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National Consensus Project Clinical Practice Guidelines: Improving Education on the Tenets of Palliative Care


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The provision of palliative care (primary or specialty) is paramount to providing excellent quality care to all patients with cancer. Palliative care is associated with improving the quality of life, mood, and survival in patients with cancer. In fact, ASCO guidelines recommend that patients with advanced cancer should “receive dedicated palliative care services, early in the disease course, concurrent with active treatment.”


In this guideline, clinicians offering primary palliative care can utilize the knowledge and skills within the criteria.... Additionally, the guidelines can be used to implement and design new pallative care programs as well as educational and research content.
— Cardinale B. Smith, MD, PhD

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The guideline presented by Ferrell and colleagues in “The National Consensus Project 4th Edition of Clinical Practice Guidelines for Quality Palliative Care,”1 reviewed in this issue of The ASCO Post, provides the latest update on clinical practice guidelines for providing quality palliative care. With this guideline, clinicians offering primary palliative care can utilize the knowledge and skills within the criteria. Each domain contains a section on the use of specific strategies and their application to delivering primary palliative care.

Additionally, the guidelines can be used to implement and design new palliative care programs as well as educational and research content. This is particularly important in the era of value-based payment, such as the Centers for Medicare and Medicaid Services Oncology Care Model. This program incentivizes oncology practices to improve quality by reducing hospitalizations, enhancing prognostic communication, and facilitating earlier referral to hospice—all core skills identified within these clinical practice guidelines and specific to palliative care.

First Formal Consensus-Based Recommendations

These guidelines are also aligned with the first formal consensus-based recommendations regarding the types of palliative care services that constitute high-quality primary palliative care in oncology—ie, those identified in the joint publication by ASCO and the American Academy of Hospice and Palliative Medicine. These recommendations identified nine palliative care domains, with the largest items falling into symptom management. The areas of highest consensus were those of end-of-life care, communication, and shared-decision making. Training oncologists in the skills and knowledge of a higher level of palliative care practice is imperative, because the current delivery systems and evidence base, as well as the foreseeable palliative care workforce will not support patients with cancer obtaining specialty-level palliative care. These guidelines help address these issues specifically.

The purpose of specialty level palliative care is to help provide care for patients in conjunction with primary oncologists, in both curative-intent treatment and life prolonging–intent treatment. These guidelines help address the components of quality palliative care to better educate palliative care experts and those oncologists on the front line of patient care. 

Dr. Smith is Associate Professor of Medicine and Director of Quality for Cancer Services, Mount Sinai Health System, Division of Hematology/Medical Oncology and Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York.

DISCLOSURE: Dr. Smith is a consultant/advisor for and has received honoraria from Teva.

REFERENCE

1. Ferrell BR, Twaddle ML, Melnick A, et al: National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. J Palliat Med. September 4, 2018 (early release online).


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