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KEY CONCEPTS
Inpatient palliative or supportive care service is an interdisciplinary team of palliative care providers, including a physician, counselor, chaplain, social worker, pharmacist, palliative care nurses, and many others, who provide an integrated model of care to advanced cancer patients alongside the oncology teams.
Supportive care consultation can help identify and manage complex symptom issues like missed delirium and refractory pain in patients with advanced cancer, as well as psychosocial, emotional, and spiritual distress, while reducing the amount of opioids and other psychotropic agents (polypharmacy).
Early integration of supportive care has improved patient-reported outcomes and discharge outcomes, including an intensive care unit and overall hospital mortality, without increasing length of stay.
An acute palliative and supportive care unit (PSCU) at a tertiary care hospital is different from an acute inpatient hospice facility, because patients with a prognosis of more than six months can be admitted to a PSCU for the management of physical symptoms and the psychosocial, emotional, and spiritual distress for both the patient and their family.
An acute PSCU not only provides clinical care and education to the patient and family but also provides opportunities for education of the different disciplines involved in the patient's care as well as research geared toward improving the quality of life of patients, family, caregivers, and care providers.
The supportive care team, when part of the care continuum, can proactively assist with early identification and clarification of goals of care and completion of advanced-care directives, as well as provide a smoother transition and/or discharge plan for patients with advanced cancer.
An overwhelming majority of patients with cancer, as well as junior oncology colleagues, feel that they benefit from the integration of an interdisciplinary palliative and supportive care team.
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Patients with advanced illnesses such as cancer often experience high physical and psychological symptoms that can affect them throughout the trajectory of their disease.1–3 The literature has shown that patients with advanced cancer experience an average of 8 to 12 symptoms, suggesting that many symptoms are not recognized by their treating teams and often remain untreated.1,4 In addition to physical and psychological needs, patients and caregivers often struggle with decision making.4 Provision of specialized palliative and supportive care services has improved patients' physical, psychosocial, and spiritual well-being.5–9 The World Health Organization has defined palliative care as:
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”An approach that improves the quality of life of patients and their families facing the problem associated with a life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. … Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to understand better and manage distressing clinical complications.”10
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