Kesho Conference 2014

1. Indicators of Integration of
Palliative Care Services into an
existing Oncology Programme
Dr. John Weru
Aga Khan University Hospital
John.weru@aku.edu
@drjohnweru

2. Background
 Scientific advances in novel cancer therapeutics have led to
longer lives for patients diagnosed with incurable
malignancies.
 However, this is not matched with a similar availability of
efficacious supportive care interventions aimed at relieving
symptoms due to progressive disease and treatment side
effects.
 Accumulating data shows that there is meaningful
improvement in the experiences of patients and family
caregivers by incorporating symptom management, quality of
life issues and treatment planning.
2

3. Aim
 This study set out to assess the understanding
of clinicians regarding integration of palliative
care services into an existing oncology
programme.

4. Methodology
 Questionnaires with statements either to agree or refute
were sent out to 10 clinicians taking care/ involved in the care
of cancer patients.
 Four responses: a) strongly disagree, b) disagree, c) agree, d)
strongly agree. If c or d, rate the importance from 1-10 with
10 being very important
 The criteria comprised of: clinical processes, clinical
outcomes, education and research as regards palliative care
in oncology.

5. Results-- Clinical
• Q: In your opinion, should the following criteria be used as
indicators of integration of palliative care services and oncology
programmes in mid- to large- size hospitals (100 beds or more)
• Proportion of advanced cancer patients seen by palliative care
before death---90%
• Median time from diagnosis of advanced cancer to outpatient
palliative care consultation--- 50%
• Proportion of outpatients with pain ASSESSED on either of the last
two visits before death--- 100%
5

6. Results- Clinical
• Proportion of outpatients with pain intensity QUANTIFIED on
either of the last 2 visits before death--- 100%
• Proportion of patients with 2 or more emergency room visits
in last 30 days of life (negative indicator)--- 20%
• Proportion of patients with 2 or more hospital admissions in
last 30 days of life (negative indicator)--- 30%
• Proportion of patients who died in a hospital (negative
indicator)--- 20%
6

7. Results- Education
• Q: In your opinion, should the following criteria be used as
indicators of integration of palliative care services and
oncology programmes in mid- to large- size hospitals (100
beds or more).
• Didactic palliative care curriculum for residents/ oncology
fellows provided by palliative care teams--- 90%
• Oncology residents have routine rotation in palliative care---
70%
• Combined palliative care and oncology educational activities
for residents--- 70%
• Continuing medical education in palliative care for attending
oncologists– 30% 7

8. Results- Research
• Q: In your opinion, should the following criteria be
used as indicators of integration of palliative care
services and oncology programmes in mid- to large-size
hospitals (100 beds or more).
• Institutional funding for palliative oncology research-
50%
• Tenured faculty in palliative care--- 60%
• Endowed leadership in palliative care--- 70%

9. Results- Research
• Peer reviewed publications in palliative
oncology--- 90%
• Collaborative research between oncology and
palliative care--- 20%

10. Results- Ethical legal
• Q: In your opinion, should the following criteria be used as
indicators of integration of palliative care services and
oncology programmes in mid- to large- size hospitals (100
beds or more).
• Ethical legal discussions on first contact--- 10%
• DNR orders discussed/instituted before death--- 90%
• Patient /family understanding of prognosis--- 70%
• Resolved patient/family/physician conflicts--- 40%

11. 11
Results
Criteria Agree Disagree Importan
ce(5/10)
Clinical 72% 28% 80%
Education 32% 68% 46%
Research 26% 74% 38%
Ethical
legal
60% 40% 78%

12. Limitations
• Assumption that the contacted persons were aware
of what palliative care is.
• Likely participant bias to answer in the affirmative/
negate.
• Researcher bias on sampling.
• Few people, ten participants, were studied making it
difficult to generalize the findings.

13. Recommendation
• Need for training and research on the clinical implication of
palliative care in oncology.
• Palliative care consults in comprehensive cancer centers are
important and associated with improvement in a number of
physical and psychological symptoms, such as pain, fatigue,
depression and anxiety. Positive ethical legal outcomes.
• There is need for integrated palliative care which has the
advantage of co-management in a complementary manner.
• For this to be feasible, palliative care education, competency
developments and shared clinical processes & outcome are
necessary components.