Palliative and Supportive Care: A Team Approach

Palliative care is best delivered through an interdisciplinary teaching approach. The core focus is aimed at optimizing the quality of life in patients with a chronic illness, in our practice, the focus is mostly on the care of the Hematologic/Oncologic patient. Over recent years, we have seen a shift in the acknowledgment of the importance of palliative care as an integral part of patient care.

The best way palliative care is introduced to the patient initially is from their primary oncologist, APP, or primary team. In doing so, this fosters a team approach with a focus on trust. Supportive and palliative care does not seek to take over any element of care but instead serves to enhance the overall care that is being delivered. Much of the current literature in advanced cancer concludes that early palliative and supportive care can improve quality of life and survival. These outcomes were better in patients receiving a systematic, multi-disciplinary approach to their care. Best supportive care is also becoming an important aspect of anti-cancer treatments to help patients achieve optimum results.

Patients are more likely to pursue a palliative care referral if it is recommended by their oncologist. The supportive care team will work in conjunction with the oncology care team to manage the patients' care and maintain the best possible quality of life. Palliative and supportive care specialists also provide caregiver support, facilitate communication among members of the health care team, and help with discussions focusing on goals of care for the patient.

Being introduced as part of the team upfront from the Oncologist or Advanced practice provider promotes support as a whole. It enables the patients to accept the referral as it is coming from someone they already trust and respect.

For many patients and/or families their only association with palliative care equates to hospice type care. Introducing this service early and focusing on symptom control will ease them into the more difficult conversations when that time may come. Referral for symptom management was frequently identified as a mechanism to promote relationship building between palliative care clinicians and patients with poor prognoses.

Initially, the short term focus may be on better management of symptoms that affect the quality of life, but long term, you're developing a rapport with a team who has become familiar with the wants and wishes of the patient, so when the time to discuss hospice presents, they are comfortable with the decision because these are not strangers anymore instead, they have been involved as a team all along.

The earlier referral makes palliative and supportive care, not such a scary concept. Referrals can come from any part of the NYCBS team. So many people are involved in the care of our patients and our patients find comfort in all our disciplines. From the first person that greets them at the front desk and spends the time making their appointments, to the lab technician who makes the blood draws less scary, the infusion or shot room nurses that get to know these patients’ whole life stories and see them as they are, and the medical assistants who take their time updating their information at each visit. Our entire staff takes the time to not only do the respected elements of their job but instead to develop relationships. It means so much to our patients that they are not treated only as patients but as people. Over time all these encounters allow bonds to be built. As you develop this, patients confide in their needs because of their comfort level. If anyone feels a patient can benefit from these services, please refer to the palliative and supportive team. Tell the patients about the service, ease their fears, and promote the team approach. In doing so, we will continue to foster exceptional service and delivery of patient care.