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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Semin Oncol Nurs. Author manuscript; available in PMC 2011 November 1.
Published in final edited form as:
Semin Oncol Nurs. 2010 November; 26(4): 266–284.
doi: 10.1016/j.soncn.2010.08.006

Table 4

How a Concurrent Oncology Palliative Care Programs Might Influence “Usual Care” for Advanced Cancer Patients and their Families

“Usual” CareCare Process with a COPC
Patient is diagnosed with stage IV lung
cancer and meets with oncologist.
Treatment plan is developed and explained
to patient/caregiver in detail. Expected
side effects of treatment plan reviewed.
Patient is diagnosed with stage IV lung
cancer and meets with oncologist. Patient
meets criteria (eg newly diagnosed IIIB or
IV lung cancer) and is also referred for
initial outpatient Palliative Care Team
(PCT) Consultation and standardized
holistic assessment
  • PCT documents and communicates consultation to patient/family & referring oncology team
  • Advance directives documents completed including patient’s preference for resuscitation status
  • Prospective symptom management plan identified including psycho/social/spiritual needs with interventions.
  • Community-based resources in place
  • Regular PCT follow up planned in conjunction with other medical appointments when possible (including MSW, chaplain, healing arts providers as appropriate)
Overwhelmed caregiver calls oncology
regarding symptoms and is directed to ED
with subsequent admission.
Patient develops anticipated disease
and/or chemotherapy-related
symptoms/side effects and caregiver
contacts PCT staff by phone. Instructed to
come to clinic for evaluation. Caregiver
anxiety previously identified, addressed
and psychosocial PCTmembers consulted
for ongoing support.
Inpatient / hospitalist medical team
continues diagnostic workup
Patient requires brief, planned hospital
admit for symptom relief; continuity of care
ensured by preplanned inpatient PCT
follow up over hospitalization, including
management of caregiver needs.
Patient undergoes tests and procedures.
Symptom management per medical team.
Patient and caregiver feel overwhelmed
when a DNR discussion is broached by
intern staff. Tension develops between the
team and patient who asks ‘am I dying?
Why are they giving up on me?’.
PCT assists with symptom assessment
and management including
recommendations for palliative symptom
interventions. Goals of care addressed in
an ongoing fashion to assure interventions
match patient/family goals. Advance Care
Planning discussions that happened at
diagnosis are reviewed. If patient is
approaching end of life, desired place of
death is identified with patient and
caregivers and plans for final days are
carefully crafted for optimum patient
Patient’s disease process is not able to be
reversed. Patient develops acute
deterioration and is transferred to the
intensive care unit on ventilator.
Discharge plan coordinated by inpatient
PCT for patient to have home care (or
hospice care) as needed. If death is
imminent, standardized Comfort Measures
Order Set is implemented.
After prolonged stay, patient dies in
hospital. Family is in shock, feeling
unprepared for death.
Patient dies in preferred site of death.
Bereavement care offered to family after
the death