Early Palliative Care Integration Supports Patients With Cancer

Early involvement of palliative care can make a significant difference for patients with advanced cancer, according to Cassie A. Gray, MS, RN, OCN, CHPN.

In an interview with Oncology Nursing News, Gray emphasized that meeting patients early in their cancer journey helps build trust, establish rapport, and prepare for the difficult conversations that may come later.

At the University of Wisconsin, Gray, clinical program coordinator of palliative care at UW Carbone Cancer Center in Madison, Wisconsin, and her colleagues have developed an interprofessional palliative care team within the comprehensive cancer center. Their clinic is staffed 5 days a week by a rotating group that includes physicians, a nurse practitioner, nurses, a social worker, and a chaplain. This structure allows the team to provide consistent, specialized support while also recognizing the essential role oncology clinicians play in delivering primary palliative care.

Gray explained that the team narrows its focus to patients with advanced cancer, aiming to see them as close to diagnosis as possible. This approach not only provides clinical benefits but also strengthens the therapeutic alliance. By engaging patients earlier, Gray noted, the care team can better support them through treatment and ensure palliative care is not limited to end-of-life discussions.

Transcript

At our institution, we have an interprofessional team embedded within our comprehensive cancer center. When I say interprofessional, that means a variety of different team members that have different disciplines and backgrounds. Our team has a couple physicians, a nurse practitioner, a social worker, a chaplain, and a couple clinic nurses; I am our Clinical Program Coordinator. We have a clinic that is open 5 days a week, and each of those days, we have 2 providers that are available to see patients. We schedule our patients in advance and really try to meet them where they’re at.

Given the complexities of access to care, how many of us are available, and how many physicians and providers we have as part of our team, what we have done here at the University of Wisconsin is to narrow our scope to take care of the folks that do have advanced cancer diagnoses.

We firmly believe that every member of the oncology team is going to be providing a layer of primary palliative care, and we're the specialists that are going to take care of the folks that have advanced metastatic disease. We're trying to meet these people as close to time of diagnosis as we can because the literature talks about how much patients can really benefit from this.

To be quite honest, it's not just about patients either. We love getting to know these people early on in their trajectory so that we can establish relationship and rapport moving forward. That way, when it is time to have the tough conversations and the ones that we never want to have, they go a lot more smoothly because we have this relationship with the patient. So again, we try and see folks early on in their diagnosis, but then we're really trying to focus on if and when we do get involved, we are still seeing patients before it's time to have a conversation about hospice. We want to be the team that is going to be taking care of patients along the trajectory of their cancer treatments.

This transcript has been edited for clarity and conciseness.