Palliative Cancer Care in the Outpatient Setting: Which Model Works Best?
Multiple randomized controlled trials have underscored the importance of timely referral to palliative care for patients with advanced cancer. Outpatient palliative care can facilitate timely referral and is increasingly available in many cancer centers. The key question is which model of outpatient palliative care is optimal. There are currently many variations for how palliative care is delivered in the outpatient setting, including (1) Interdisciplinary Specialist Palliative Care in Stand-Alone Clinics, (2) Physician-Only Specialist Palliative Care in Stand-Alone Clinics, (3) Nurse-Led Specialist Palliative Care in Stand-Alone Clinics, (4) Nurse-Led Specialist Palliative Care Telephone-Based Interventions, (5) Embedded Specialist Palliative Care with Variable Team Makeup, and (6) Advanced Practice Providers-Based Enhanced Primary Palliative Care. It is important to make a clear distinction among these delivery models of outpatient palliative care because they have different structures, processes, and outcomes, along with unique strengths and limitations. In this review article, we will provide a critical appraisal of the literature on studies investigating these models. At this time, interdisciplinary specialist palliative care in stand-alone clinics remains the gold standard for ambulatory palliative care because this approach has the greatest impact on multiple patient and caregiver outcomes. Although the other models may require fewer resources, they may not be able to provide the same level of comprehensive palliative care as an interdisciplinary team. Further research is needed to evaluate the optimal model of palliative care delivery in different settings.
KeywordsClinical trial Interdisciplinary health team Outcome and process assessment (health care) neoplasms Ambulatory care Palliative care
Compliance With Ethical Standards
Conflict of Interest
David Hui has received research funding from Insys and Teva. He is also supported in part by grants from the National Cancer Institute (1R01CA214960-01A1, 1R01CA225701-01A1), the National Institute of Nursing Research (1R21NR016736–01), and the American Cancer Society (MRSG-14-1418-01-CCE).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Hui D, Bruera E. Integrating palliative care into the trajectory of cancer care Nat Rev. Clin Oncol. 2016;13(3):159–71.Google Scholar
- 9.Gaertner J, Siemens W, Meerpohl JJ, Antes G, Meffert C, Xander C, et al. Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis. BMJ. 2017;357:j2925.CrossRefGoogle Scholar
- 14.•• Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care. CA Cancer J Clin. 2018;68(5):356–76 Timely review providing more in-depth discussions on various contemporary models of palliative care and explaining the concept of interdisciplinary care in greater detail.CrossRefGoogle Scholar
- 23.Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, et al. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol. 2011;29(17):2319–26.CrossRefGoogle Scholar
- 26.Groenvold M, Petersen MA, Damkier A, Neergaard MA, Nielsen JB, Pedersen L, et al. Randomized clinical trial of early specialist palliative care plus standard care versus standard care alone in patients with advanced cancer: The Danish Palliative Care Trial. Palliat Med. 2017;31(9):814–24.CrossRefGoogle Scholar
- 27.do Carmo TM, Paiva BSR, de Oliveira CZ, Nascimento MSA, Paiva CE. The feasibility and benefit of a brief psychosocial intervention in addition to early palliative care in patients with advanced cancer to reduce depressive symptoms: a pilot randomized controlled clinical trial. BMC Cancer. 2017;17(1):564.CrossRefGoogle Scholar
- 29.Scarpi E, Dall’Agata M, Zagonel V, Gamucci T, Berte R, Sansoni E, Amaducci E, Broglia CM, Alquati S, Garetto F, Schiavon S, Quadrini S, Orlandi E, Casadei Gardini A, Ruscelli S, Ferrari D, Pino MS, Bortolussi R, Negri F, Stragliotto S, Narducci F, Valgiusti M, Farolfi A, Nanni O, Rossi R, Maltoni M (2018) Systematic vs. on-demand early palliative care in gastric cancer patients: a randomized clinical trial assessing patient and healthcare service outcomes. Support Care Cancer. https://doi.org/10.1007/s00520-018-4517-2.
- 31.Tattersall MHN, Martin A, Devine R, Ryan R, Jansen J, Hastings L, et al. Early Contact with Palliative Care Services: A Randomized Trial in Patients with Newly Detected Incurable Metastatic Cancer. J Palliat Care Med. 2014;4(170):1–6.Google Scholar
- 35.Hui D, Bruera E (2019) Models of Palliative Care Delivery for Cancer Patients. J Clin Oncol. (in press).Google Scholar
- 50.Fischer SM, Kline DM, Min SJ, Okuyama-Sasaki S, Fink RM. Effect of Apoyo con Carino (Support With Caring) Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latino Adults With Advanced Cancer: A Randomized Clinical Trial. JAMA Oncol. 2018;4(12):1736–41.CrossRefGoogle Scholar