Interdisciplinary palliative care delivery can help to improve quality and health disparities among underserved cancer patient populations, according to oncology specialists.
Cancer patients across diverse cultural, ethnic and racial backgrounds often lack access to goal-concordant care that sufficiently addresses their physical, emotional and spiritual needs, according to Nadine Barrett, president of the Association of Cancer Care Centers (ACCC).
These disparities leave opportunities for greater collaborative partnerships between palliative care providers and oncologists, Barrett said in a recent ACCC Open Forum discussion. Barrett is also the associate director of community outreach and engagement at Atrium Health Wake Forest Baptist’s Office of Cancer Health Equity.
“It’s that you can relate to and be able to know how to walk in humility with that patient for where they are and who they are is a critical component,” Barrett said during the discussion. “We really have to build capacity and maximize impact as we work together to care for our patients, and particularly our focus around palliative care oncology, and specifically in the context of challenges and opportunities.”
Cancer patients in general need palliative care, but widespread misconceptions among underserved populations often pose a barrier, Barrett recently told Palliative Care News. Palliative care providers have sought to strengthen their referral strategies with oncologists in order to better reach patients.
Establishing effective communication avenues between oncology teams and interdisciplinary palliative care professionals is a large key to improving outcomes among underserved cancer patients, Barrett stated.
Also important is ensuring that staff are trained in delivering culturally appropriate care that honors a person’s beliefs and values, a sticking point in many palliative care education programs, she added.
“[Clinicians] don’t naturally know how to communicate, especially a topic around the context of palliative care, and also across a variety of cultures as well,” Barrett said. “[It’s] this whole idea of language and the words that we use really do matter, right? The words that we use have power in terms of influencing what people perceive. And so whether it be talking about consultations that can only happen in palliative care, but yet not happening in other disciplines. There’s a huge gap there.”
Palliative care’s momentum
Though access to palliative care has generally expanded in recent years, utilization of these services remains low among patients with various types of advanced cancers. Research has increasingly found palliative disparities among blood and breast cancer patients, particularly proliferating among American Indian and Alaska Native populations, as well as Black, Hispanic and Asian American, Native Hawaiian and Pacific Islander communities.
Palliative care may be gaining momentum across the health continuum in recent years, but several barriers exist preventing greater access and awareness, according to Dr. Kimberly Johnson, professor of medicine in the division of geriatrics at Duke Palliative Care and director of the Duke Center for Research to Advance Health Care Equity.
“We have seen tremendous growth in the field of palliative care in what has really been a reasonably short period of time,” Johnson said during the discussion. “We see the availability of specialist palliative care services popping up in the vast majority of large hospitals, and still there are places where people don’t have access to those services. There are huge opportunities for us to do better and add that palliative care in its reach of underserved populations, particularly minoritized racial and ethnic groups. It really is normalizing palliative care as part of its integration in cancer care and serious illness care”
Access to palliative care has increasingly been linked to improved patient outcomes, increased communication with their health care providers and better symptom management, according to Johnson. Additionally, health systems that have integrated palliative care services have seen less emergency care utilization and decreased costs, she added.
Keys to better access
Developing coordinated care delivery approaches is a significant part of addressing health disparities, according to Dr. Declan Walsh, chair of the department of supportive oncology at Atrium Health Levine Cancer Institute.
Collaborating with palliative care teams can help improve patients’ overall quality of life as their illness progresses, Walsh stated. Palliative care providers are often trained in having goals of care discussions with seriously ill patients and can assist with advance care planning services. Embedding palliative care professionals across different settings in the health care continuum is important to helping clinical teams understand patient preferences and their evolving needs.
“You’ve got to adopt a wider approach to that patient’s experience of their illness, to say, ‘You have a very serious illness, but we are going to fight hard and work hard to improve your quality of life,” Walsh said during the discussion. “And that that is a priority for our health care system, for our hospitals, for our cancer centers — irrespective of the ultimate outcome of the illness. That approach and that energy in providing that type of care is seen as being a priority. That really, I think, is very important, and the secret sauce in getting palliative care to the forefront of modern health care.”
A large issue fueling disparities among cancer patients is that the nations’ health care system remains fragmented, said Dr. Ramona Rhodes, associate professor of internal medicine at UT Southwestern Medical Center, where she also provides geriatric, hospice and palliative care.
Many health care professionals lack insight as to the nature of palliative care and when a patient might benefit from receiving these services, Rhodes stated. Health care providers also can mistakenly conflate palliative care with hospice.
Integrating palliative care services earlier in a cancer patient’s illness trajectory could have positive effects in terms of quality, as well as continuity and transitions of care, Rhodes indicated. It could also lead to better awareness of patients’ unmet needs, she added.
“A lot of times we work in silos as opposed to working together,” Rhodes said. “There are some specialists that have not accepted or adopted the concept or the philosophy of palliative care, so definitely working together would be helpful. Early integration of palliative care and introduction of discussions about palliative care with a clinician and communication and their family would definitely be beneficial.”
