Precision palliative care as a pragmatic solution for a care delivery problem

Article indépendant

SEDHOM, Ramy | SHULMAN, Lawrence N. | PARIKH, Ravi B.

ASCO and National Comprehensive Cancer Network guidelines recommend all patients with advanced cancer receive early palliative care (PC), within 8 weeks of diagnosis,1,2 on the basis of evidence that concurrent care improves patient symptoms, mood and quality of life (QOL), caregiver distress, and quality of care at the end of life.3 Unfortunately, guidelines ignore the reality that demand for PC outweighs the supply of specialists,4 and the evidence that not all patients have supportive care needs at the time of diagnosis.5 Key opinion leaders have instead advocated for timely PC on the basis of patient needs.6-8 The Symptom Screening with Targeted Early Palliative care (STEP) trial demonstrated proof of concept: using systemic assessment, the research team was able to identify who benefited from timely PC, and who did not demonstrate any PC need.9 Checklists, on the basis of patient symptoms or risk,10 and electronic health record (EHR) prediction models,11 have also successfully triggered timely PC referral. These studies force us to reimagine the current resource-intensive standard of early PC. We propose adoption of precision PC, a pragmatic approach that captures heterogeneous, time-varying, and complex patient/caregiver needs, while considering limited human and system resources.

http://dx.doi.org/10.1200/JCO.22.02532

Voir la revue «Journal of clinical oncology, 41»

Autres numéros de la revue «Journal of clinical oncology»

• Description
• Sujet/Public
• Outil
• Outil d'anticipation
• Gestion