Bowers A

Background: A growing body of evidence suggests that palliative care is an important element of comprehensive cancer treatment by assisting with symptom management and establishing goals of care. Research suggests that enhanced integration of palliative care and oncology medicine has a positive effect on mortality and quality of life outcomes, and integration of the two is now considered standard care. However, there are no standard models for how this integration might occur. At our facility, there was no formal connection between the Oncology service and the Palliative Care Team.

Methods: The interdisciplinary Palliative Care Consult Team established weekly “Lightning Rounds” with Heme-Onc trainees, in which trainees answered questions about each patient regarding symptoms, prognosis, goals of care, and whether Palliative Care support was needed. In addition, trainees received brief didactics—“ teaching pearls”—that addressed components of palliative medicine (eg, use of opioids).

Trainees completed surveys Pre- and Post- Lightning Rounds, rating on a scale of 1 to 5 (Not at all to Very Much) how much they understand about, how confident they are in explaining, and how supported they feel by Palliative Care.

Results: From November 2017 – April 2019, we rounded on 105 unique patients in 26 Lightning Rounds sessions. Pre- and Post- samples are not paired. Average ratings of Pre- (n=18) and Post- (n=14) data show an increase in Understanding (4.2 to 4.6 on a 5-point scale); Confidence (4.0 to 4.6) and Support (4.8 to 5).

Conclusions: The current project sought to enhance integration between Oncology and Palliative Care by establishing a brief weekly Lightning Rounds in which Oncology trainees met with Palliative Care team members. We found that trainees’ understanding in what a Palliative Care consult can provide; their confidence in knowing when to offer a Palliative Care consult, and how supported they feel by our Palliative Care team, all increased from pre- to post-Lightning Rounds. These findings support our initial hypotheses and are encouraging continued involvement via this medium.

Background: A growing body of evidence suggests that palliative care is an important element of comprehensive cancer treatment by assisting with symptom management and establishing goals of care. Research suggests that enhanced integration of palliative care and oncology medicine has a positive effect on mortality and quality of life outcomes, and integration of the two is now considered standard care. However, there are no standard models for how this integration might occur. At our facility, there was no formal connection between the Oncology service and the Palliative Care Team.

Methods: The interdisciplinary Palliative Care Consult Team established weekly “Lightning Rounds” with Heme-Onc trainees, in which trainees answered questions about each patient regarding symptoms, prognosis, goals of care, and whether Palliative Care support was needed. In addition, trainees received brief didactics—“ teaching pearls”—that addressed components of palliative medicine (eg, use of opioids).

Trainees completed surveys Pre- and Post- Lightning Rounds, rating on a scale of 1 to 5 (Not at all to Very Much) how much they understand about, how confident they are in explaining, and how supported they feel by Palliative Care.

Results: From November 2017 – April 2019, we rounded on 105 unique patients in 26 Lightning Rounds sessions. Pre- and Post- samples are not paired. Average ratings of Pre- (n=18) and Post- (n=14) data show an increase in Understanding (4.2 to 4.6 on a 5-point scale); Confidence (4.0 to 4.6) and Support (4.8 to 5).

Conclusions: The current project sought to enhance integration between Oncology and Palliative Care by establishing a brief weekly Lightning Rounds in which Oncology trainees met with Palliative Care team members. We found that trainees’ understanding in what a Palliative Care consult can provide; their confidence in knowing when to offer a Palliative Care consult, and how supported they feel by our Palliative Care team, all increased from pre- to post-Lightning Rounds. These findings support our initial hypotheses and are encouraging continued involvement via this medium.

Background: A growing body of evidence suggests that palliative care is an important element of comprehensive cancer treatment by assisting with symptom management and establishing goals of care. Research suggests that enhanced integration of palliative care and oncology medicine has a positive effect on mortality and quality of life outcomes, and integration of the two is now considered standard care. However, there are no standard models for how this integration might occur. At our facility, there was no formal connection between the Oncology service and the Palliative Care Team.

Methods: The interdisciplinary Palliative Care Consult Team established weekly “Lightning Rounds” with Heme-Onc trainees, in which trainees answered questions about each patient regarding symptoms, prognosis, goals of care, and whether Palliative Care support was needed. In addition, trainees received brief didactics—“ teaching pearls”—that addressed components of palliative medicine (eg, use of opioids).

Trainees completed surveys Pre- and Post- Lightning Rounds, rating on a scale of 1 to 5 (Not at all to Very Much) how much they understand about, how confident they are in explaining, and how supported they feel by Palliative Care.

Results: From November 2017 – April 2019, we rounded on 105 unique patients in 26 Lightning Rounds sessions. Pre- and Post- samples are not paired. Average ratings of Pre- (n=18) and Post- (n=14) data show an increase in Understanding (4.2 to 4.6 on a 5-point scale); Confidence (4.0 to 4.6) and Support (4.8 to 5).

Conclusions: The current project sought to enhance integration between Oncology and Palliative Care by establishing a brief weekly Lightning Rounds in which Oncology trainees met with Palliative Care team members. We found that trainees’ understanding in what a Palliative Care consult can provide; their confidence in knowing when to offer a Palliative Care consult, and how supported they feel by our Palliative Care team, all increased from pre- to post-Lightning Rounds. These findings support our initial hypotheses and are encouraging continued involvement via this medium.

Background: To best address the psychosocial concerns experienced by patients with cancer, the 2007 report of the IOM, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, described the importance of distress screening and identifying psychosocial needs to optimize the quality of the cancer care. This may be especially critical when treating the Veteran population, where psychosocial needs as a whole may be elevated compared to non-VA institutions. The NCCN distress thermometer screening tool is a commonly used, validated, and easily administered screen of distress (eg, Hoffman et al, 2004). However, challenges can arise in successful implementation, adherence, and responsiveness to the information gleaned from this screen (eg, Zebrack et al, 2015).

As an institution accredited by the commission on cancer, it is important to not only meet the distress screening standard (ie, assess and identify psychosocial needs) but to understand barriers to identifying psychosocial needs and to appropriately triage when psychosocial concerns are identified. Goals of this project were to understand challenges with distress screening, address barriers to distress screening, and improve quality of assessment and referrals following positive screens.

Results: At Hines VAMC, we rolled out distress screening in 2015 and 2016, with rates of screening administration increasing over the course of the first year. However, without continued monitoring and re-education, successful adherence decreased overtime. Additionally, of the 862 screens administered to date, 37% were found to be considered “positive.” We will discuss the various barriers and challenges associated with managing referrals to nonmedical providers.

Our team has identified several essential aspects of successful screening and follow-up including staff/nursing education, continued tracking and re-education over time, and establishing and maintaining relationships with psychosocial clinicians to best address these aspects of care and to optimize quality of cancer care overall. We will discuss the impact of the above interventions on adherence and responsiveness.

Background: To best address the psychosocial concerns experienced by patients with cancer, the 2007 report of the IOM, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, described the importance of distress screening and identifying psychosocial needs to optimize the quality of the cancer care. This may be especially critical when treating the Veteran population, where psychosocial needs as a whole may be elevated compared to non-VA institutions. The NCCN distress thermometer screening tool is a commonly used, validated, and easily administered screen of distress (eg, Hoffman et al, 2004). However, challenges can arise in successful implementation, adherence, and responsiveness to the information gleaned from this screen (eg, Zebrack et al, 2015).

As an institution accredited by the commission on cancer, it is important to not only meet the distress screening standard (ie, assess and identify psychosocial needs) but to understand barriers to identifying psychosocial needs and to appropriately triage when psychosocial concerns are identified. Goals of this project were to understand challenges with distress screening, address barriers to distress screening, and improve quality of assessment and referrals following positive screens.

Results: At Hines VAMC, we rolled out distress screening in 2015 and 2016, with rates of screening administration increasing over the course of the first year. However, without continued monitoring and re-education, successful adherence decreased overtime. Additionally, of the 862 screens administered to date, 37% were found to be considered “positive.” We will discuss the various barriers and challenges associated with managing referrals to nonmedical providers.

Our team has identified several essential aspects of successful screening and follow-up including staff/nursing education, continued tracking and re-education over time, and establishing and maintaining relationships with psychosocial clinicians to best address these aspects of care and to optimize quality of cancer care overall. We will discuss the impact of the above interventions on adherence and responsiveness.

Background: To best address the psychosocial concerns experienced by patients with cancer, the 2007 report of the IOM, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, described the importance of distress screening and identifying psychosocial needs to optimize the quality of the cancer care. This may be especially critical when treating the Veteran population, where psychosocial needs as a whole may be elevated compared to non-VA institutions. The NCCN distress thermometer screening tool is a commonly used, validated, and easily administered screen of distress (eg, Hoffman et al, 2004). However, challenges can arise in successful implementation, adherence, and responsiveness to the information gleaned from this screen (eg, Zebrack et al, 2015).

As an institution accredited by the commission on cancer, it is important to not only meet the distress screening standard (ie, assess and identify psychosocial needs) but to understand barriers to identifying psychosocial needs and to appropriately triage when psychosocial concerns are identified. Goals of this project were to understand challenges with distress screening, address barriers to distress screening, and improve quality of assessment and referrals following positive screens.

Results: At Hines VAMC, we rolled out distress screening in 2015 and 2016, with rates of screening administration increasing over the course of the first year. However, without continued monitoring and re-education, successful adherence decreased overtime. Additionally, of the 862 screens administered to date, 37% were found to be considered “positive.” We will discuss the various barriers and challenges associated with managing referrals to nonmedical providers.

Our team has identified several essential aspects of successful screening and follow-up including staff/nursing education, continued tracking and re-education over time, and establishing and maintaining relationships with psychosocial clinicians to best address these aspects of care and to optimize quality of cancer care overall. We will discuss the impact of the above interventions on adherence and responsiveness.