Complex Illness Support Alongside Standard Oncology Care
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Aim. To evaluate the effect of Complex Illness Support alongside standard oncology care for patients with incurable cancer on symptom control, patient satisfaction with care, and chemotherapy utilization within 30 days of death.
Design. This was a descriptive study to evaluate the effect of Complex Illness Support alongside standard oncology care for patients with incurable cancer on symptom control and patient satisfaction with care. Additionally, the use of chemotherapy within 30 days of death was evaluated using inferential statistics.
Method. A convenience sample of consecutive patients with incurable cancer who presented through a lung cancer clinic in a Midwestern urban community hospital was utilized for this project. This was a descriptive study that examined symptom control, patient satisfaction with care, and chemotherapy use within 30 days of death. One patient satisfaction survey was used to evaluate patient satisfaction with Complex Illness Support care. Patients self-report of overall symptom burden (mild, moderate, severe) was assessed and documented at the first consultation visit and at the three month follow up visit. For those patients who died within the study period, the electronic medical record was reviewed to determine chemotherapy utilization within 30 days of the patient’s death.
Results. Through the lung cancer clinic, 13 physicians referred 22 patients with terminal illness to Complex Illness Support for a total of 22 patient visits over a 5 month timeframe. Of the 18 patients seen, 10 have died (56%). Patients were highly symptomatic and a variety of interventions were used to support patients. Symptoms of the two patients seen consistently remained stable from initial consultation to the three month follow up visit. Chemotherapy use within 30 days of death (two of the four patients received chemotherapy) was within national benchmark measures, and patients strongly endorsed satisfaction with the Complex Illness Support team.
Conclusion. Patients with incurable cancer frequently experience significant symptom burden and psychosocial distress. Complex Illness Support addresses many of these concerns. Patients and providers are accepting of and asking for outpatient Complex Illness Support. In this five month project, 56% of patients referred to this service died; this affirms the rationale and need for early supportive care intervention. To ensure high quality care and early access to supportive services, Complex Illness Support needs to be available to patients where they most often access oncology care – in the cancer center. Integration of Complex Illness Support as part of standard oncologic care would enhance patient care and satisfaction.
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