Purpose: This literature review was performed to better understand how to facilitate the integration of palliative care and oncology care at the onset of treatment for patients at a VAMC facility.
Background: Palliative care is defined by the World Health Organization (WHO) as an approach to care aimed at improving the quality of life of patients and their families who are facing obstacles associated with a serious or terminal illness (WHO). The intention of palliative care is not curative; it does however address the prevention, early identification and treatment of pain, and problems which may be physical, psychosocial and spiritual. Palliative care should be integrated early in the course of the disease and in conjunction with life-saving treatments (Greer et al, 2013).
Methods: A search of databases included Google Scholar, PubMed, Ovid, and CINAHL identified randomized clinical trials, systematic reviews and expert reviews regarding the integration of palliative care at the initial diagnosis and when cancer treatment begins.
Results: Several interventions for integration of palliative care with standard cancer were identified as well as increase patient outcomes. The National Comprehensive Care Network,(NCCN), the American Society of Clinical Oncology, (ASCO), and the Institute of Medicine (IOM), all advocate for the initiation of palliative care at the onset of treatment. Guidelines for screening, assessments, and interventions are available to begin the process of integration. There are several barriers, however, affecting the integration of palliative care with comprehensive oncology care. These barriers include inadequate staffing, inadequate training, standardized assessment and screening tools. The process also requires the cooperation and support of facility leadership and administration.
Implications: There is strong evidence for the integration of palliative and oncology care for Veterans receiving cancer care at VAMC facilities. Oncology would continue to focus on the treatment of disease with the primary assessment of pain, other symptom management, and goals of care. Palliative care would be able to assist the patient with the more complicated symptomatology, psychosocial support, advance care planning and easier transitions into hospice care. Each discipline has a role in the improved outcomes and improved quality of life for patients.
