National Consensus Project palliative care guideline 1.9, to try to provide care in the patient’s preferred setting. We have been able to offer outpatient palliative care services to radiation oncology patients, who generally do not access inpatient services till much later in their disease trajectory. This was possible with just 1 palliative care physician on staff for both inpatient and outpatient services.

Short description

Phoebe Putney Memorial Hospital is a not for profit community hospital in Albany, Georgia with 443 beds. There has been a full time palliative care inpatient consult service in place since July 2006. We have been able to provide outpatient palliative care services in the radiation oncology outpatient clinic since January 2007, by having the sole palliative care physician on the inpatient consult service, see radiation oncology patients in their clinic area, one morning a week. This allowed for patients to be seen in their preferred setting.

• Prior to starting the clinic, the palliative care physician and her administrator met with the radiation oncology medical director and his administrator to discuss the opportunity.
• It was clarified that the role of this clinic was to offer assistance to their team and their patients, in complex symptom management and other palliative care needs.
• Prior to starting the clinic, the palliative care physician met initially with the rest of the clinical staff, then subsequently with all the staff in the department, by attending one of their lunchtime staff meetings. She was able to clarify that this clinic would not generate any extra work for them and answer questions regarding the service to be provided.
• Only patients already registered and known to radiation oncology are seen in this clinic.
• One morning a week clinic, on a day when one of the radiation oncology physicians has responsibilities elsewhere and one of their examination rooms is available for use.
• The palliative care physician calls patients in from the waiting area herself, weighs her own patients and does her own vital signs to avoid using extra support staff.
• Scheduling, telephone calls and other patient issues continue to be handled by the radiation oncology staff, as these remain their patients.
• The palliative care physician offers telephone advice to the radiation oncology team anytime, outside the day she is in their department.
• The palliative care physician tries to accommodate the occasional situation when a patient may be in the radiation oncology clinic, in crisis from uncontrolled symptoms, on her none scheduled clinic day and goes to the radiation oncology department to see the patient if needed.

Summary of Results/What Worked and Why

The clinic was started in January 2007 (six months after a full time palliative care physician started the inpatient palliative care consult service).

There have been a total of 52 referrals since inception of the clinic, till August 2009. The most common reason for referral was help with pain management. The most common cancer diagnosis was head and neck cancer (20 of 52 referrals).

The 2 radiation oncology physicians and their 2 physician assistants (PA) completed a satisfaction survey in July 2009.

The future

The plan had initially been to offer similar outpatient services to both medical and radiation oncology. However, after piloting this method with the much smaller radiation oncology team, it became obvious that there was not enough palliative care personnel to offer a good quality service to the much bigger medical oncology team (8 physicians and 2 nurse practitioners). We are still hopeful that as the inpatient palliative care consult team expands, the palliative care team may have more time to offer a similar service to medical oncology. The ultimate goal is to have a true palliative care clinic for follow up of patients seen in the hospital, as well as seeing new referrals. This would provide the much needed continuity of care and also hopefully allow for much earlier referral of appropriate patients, before they end up in the hospital, which is often much later in their disease trajectory.