When the Supportive Oncology Clinic (SOC) was in its forming stages over 35 years ago, its founders dreamed of a collaborative effort that would support palliative care in the Chicago area. Today, over 250 clinicians, educators, administrators, and visionaries from more than 25 institutions in the Chicagoland area work together to provide education, training, and oncology care to patients in need. From screening tools to training programs and clinician resources to improved efficiency in care, the SOC provides area medical professionals the opportunity for innovative oncology care.
"The collaborative was initially formed by inviting medical professionals across various institutions in the Chicagoland area to an exploratory meeting," noted Rosa Berardi, Senior Program Officer for The Coleman Foundation. "We initially invited 40 people, but others became aware of the gathering and interest grew to 80 people from 25 institutions at the first meeting.
"We began embarking on a completely new process for [SOC sponsor] The Coleman Foundation. As with most innovative projects, things didn't quite happen the way we thought they would, but the outcomes have been pleasantly surprising."
Since that first meeting, Berardi has seen the SOC and its partners continue to grow and learn by tapping into experts that work in the palliative and oncology fields.
"Though we were initially focused on process improvement regarding how best to deliver supportive oncology care, the wide range of knowledge we were able to tap into has allowed us to expand our idea of what the project would look like and all the activities that would happen," she stated.
Innovative Oncology Resources
Though the SOC has had over 30 projects on the table throughout its tenure, Berardi said that the team's advisory council and team of supporters quickly found that one of the most necessary projects was a screening tool for oncology patients.
"Institutions across the area were screening individuals, but in some cases they were not being screened appropriately and the results were not conclusive enough," she said. "We set off to develop a collaborative tool that went through 40 revisions, examined various other standards and screening tools, and brought all of the knowledge together to create a tool that contains all the care concerns a clinician should look at."
The resulting tool is used to identify issues and concerns related to oncology care, allowing clinicians to discover things that may be impacting care that might not otherwise be addressed.
"The screening tool helps to guide the conversation between the physician and the patient by asking supportive questions that could highlight transportation concerns, the patient's inability to get food, or other items that might impact care," Berardi said.
For clinicians using the tool, the advantages are unparalleled. "The Supportive Oncology Clinic's patient-driven screening tool allows clinicians to evaluate every single patient with cancer for signs of distress, whether it be physical, emotional, psychology, financial, or social," explained Stacie Levine, MD, Professor of Medicine and Chief in the Section of Geriatrics and Palliative Medicine at the University of Chicago.
"The tool can be incorporated into a busy ambulatory practice or a hospital. You don't need to be a physician or a medical provider to ask a patient to fill out the survey, and if it triggers some form of distress, the SOC created documents to advise clinicians on what to do next," she said. "For example, if a patient complains of nausea, the documents will advise on simple clinical interventions to support the patient. It will also determine when to refer, for example, to a psychosocial clinician or when to get a chaplain involved."
In total, there are more than 100 supporting documents that can be referenced, including a "take charge" brochure that provides caregivers with knowledge on what they should look for and things they can do to help, Berardi noted. Recent additions to the toolkit include patient handouts for various symptoms such as trouble breathing or constipation.
"The screening tool provides an opportunity for doctors to provide basic primary intervention, but it's also valuable for those providing primary-level palliative care out in the community, including primary care providers, nurse practitioners, physician assistants, clinicians in generalist clinics, dialysis centers, nursing homes, and anyone else taking care of older adults or people with some form of advanced illness, frailty, or cancer," Levine said.
"The synergistic education program and patient-level screening tools are for anyone in cancer practice who wants to learn how to screen someone for anything from financial distress to religious concerns; it tells you what questions to ask and what to do with the information once you have it."
Training Opportunities
In addition to the screening tool and document resources, the SOC offers 26 training modules covering a variety of oncology- and palliative-related topics appropriate for doctors, nurses, social workers, and more.
"In medicine today, it has become more challenging to see a large volume of patients," Levine said. "The complexity of oncology patients has changed over the years, largely related to the fact that we are developing new therapies to target cancer and people are fortunately living longer, but unfortunately developing comorbidities."
That growth in patients has been compounded by a large shortage of palliative care professionals and a low number of physicians with the subspecialty of palliative care, Berardi noted. "To combat that, [the SOC] brought together a collective group of doctors in the Chicagoland area who have a subspecialty in palliative care and developed a training program."
The training addresses the struggle in oncology to find a balance between a curative approach and symptom management.
"It's amazing to go to training sessions and see that there is still so much work that needs to be done for clinicians who are out there practicing every day," Berardi stated, such as a lack of palliative care and interdisciplinary teams at hospitals. "Palliative care begins at diagnosis, not the end of life. If it starts early in the diagnosis of cancer, patients will be able to manage better throughout the trajectory of care."
Levine noted that the training frames support oncology care as a dynamic process. "Through the training provided by the SOC, clinicians are focused on transitioning patients across all care settings, from the hospital to home, and following the patient along to monitor how they're feeling, the quality of life, and incorporating advanced care planning over time," she said.
4R Initiative
The latest training initiative out of the SOC is 4R-right information, right care, right patient, right time. "4R builds on the work we have put into patient care sequences and supportive cancer care," Berardi explained. "It allows the oncology team to work in an interdisciplinary way where the patient is part of the team. With 4R, the whole team is on the same page with any treatment or care event that needs to happen."
In this project management approach, the focus is on quality of care while streamlining health care resources to maximize efficiency. From the clinician perspective, the collaborative approach has provided opportunities to improve patient care beyond initial expectations.
"I cannot think of another program in the U.S. that has brought together such a wide variety of people with different strengths from different communities," Levine said. "I have met hundreds of people who are very mission-driven and have core values to improve the care of patients with cancer and want to impart knowledge on those who want to do the same, but don't have access to education and aren't sure how to drive change in their own practices."
In coming years, the SOC's goal is that patients are receiving the same level of care no matter what institution they're seen in, Berardi shared. "The 4F initiative we are embarking on is meant to level the playing field so that every patient is treated the same, regardless of the type of cancer they have, their economic status, or where they receive services."
The SOC has not only been a burgeoning initiative for patient care, clinician resources, and training opportunities, but an avenue to bring together all those practicing in oncology.
"It's been both exciting and amazing the way this initiative has evolved and the way people have been open to working together," Berardi noted. "It's not just one institution or one individual coming up with a plan for how to solve cancer care, but all of us working together to lift up the care for cancer patients by inspiring each other to work harder and better."
The Supportive Oncology Clinic screening tool, follow-up documents, and training opportunities are available for free on its website, https://www.supportiveoncologycollaborative.org/.
Kelly Wolfgang is a contributing writer.
PCHETA Legislation Aims to Improve Palliative Care
H.R.647, the Palliative Care and Hospice Education and Training Act (PCHETA), was introduced late last year to provide funding and infrastructure to address the areas of education, awareness, and research in the field.
"PCHETA would increase federal research funding for palliative care while also establishing and working to standardize palliative care education and training programs for doctors, nurses, caretakers, and other health professionals to build a robust workforce dedicated to palliative care," noted Keysha Brooks-Coley, Vice President of Federal Advocacy with the American Cancer Society Cancer Action Network. The legislation would arm clinicians to be able to provide better coordinated care and improve quality of life for patients receiving treatment for a serious illness like cancer.
Brooks-Coley noted that PCHETA passed the House of Representatives with overwhelming support last year and received significant bipartisan support in both houses of Congress. Currently, H.R.647 has 124 bipartisan cosponsors, with more members expected to agree to cosponsor the bill. H.R.647 supporters are working with Senate champions to get PCHETA reintroduced and taken up by the Committee on Health, Education, Labor and Pensions quickly after reintroduction. To learn more about the bill, visit the Patient Quality of Life Coalition website at http://patientqualityoflife.org/.
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