Early palliative care integration in advanced cancer: two institutional quality improvement projects.

IF 2 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

BMJ Supportive & Palliative Care Pub Date : 2025-06-27 DOI:10.1136/spcare-2025-005644

Meenakshi V Venketeswaran, Jewell Joseph, Shanthi Prasoona Thotampuri, Praveen Kumar Marimuthu, Jefrilla Nancy Joseph, Vivaan Dutt, Ramakrishnan Ayloor Seshadri, Jenifer Jeba Sundararaj

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引用次数: 0

Abstract

Background: Guidelines recommend early palliative care (PC) integration in advanced cancers. This remains a challenge in countries with high cancer burden and limited PC access. We report the quality improvement (QI) journey aimed at improving timely PC integration in patients with advanced gastric, colorectal and lung cancers at two centres in India.

Methods: Centre A, an academic institution, and Centre B, a standalone cancer centre, used the A3 methodology for the QI process. An audit was conducted prior to August 2023 to establish the baseline PC referral rate. Process mapping, root cause analysis and Pareto chart were done, and key drivers were identified and interventions were planned. The common interventions were to increase oncologists' awareness, ensure holistic symptom assessment and establish a referral process. The proportion of patients with advanced cancer referred timely to PC was measured and recorded. Sustainability of the QI projects was assessed until September 2024.

Results: There was an increase in the timely PC referral from 37% to 66% in Centre A, and from 30% to 60% in Centre B, from before August 2023 to April 2024.

Conclusion: QI projects are feasible and effective when supported by good stakeholder collaboration to achieve the target of early and timely PC referral within oncology settings.

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晚期癌症的早期姑息治疗整合：两个机构质量改善项目。

背景：指南推荐晚期癌症的早期姑息治疗（PC）整合。在癌症负担高和个人电脑接入有限的国家，这仍然是一个挑战。我们报告了印度两个中心的质量改善（QI）之旅，旨在改善晚期胃癌、结直肠癌和肺癌患者的及时PC整合。方法：A中心是一个学术机构，B中心是一个独立的癌症中心，采用A3方法进行QI过程。在2023年8月之前进行了一次审计，以确定PC的基线转诊率。完成了过程图、根本原因分析和帕累托图，确定了关键驱动因素，并制定了干预措施。常见的干预措施是提高肿瘤学家的意识，确保整体症状评估和建立转诊流程。测量并记录晚期肿瘤患者及时转诊至PC的比例。QI项目的可持续性评估将持续到2024年9月。结果：从2023年8月前到2024年4月，A中心的PC及时转诊率从37%上升到66%，B中心从30%上升到60%。结论：在良好的利益相关者协作的支持下，QI项目是可行和有效的，可以实现肿瘤环境中早期和及时的PC转诊目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.