Advertisement

National Survey Using CFIR to Assess Early Outpatient Specialty Palliative Care Implementation

  • Author Footnotes
    a Rachel E Rosenblum is now affiliated with Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
    Rachel E. Rosenblum
    Correspondence
    Address correspondence to: Rachel E. Rosenblum, MD, Division of Hematology & Oncology, Allegheny Health Network Cancer Institute, 314 E. North Ave, Level 1, Pittsburgh, PA 15212, USA.
    Footnotes
    a Rachel E Rosenblum is now affiliated with Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
    Affiliations
    Division of Hematology & Oncology (R.E.R.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
  • Shari S. Rogal
    Affiliations
    Center for Health Equity Research and Promotion (S.S.R.), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA

    Departments of Medicine and Surgery (S.S.R.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
  • Elyse R. Park
    Affiliations
    Departments of Psychiatry and Medicine (E.R.P.), Massachusetts General Hospital, Boston, Massachusetts, USA
    Search for articles by this author
  • Carolyn Impagliazzo
    Affiliations
    Division of General Internal Medicine(C.I., L.B.A., R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Palliative Research Center (PaRC) (C.I., L.B.A., R.M.A., Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
  • Author Footnotes
    b Lindsay B Abdulhay is now affiliated with Chippenham Hospital, HCA Healthcare, Richmond, VA, USA.
    Lindsay B. Abdulhay
    Footnotes
    b Lindsay B Abdulhay is now affiliated with Chippenham Hospital, HCA Healthcare, Richmond, VA, USA.
    Affiliations
    Division of General Internal Medicine(C.I., L.B.A., R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Palliative Research Center (PaRC) (C.I., L.B.A., R.M.A., Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
  • Philip J. Grosse
    Affiliations
    Clinical and Translational Science Institute (P.J.G.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
  • Jennifer S. Temel
    Affiliations
    Division of Hematology & Oncology (J.S.T.), Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Author Footnotes
    c Robert M Arnold and Yael Schenker should be considered joint senior author.
    Robert M. Arnold
    Footnotes
    c Robert M Arnold and Yael Schenker should be considered joint senior author.
    Affiliations
    Division of General Internal Medicine(C.I., L.B.A., R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Palliative Research Center (PaRC) (C.I., L.B.A., R.M.A., Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
  • Author Footnotes
    c Robert M Arnold and Yael Schenker should be considered joint senior author.
    Yael Schenker
    Footnotes
    c Robert M Arnold and Yael Schenker should be considered joint senior author.
    Affiliations
    Division of General Internal Medicine(C.I., L.B.A., R.M.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Palliative Research Center (PaRC) (C.I., L.B.A., R.M.A., Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
  • Author Footnotes
    a Rachel E Rosenblum is now affiliated with Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
    b Lindsay B Abdulhay is now affiliated with Chippenham Hospital, HCA Healthcare, Richmond, VA, USA.
    c Robert M Arnold and Yael Schenker should be considered joint senior author.

      Abstract

      Context

      The American Society of Clinical Oncology (ASCO) recommends that outpatient specialty palliative care (OSPC) be offered within eight weeks of an advanced cancer diagnosis. To meet the rising demand, there has been an increase in the availability of OSPC services at National Cancer Institute (NCI)-designated cancer centers; however, many OSPC referrals still occur late in the disease course.

      Objectives

      Using the Consolidated Framework for Implementation Research (CFIR), we evaluated facilitators and barriers to early OSPC implementation and associated clinic characteristics.

      Methods

      We selected relevant CFIR constructs for inclusion in a survey that was distributed to the OSPC clinic leader at each NCI-designated cancer center. For each statement, respondents were instructed to rate the degree to which they agreed on a five-point Likert scale. We used descriptive statistics to summarize responses to survey items and explore differences in barriers based on OSPC clinic size and maturity.

      Results

      Of 60 eligible sites, 40 (67%) completed the survey. The most commonly agreed upon barriers to early OSPC included inadequate number of OSPC providers (73%), lack of performance metric goals (65%), insufficient space to deliver early OSPC (58%), logistical challenges created by early OSPC (55%), and absence of formal interdisciplinary communication systems (53%). The most frequently reported barriers differed according to clinic size and maturity.

      Conclusion

      Most barriers were modifiable in nature and related to the “Inner Setting” domain of the CFIR, which highlights the need for careful strategic planning by leadership when implementing early OSPC.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Temel JS
        • Greer JA
        • Muzikansky A
        • et al.
        Early palliative care for patients with metastatic non-small-cell lung cancer.
        N Engl J Med. 2010; 363: 733-742
        • Zimmermann C
        • Swami N
        • Krzyzanowska M
        • et al.
        Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial.
        Lancet. 2014; 383: 1721-1730
        • Hannon B
        • Swami N
        • Rodin G
        • Pope A
        • Zimmermann C.
        Experiences of patients and caregivers with early palliative care: a qualitative study.
        Palliat Med. 2017; 31: 72-81
        • Vanbutsele G
        • Pardon K
        • Van Belle S
        • et al.
        Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial.
        Lancet Oncol. 2018; 19: 394-404
        • Hoerger M
        • Wayser GR
        • Schwing G
        • Suzuki A
        • Perry LM.
        Impact of interdisciplinary outpatient specialty palliative care on survival and quality of life in adults with advanced cancer: a meta-analysis of randomized controlled trials.
        Ann Behav Med. 2019; 53: 674-685
        • Ferrell BR
        • Temel JS
        • Temin S
        • et al.
        Integration of palliative care into standard oncology care: American society of clinical oncology clinical practice guideline update.
        J Clin Oncol. 2017; 35: 96-112
        • Hui D
        • De La
        • Rosa A
        • Chen J
        • et al.
        State of palliative care services at US cancer centers: an updated national survey.
        Cancer. 2020; 126: 2013-2023
        • Hausner D
        • Tricou C
        • Mathews J
        • et al.
        Timing of palliative care referral before and after evidence from trials supporting early palliative care.
        Oncologist. 2021; 26: 332-340
        • Hawley P.
        Barriers to access to palliative care.
        Palliat Care. 2017; 101178224216688887
        • Kaasa S
        • Loge JH
        • Aapro M
        • et al.
        Integration of oncology and palliative care: a Lancet Oncology Commission.
        Lancet Oncol. 2018; 19: e588-e653
        • Center for Clinical Management Research
        Consolidated framework for implementation research.
        Center for Clinical Management Research, Ann Arbor2014 (Available from:) (Accessed February 7, 2021)
        • Keith RE
        • Crosson JC
        • O'Malley AS
        • Cromp D
        • Taylor EF
        Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation.
        Implementation Sci. 2017; 12: 15
        • National Cancer Institute
        NCI-Designated cancer centers.
        National Institutes of Health, Washington, DC2019 (Available from:) (Accessed October 11, 2021)
        • Kelley AS
        • Morrison RS.
        Palliative care for the seriously ill.
        N Engl J Med. 2015; 373: 747-755
        • Lupu D
        • Quigley L
        • Mehfoud N
        • Salsberg ES.
        The growing demand for hospice and palliative medicine physicians: will the supply keep up?.
        J Pain Symptom Manage. 2018; 55: 1216-1223
        • Hui D
        • Hannon BL
        • Zimmermann C
        • Bruera E.
        Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care.
        CA Cancer J Clin. 2018; 68: 356-376
        • Quill TE
        • Abernathy AP.
        Generalist plus specialist palliative care: creating a more sustainable model.
        N Engl J Med. 2013; 368: 1173-1175
        • Kamal AH
        • Bowman B
        • Ritchie CS.
        Identifying palliative care champions to promote high-quality care to those with serious illness.
        J Am Geriatr Soc. 2019; 67: S461-S467
        • Johnston G
        • Crombie IK
        • Davies HT
        • Alder EM
        • Millard A.
        Reviewing audit: barriers and facilitating factors for effective clinical audit.
        Qual Health Care. 2000; 9: 23-36
        • Rosenblum R
        • Huo R
        • Scarborough B
        • Goldstein N
        • Smith CB.
        Comparison of quality oncology practice initiative metrics in solid tumor oncology clinic with or without concomitant supportive oncology consultation.
        J Oncol Pract. 2018; 14: e786-e793
        • Patel TA
        • Jain B
        • Parikh RB.
        The enhancing oncology model: leveraging improvement science to increase health equity in value-based care.
        J Natl Cancer Inst. 2022; : djac194https://doi.org/10.1093/jnci/djac194
        • Earp MA
        • Sinnarajah A
        • Kerba M
        • et al.
        Opportunity is the greatest barrier to providing palliative care to advanced colorectal cancer patients: a survey of oncology clinicians.
        Curr Oncol. 2018; 25: e480-e485
        • McIlfatrick S
        • Slater P
        • Beck E
        • et al.
        Examining public knowledge, attitudes and perceptions towards palliative care: a mixed method sequential study.
        BMC Palliat Care. 2021; 20: 44