title: Training mid-level providers on palliative care: bringing advanced directives and symptom assessment and management to community oncology practices.
abstract: Palliative care services are not available in most outpatient oncology practices. A program training 11 mid-level providers from oncology practices on advanced directive discussions and supportive symptom assessment and management performed by palliative care specialists was completed. A follow-up session 9 months later identified barriers to implementation. Of the 11 mid-level providers, 8 participated in the follow-up session, and 9 of the 11 providers implemented advanced directive's discussions and symptom assessment and management for patients with metastatic cancer. Main barriers included uncertainties about reimbursement, patients' lack of knowledge about palliative care, and lack of access to supportive services. This program successfully promoted advanced directive discussions and supportive/palliative care symptom assessment and management to community oncology practices, which will hopefully translate into improved quality of life for patients with metastatic cancer.
authors.affiliation: 1Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Lesperance
authors.forename: Robert
authors.initials: R
authors.lastname: Shannon
authors.forename: Phyllis K
authors.initials: PK
authors.lastname: Pumphrey
authors.forename: Erin
authors.initials: E
authors.lastname: Dunbar
authors.forename: Renee
authors.initials: R
authors.lastname: Genther
authors.forename: C Lynn
authors.initials: CL
authors.lastname: Coleman
authors.forename: Margaret
authors.initials: M
authors.lastname: Tabano
authors.forename: Jennifer
authors.initials: J
authors.lastname: Maurer
authors.forename: Adrienne
authors.initials: A
authors.lastname: Vazquez
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Capp
authors.forename: Jessica
authors.initials: J
authors.lastname: McMillan
authors.forename: Katie
authors.initials: K
authors.lastname: Wilkerson
authors.forename: Gerald
authors.initials: G
authors.lastname: Robbins
authors.forename: Dorothy Green
authors.initials: DG
authors.lastname: Phillips
authors.forename: Priscilla
authors.initials: P
authors.lastname: Howick
authors.forename: Catherine
authors.initials: C
authors.lastname: Solaun
authors.forename: Jeff
authors.initials: J
authors.lastname: Sloan
authors.forename: Gerardo
authors.initials: G
authors.lastname: Colón-Otero
mesh_terms: D016223:Advance Directives; D000553:Ambulatory Care / Q000379:methods; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008495:Medical Oncology / Q000193:education* / Q000379:methods; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data; D065126:Palliative Medicine / Q000193:education*; D016730:Program Development
keywords: community oncology practices; metastatic cancer; mid-level providers; outpatient oncology practices; palliative care; quality of life; supportive services