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Palliative Care Out-Patient Services

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Post Working with Oncologists
Author: lbogmd
Date: Nov 20, 2010 8:56 am
In sharing the NEJM article with oncologists, they are reluctant to refer so early, thinking that their patients might feel that their oncologist doesn't feel competent to handle their symptoms. I suggested they provide "primary" symptom management, and refer to me as the "specialist" if symptoms returned or were not adequately treated. Any other suggestions for encouraging the earliest possible referral of cancer patients from their oncologist? How does that interaction look in practice?
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Re:Working with Oncologists (by lynceronsky on 11/26/2010)
Hello,
Your suggesting of partnering with oncologists to address complicated symptom management seems very appropriate. Palliative Care clinicians are also establshing oncology survivorship programs, which is another way to support quality of life through anticipatory guidance, psychosocial spiritual support, and symptom management. The NCCN Guidelines for Supportive Care (includes pain, palliative care, distress management and other topics) may be a way to mutually plan your involvement with your oncology colleagues. Local practice, resouces, and culture are big factors. Many patients and families sincerely appreciate the involvement of a team of specialists, including supprotive/palliative care, as the most comprehensive approach and "safety net" during treatment and beyond. Best of luck as you continue to advocate for palliative care for oncology patients and families.

Lyn Ceronsky
Director, Fairview Palliative Care
A Palliative Care Leadership Center
Minneapolis, MN
+ Re:Working with Oncologists (by bonafide1976 on 03/22/2012)
We have similar problem as well.It is very hard to convince Oncology service to use palliative care service as they feel self -sufficient enough to provide any symptom management themselves as well as bereavement support.They do have late referrals to Hospice however . There is a great discomfort preparing patients for the worst also.Are there any suggestions re: communication with oncology team in term of establishing palliative care referrals ?
Re:Working with Oncologists (by hcgmille on 03/22/2012)
i have been "inside" an oncology practice providing palliative care for nearly 7 years. although oncologists value palliative care they remain slow to refer. i have found the oncology nurses to be far more sensitive to the patients's current needs and they are a great resource to facilitate referrals.
Re:Working with Oncologists (by yaegerj on 03/22/2012)
We established a Palliative-Oncology Conference about 1 year ago. It is like a tumor board and we discuss cases we have in common and anyone can bring cases to the conference. We meet at noon twice per month. We start with a brief didactic session at least once per month and CME credit is given. This is well attended by an interdisciplinary group and I have found that the oncologists start to hold each other accountable for pressing forward with more treatment when from an objective viewpoint there is nothing to be gained. In addition to medical oncologists, we have palliative care providers, a hospice medical director and radiation oncologist present at nearly every meeting. It gets the conversations started!

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