care clinic or a home-based provider; consulting the inpatient palliative care team to evaluate the patient while in the cancer clinic; working with an oncology social worker; or arranging a tele-consult with a remote palliative care specialist. Barriers to providing outpatient palliative care included not enough palliative care staff, not enough clinic space, and patients or oncologists declining a palliative care referral. Clinicians expressed that they would provide more outpatient palliative care if they
had more palliative care staff, more clinic space, and more palliative care training for oncologists.

Conclusions: This project identified that some sites have found creative approaches to providing outpatient palliative oncology care. In addition, clinicians emphasized the ongoing need for additional specialty palliative care staff, primary palliative care training for oncologists, and clinic space in order to provide optimal outpatient palliative oncology care for VA patients.

Purpose: Palliative care is essential to oncology. The purpose of this project was to characterize the interface between VA oncologists and palliative care specialists in the outpatient setting and to identify barriers to outpatient palliative oncology care in the VA.

Background: The American Society of Clinical Oncology (ASCO) recommends palliative care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. The VA mandates palliative care inpatient consult teams for all medical facilities. It is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. The 2016 VHA Cancer Care Survey was a comprehensive assessment of 140 VA facilities regarding their cancer care infrastructure. On this survey, 23% of sites (N=32) reported that they were not able to provide adequate palliative oncology care in the outpatient setting.

Methods: We contacted clinicians at each of these 32 sites to characterize the outpatient oncology/palliative care interface and identify potential barriers.

Results: Of the 32 sites, 17 reported that they provided limited oncologic care and generally referred patients to other facilities for cancer treatment. The remaining 15 sites reported providing full oncology services. These 15 sites employed a variety of methods to engage palliative care specialists. These included referring patients to a separate outpatient palliative care clinic or a home-based provider; consulting the inpatient palliative care team to evaluate the patient while in the cancer clinic; working with an oncology social worker; or arranging a tele-consult with a remote palliative care specialist. Barriers to providing outpatient palliative care included not enough palliative care staff, not enough clinic space, and patients or oncologists declining a palliative care referral. Clinicians expressed that they would provide more outpatient palliative care if they
had more palliative care staff, more clinic space, and more palliative care training for oncologists.

Conclusions: This project identified that some sites have found creative approaches to providing outpatient palliative oncology care. In addition, clinicians emphasized the ongoing need for additional specialty palliative care staff, primary palliative care training for oncologists, and clinic space in order to provide optimal outpatient palliative oncology care for VA patients.

Purpose: Palliative care is essential to oncology. The purpose of this project was to characterize the interface between VA oncologists and palliative care specialists in the outpatient setting and to identify barriers to outpatient palliative oncology care in the VA.

Background: The American Society of Clinical Oncology (ASCO) recommends palliative care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. The VA mandates palliative care inpatient consult teams for all medical facilities. It is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. The 2016 VHA Cancer Care Survey was a comprehensive assessment of 140 VA facilities regarding their cancer care infrastructure. On this survey, 23% of sites (N=32) reported that they were not able to provide adequate palliative oncology care in the outpatient setting.

Methods: We contacted clinicians at each of these 32 sites to characterize the outpatient oncology/palliative care interface and identify potential barriers.

Results: Of the 32 sites, 17 reported that they provided limited oncologic care and generally referred patients to other facilities for cancer treatment. The remaining 15 sites reported providing full oncology services. These 15 sites employed a variety of methods to engage palliative care specialists. These included referring patients to a separate outpatient palliative care clinic or a home-based provider; consulting the inpatient palliative care team to evaluate the patient while in the cancer clinic; working with an oncology social worker; or arranging a tele-consult with a remote palliative care specialist. Barriers to providing outpatient palliative care included not enough palliative care staff, not enough clinic space, and patients or oncologists declining a palliative care referral. Clinicians expressed that they would provide more outpatient palliative care if they
had more palliative care staff, more clinic space, and more palliative care training for oncologists.

Conclusions: This project identified that some sites have found creative approaches to providing outpatient palliative oncology care. In addition, clinicians emphasized the ongoing need for additional specialty palliative care staff, primary palliative care training for oncologists, and clinic space in order to provide optimal outpatient palliative oncology care for VA patients.

Background: Understanding a patient’s expectations with treatment for their cancer is an important first step in caring for patients with cancer. Establishing goals of care allows providers to understand what their patients are willing to endure especially if they have a limited life expectancy. It provides a plan of care that is agreed upon by both the patient and provider. However, talking to patients about goals of care requires a skill set that many providers have not fully developed.

The use of simulated patients (SPs) has been shown to be an effective method to teach communication skills. However, many people feel intimidated when they are asked to work with SPs, especially if their conversations are viewed and critiqued by others. At the Pittsburgh VA we have developed a method that uses SPs to teach communication skills in a comfortable non-threatening environment for the learner. We tested this method with our Oncology providers.

Methods: Oncologists, nurses and social workers attended a meeting where they were asked to view a scenario where a patient and his family( SPs) were informed that the patient had progression of his cancer. In the first scenario the information was presented to SPs focusing on the cancer and treatment options. In the second scenario the same information was presented by an oncologist trained in palliative care focusing on the patient’s understanding of his disease and his goals of care. SPs were asked to contrast and comment on the different styles. The audience was then asked to provide comments and feedback.

Results: Twenty-two participants provided feedback. Twenty one of the participants agreed or strongly agreed that the simulation improved their knowledge and skill set and was done in a safe and comfortable learning environment.

Conclusions: Using SPs and allowing providers to contrast different styles of communicating the same set of information can be an effective and non-threatening teaching method of teaching communication skills. Longitudinal review of patient records will further help to determine the effectiveness of this method of training.

Background: Understanding a patient’s expectations with treatment for their cancer is an important first step in caring for patients with cancer. Establishing goals of care allows providers to understand what their patients are willing to endure especially if they have a limited life expectancy. It provides a plan of care that is agreed upon by both the patient and provider. However, talking to patients about goals of care requires a skill set that many providers have not fully developed.

The use of simulated patients (SPs) has been shown to be an effective method to teach communication skills. However, many people feel intimidated when they are asked to work with SPs, especially if their conversations are viewed and critiqued by others. At the Pittsburgh VA we have developed a method that uses SPs to teach communication skills in a comfortable non-threatening environment for the learner. We tested this method with our Oncology providers.

Methods: Oncologists, nurses and social workers attended a meeting where they were asked to view a scenario where a patient and his family( SPs) were informed that the patient had progression of his cancer. In the first scenario the information was presented to SPs focusing on the cancer and treatment options. In the second scenario the same information was presented by an oncologist trained in palliative care focusing on the patient’s understanding of his disease and his goals of care. SPs were asked to contrast and comment on the different styles. The audience was then asked to provide comments and feedback.

Results: Twenty-two participants provided feedback. Twenty one of the participants agreed or strongly agreed that the simulation improved their knowledge and skill set and was done in a safe and comfortable learning environment.

Conclusions: Using SPs and allowing providers to contrast different styles of communicating the same set of information can be an effective and non-threatening teaching method of teaching communication skills. Longitudinal review of patient records will further help to determine the effectiveness of this method of training.

Background: Understanding a patient’s expectations with treatment for their cancer is an important first step in caring for patients with cancer. Establishing goals of care allows providers to understand what their patients are willing to endure especially if they have a limited life expectancy. It provides a plan of care that is agreed upon by both the patient and provider. However, talking to patients about goals of care requires a skill set that many providers have not fully developed.

The use of simulated patients (SPs) has been shown to be an effective method to teach communication skills. However, many people feel intimidated when they are asked to work with SPs, especially if their conversations are viewed and critiqued by others. At the Pittsburgh VA we have developed a method that uses SPs to teach communication skills in a comfortable non-threatening environment for the learner. We tested this method with our Oncology providers.

Methods: Oncologists, nurses and social workers attended a meeting where they were asked to view a scenario where a patient and his family( SPs) were informed that the patient had progression of his cancer. In the first scenario the information was presented to SPs focusing on the cancer and treatment options. In the second scenario the same information was presented by an oncologist trained in palliative care focusing on the patient’s understanding of his disease and his goals of care. SPs were asked to contrast and comment on the different styles. The audience was then asked to provide comments and feedback.

Results: Twenty-two participants provided feedback. Twenty one of the participants agreed or strongly agreed that the simulation improved their knowledge and skill set and was done in a safe and comfortable learning environment.

Conclusions: Using SPs and allowing providers to contrast different styles of communicating the same set of information can be an effective and non-threatening teaching method of teaching communication skills. Longitudinal review of patient records will further help to determine the effectiveness of this method of training.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

New developments in oncology have led to a patient-centered approach in cancer treatment. Specifically, the introduction of targeted therapy has allowed oncologists to develop individualized treatment plans that target a patient’s tumor. However, this approach to cancer care remains a cancer-focused approach to treatment. It does not provide the specific needs and support that oncology patients require starting at the time of diagnosis.

Patients with cancer have many symptoms fears and expectations. The literature has shown that many patients with advanced cancer have unrealistic expectations about the effect of treatment and prognosis. At the same time, oncologists have little knowledge about the patient’s level
of understanding of their disease and their goals with treatment. Furthermore there is a lack of understanding about what a patient is willing to endure to achieve these goals. This miscommunication can result in unwanted tests, procedures and hospital stays that do not align with
the patient‘s goals of care. Methods to improve this communication gap are needed to provide better patient centered care.

Life-Sustaining Treatment Initiative (LSTI) is a national VA quality initiative from the National Center for Ethics in Health Care that was designed to improve communication between provider and patient by addressing a patient‘s understanding of their disease, eliciting their goals with treatment and what they are willing to endure to achieve these goals. It requires that providers document these discussion in a templated progress note that becomes part of the patient‘s health record. All VA facilities are required to implement this initiative by July 2018.

New developments in oncology have led to a patient-centered approach in cancer treatment. Specifically, the introduction of targeted therapy has allowed oncologists to develop individualized treatment plans that target a patient’s tumor. However, this approach to cancer care remains a cancer-focused approach to treatment. It does not provide the specific needs and support that oncology patients require starting at the time of diagnosis.

Patients with cancer have many symptoms fears and expectations. The literature has shown that many patients with advanced cancer have unrealistic expectations about the effect of treatment and prognosis. At the same time, oncologists have little knowledge about the patient’s level
of understanding of their disease and their goals with treatment. Furthermore there is a lack of understanding about what a patient is willing to endure to achieve these goals. This miscommunication can result in unwanted tests, procedures and hospital stays that do not align with
the patient‘s goals of care. Methods to improve this communication gap are needed to provide better patient centered care.

Life-Sustaining Treatment Initiative (LSTI) is a national VA quality initiative from the National Center for Ethics in Health Care that was designed to improve communication between provider and patient by addressing a patient‘s understanding of their disease, eliciting their goals with treatment and what they are willing to endure to achieve these goals. It requires that providers document these discussion in a templated progress note that becomes part of the patient‘s health record. All VA facilities are required to implement this initiative by July 2018.

New developments in oncology have led to a patient-centered approach in cancer treatment. Specifically, the introduction of targeted therapy has allowed oncologists to develop individualized treatment plans that target a patient’s tumor. However, this approach to cancer care remains a cancer-focused approach to treatment. It does not provide the specific needs and support that oncology patients require starting at the time of diagnosis.

Patients with cancer have many symptoms fears and expectations. The literature has shown that many patients with advanced cancer have unrealistic expectations about the effect of treatment and prognosis. At the same time, oncologists have little knowledge about the patient’s level
of understanding of their disease and their goals with treatment. Furthermore there is a lack of understanding about what a patient is willing to endure to achieve these goals. This miscommunication can result in unwanted tests, procedures and hospital stays that do not align with
the patient‘s goals of care. Methods to improve this communication gap are needed to provide better patient centered care.

Life-Sustaining Treatment Initiative (LSTI) is a national VA quality initiative from the National Center for Ethics in Health Care that was designed to improve communication between provider and patient by addressing a patient‘s understanding of their disease, eliciting their goals with treatment and what they are willing to endure to achieve these goals. It requires that providers document these discussion in a templated progress note that becomes part of the patient‘s health record. All VA facilities are required to implement this initiative by July 2018.