Introduction

Palliative care for cancer focuses on alleviating physical, psychological, emotional and/or spiritual burden throughout a person’s care pathway.1 Delayed access to palliative care can have a negative impact on outcomes for people with cancer and their caregivers.2 This remains a persistent issue in Norway, where people often have to travel considerable distances to access palliative care at larger hospitals.3 The Orkdal Hospital introduced an integrated clinic to combine cancer and palliative care in the Orkdal region.3 4 It employed a multidisciplinary team of cancer and palliative care specialists, who coordinated care with other healthcare professionals working in hospital and community settings. The integrated clinic increased access to and timely initiation of palliative care for people with cancer, thereby improving patient outcomes and also supporting caregiver wellbeing.3

 

Challenge

Palliative care aims to improve quality of life throughout a person’s care pathway.1 By using a person-centred approach, it can alleviate physical, psychological, emotional and/or spiritual burden. Early initiation of palliative care in cancer can improve satisfaction with care, reduce hospital admissions, relieve symptom burden and even prolong life.5 6

Delayed access to palliative care may limit people’s ability to self-manage symptoms and side effects linked to cancer and its treatment.2 As a result, people with advanced cancer may need to be hospitalised towards the end of their lives, even if they wish to remain at home with friends and family.

This is a persistent issue in Norway, where the number of home deaths is considerably lower than in other high-income countries.7 Many people with advanced cancer are treated in outpatient clinics or small community hospitals, where palliative care is often lacking.3 When people are referred to palliative care, they often have to travel considerable distances to a larger hospital.3

Solution

In 2012, Orkdal Hospital introduced an integrated clinic to combine cancer and palliative care for people in the region.3 People could be referred to the clinic by their general practitioner (GP) as well as staff at Trondheim University Hospital and Orkdal Hospital. The clinic employs oncologists and oncology nurses with experience in palliative care. They work closely with a physiotherapist, occupational therapist, chaplain, dietitian and social worker.3 This multidisciplinary team meets weekly to discuss and plan patient care, often coordinating with the internal medicine department, community-based nurses and regional cancer coordinator. Medical records from the clinic are routinely shared with GPs, and where relevant, also with community nurses, home care nurses and nursing homes.4

The clinic is equipped to provide chemotherapy, targeted therapy, blood transfusions and procedures to relieve pain and other symptoms.3 It is located next to the internal medicine department and community care emergency ward to promote further collaboration across different levels of care. The clinic’s oncologists and oncology nurses hold educational sessions on palliative care for healthcare professionals working in the hospital and community settings.3

What has been achieved

Cancer care at the clinic is led by one team with experience in both oncology and palliative care, including procedures to cure cancer, prolong life and relieve symptoms. For people with cancer, the clinic has meant that:

  • they spend less time travelling to access palliative care
  • they receive palliative care earlier in their care pathway
  • more people who want to die at home are able to do so.3

In addition, compared with standard care, caregivers of people who were treated in the integrated clinic have reported a better quality of life.3

Next Steps

The integrated clinic is involved in an ongoing trial in the Orkdal region, which aims to improve the quality of cancer and palliative care services.4 The trial includes a standardised care pathway between hospital and community settings, education on palliative cancer care for healthcare professionals, and accessible resources on palliative care for the general public, people with cancer and caregivers. It is expected to end in October 2021.4

Further information

References:

  1. World Health Organization. WHO Definition of Palliative Care. Available here: https://www.who.int/cancer/palliative/definition/en/ [accessed: January 2021]
  2. Beishon M. 2012. Stein Kaasa: Let me show you what integrated palliative care can do. [Updated 01/01/2012]. Available here: https://archive.cancerworld.net/cover-story/stein-kaasa-let-me-show-you-what-integrated-palliative-care-can-do/ [accessed: January 2021]
  3. Brenne A-T, Knudsen AK, Raj SX, et al. 2020. Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model. Pain and Therapy 9(1): 297-318
  4. Brenne A-T, Knudsen AK, Brunelli C, et al. 2014. The Orkdal model: Development, implementation, and evaluation of collaboration between specialist and community care within cancer palliative care. Journal of Clinical Oncology 32(31_suppl): 73-73
  5. Tartaglione EV, Vig EK, Reinke LF. 2018. Bridging the Cultural Divide Between Oncology and Palliative Care Subspecialties: Clinicians’ Perceptions on Team Integration. American Journal of Hospice and Palliative Medicine 35(7): 978-84
  6. Abernethy AP, Currow DC. 2011. Time for better integration of oncology and palliative care. Journal of oncology practice 7(6): 346-48
  7. Kjellstadli C. 2020. Dying at home in Norway: Health care service utilization in the final months of life. Bergen: Bergen Open Research Archive