title: Supportive and palliative radiation oncology service: impact of a dedicated service on palliative cancer care.
abstract: OBJECTIVE
  The American Society of Clinical Oncology has recommended tailoring palliative cancer care (PCC) to the distinct and complex needs of advanced cancer patients. The Supportive and Palliative Radiation Oncology (SPRO) service was initiated July 2011 to provide dedicated palliative radiation oncology (RO) care to cancer patients. We used care providers' ratings to assess SPRO's impact on the quality of PCC and compared perceptions of PCC delivery among physicians practicing with and without a dedicated palliative RO service.
  
  
  METHODS
  An online survey was sent to 117 RO care providers working at 4 Boston-area academic centers. Physicians and nurses at the SPRO-affiliated center rated the impact of the SPRO service on 8 PCC quality measures (7-point scale, "very unfavorably" to "very favorably"). Physicians at all sites rated their department's performance on 10 measures of PCC (7-point scale, "very poorly" to "very well").
  
  
  RESULTS
  Among 102 RO care providers who responded (response rate, 89% for physicians; 83% for nurses), large majorities believed that SPRO improved the following PCC quality measures: overall quality of care (physician/nurse, 98%/92%); communication with patients and families (95%/96%); staff experience (93%/84%); time spent on technical aspects of PCC (eg, reviewing imaging) (88%/56%); appropriateness of treatment recommendations (85%/84%); appropriateness of dose/fractionation (78%/60%); and patient follow-up (64%/68%). Compared with physicians practicing in departments without a dedicated palliative RO service, physicians at the SPRO-affiliated department rated the overall quality of their department's PCC more highly (P = .02).
  
  
  CONCLUSIONS
  Clinicians indicated that SPRO improved the quality of PCC. Physicians practicing within this dedicated service rated their department's overall PCC quality higher than physicians practicing at academic centers without a dedicated service. These findings point to dedicated palliative RO services as a promising means of improving PCC quality.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts.
authors.forename: Yolanda D
authors.initials: YD
authors.lastname: Tseng
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: mkrishnan@lroc.harvard.edu.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Krishnan
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Jones
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Sullivan
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gorman
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Allison
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Pacold
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kalinowski
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Mamon
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Janet
authors.initials: J
authors.lastname: Abrahm
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D009726:Nurses / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D018787:Radiation Oncology / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data