This document outlines guidelines for palliative care services provided at UF Health Cancer Center-Orlando Health (UFHCCOH) for patients with cancer or other serious illnesses. It describes how referrals can be made for outpatient or inpatient palliative care services to manage pain and other distressing symptoms. Referrals must be made by a UFHCCOH provider for patients under their ongoing care. The guidelines also provide information on documentation procedures and cross-coverage for palliative care patients.

1.
Guideline
Title:
UFHCC-­‐OH
Medical
Oncology
Palliative
Care
Guideline
Guideline
Number:
GUID-­‐
Page
1
of
3
©
Orlando
Health
2012
1414
Kuhl
Ave.
Orlando,
FL
32806
DEPARTMENT
GUIDELINE
Issue
date:
07/2016
Replaces
Dept.
Policy:
N/A
Revision
dates:
N/A
Developed
by:
Keri
Lowe,
Lindsay
Jacques,
Ariel
Fittery
Approved
by:
Brian
Wetzel,
COO
Approved
by:
Lindsay
Jacques,
Director
of
Physician
Practices
Signature:
Signature:
Department
Numbers:
All
medical
oncology
outpatient
clinic
departments
I. PURPOSE:
This
policy
outlines
the
services
which
are
provided
on-­‐site
to
patients
at
UF
Health
Cancer
Center-­‐
Orlando
Health
(UFHCCOH)
and
documents
how
referrals
are
made
for
both
inpatient
and
outpatient
services.
II. DEFINITION:
A. Palliative
Care:
Refers
to
patient-­‐
and
family-­‐centered
care
that
focuses
on
improving
a
patient’s
quality
of
life
by
managing
pain
and
other
distressing
symptoms
of
a
serious
illness,
including
cancer.
Palliative
care
is
for
persons
of
any
age,
at
any
stage
in
an
illness,
whether
it
be
curable,
chronic,
or
life-­‐threatening.
III. DEPARTMENT
GUIDELINE:
It
is
the
guideline
of
the
medical
oncology
clinics
that
the
patient
will
receive
verbal
and
printed
materials
regarding
their
diagnosis,
goals
of
therapy,
planned
duration
of
treatment,
short
and
long
term
side
effects,
contact
information
for
symptom
management
and
plan
for
monitoring
and
follow
up.
Much
of
this
information
is
available
in
the
New
Patient
Binder
and
Patient
Resource
guide,
with
supplemental
information
coming
from
clinical
and
patient
scheduling
staff.
IV. DOCUMENTATION:
Documentation
will
be
completed
by
the
physician
and
physician
staff
as
per
medical
staff
and
hospital
policy.
(Need
to
find
policy
##)
V. PROCEDURE(S):
A. Information
regarding
referral
for
outpatient
palliative
care

2.
Guideline
Title:
UFHCC-­‐OH
Medical
Oncology
Palliative
Care
Guideline
Guideline
Number:
GUID-­‐
Page
2
of
3
©
Orlando
Health
2012
1414
Kuhl
Ave.
Orlando,
FL
32806
DEPARTMENT
GUIDELINE
i. Outpatient
palliative
care
is
provided
within
Palliative
Medicine
ii. Current
care
is
exclusively
outpatient
and
is
scheduled
with
provider
based
on
request
via
ambulatory
order
form
completed
by
UFHCCOH
provider.
iii. To
be
eligible
to
receive
care
in
the
Palliative
Medicine
Clinic
longitudinally,
patients
must
be
under
the
ongoing
care
of
UFHCC-­‐OH
oncologist
B. Appropriate
Referrals
include:
i. Patients
with
cancer-­‐related
pain
and/or
other
symptoms;
this
includes
patients
with
pain
syndromes
arising
out
of
their
cancer
treatment
who
may
have
“no
evidence
of
disease”
clinically
or
diagnostically
ii. Patients
in
need
of
counseling
about
goals
of
care
and/or
advanced
care
planning
iii. Patients
with
hematologic
illnesses
other
than
cancer,
but
with
pain
and/or
other
symptoms
associated
with
that
condition
and
who
are
under
the
care
of
a
UFHCC-­‐OH
physician
(for
example,
patient
with
chronic
pain
from
sickle
cell
disease,
hemophilia,
etc.)
C. Inappropriate/Non-­‐Applicable
Referrals
include:
i. Patients
who
present
with
non-­‐cancer
related
pain
in
the
absence
of
a
terminal
condition
or
serious
chronic
illness
for
which
they
are
receiving
care
at
UFHCC-­‐OH
ii. Patients
suffering
from
opioid
addiction
in
need
of
treatment
for
substance
abuse
disorder
iii. Patients
no
longer
suffering
from
cancer
pain
who
require
discontinuation
of
controlled
cancer
pain
medications
D. Cross-­‐coverage:
i. In
the
absence
of
the
palliative
care
physician,
cross-­‐coverage
is
provided
by
the
physician
on-­‐call
for
medical
oncology
ii. If
patient
has
no
medical
oncologist,
cross-­‐coverage
of
for
palliative
care
is
provided
by
the
oncology
physician
who
referred
the
patient
to
the
Palliative
Medicine
Clinic
(such
as
Gynecologic
Oncology,
Radiation
Oncology
and/or
Surgical
Oncology
and
related
surgical
subspecialty
services)
E. Information
regarding
patient
referrals
for
inpatient
palliative
care:

3.
Guideline
Title:
UFHCC-­‐OH
Medical
Oncology
Palliative
Care
Guideline
Guideline
Number:
GUID-­‐
Page
3
of
3
©
Orlando
Health
2012
1414
Kuhl
Ave.
Orlando,
FL
32806
DEPARTMENT
GUIDELINE
i. Inpatient
palliative
care
is
provided
either
of
two
services:
a. Cornerstone
Hospice
Unit
–
Contact
info
b. Palliative
Medicine
Associates
ii. In
most
cases,
these
services
will
provide
inpatient
care
on
a
consultative
basis
with
a
hospitalist
or
oncologist
serving
as
the
admitting
physician
of
record.
VI. SERVICES
PROVIDED:
A. Integrative
Medicine
i. Cancer
Support
Community
a. Patient
and
family
learning
center
with
provided
educational
resources
b. Acupuncture
c. Yoga
d. Healing
Touch
e. Spiritual
Care
B. Mental
health
counselors
C. Pain
and
non-­‐pain
symptom
management
a. Mindfulness
meditation
b. Transcendental
meditation
c. Oncology
Massage
therapy
D. Physical
and
Occupational
therapy
E. Lymphedema
and
Wound
Care
Clinics