Abstract
Pancreatic cancer is a serious disease that often presents severe symptoms and significant care needs. Palliative care is a holistic approach that, when integrated early, has been shown to enhance patients' well-being. However, palliative care is often misunderstood and equated with end-of-life care, which creates barriers to its early integration. There are still many unanswered questions regarding how to achieve efficient early integration of this approach to care.
Approach: A collaborative quality improvement project was initiated and led by a palliative care consultation team in partnership with a surgical team at a large academic hospital. The aim of the project was to develop and test a practice for early integrated palliative care through consultations for patients with pancreatic cancer. This initiative followed a cyclical approach, involving regular follow-up meetings to evaluate its progress and adjust the practice as needed. The research team participated in and observed these follow-up meetings, and after the project concluded, they interviewed healthcare professionals, managers, and representatives from patient associations. This was done to gain insights into their views on the integration of palliative care, the factors influencing practice integration, and the overall impact.
Results: The core components of the quality improvement practice involved incorporating palliative care consultations into surgical standard care. These consultations included symptom assessments, care level evaluations, and guidance on navigating the healthcare system. The surgical clinical nurse specialist offered the patient the opportunity for a palliative care consultation at the time of the patient’s diagnosis. However, this presented a significant barrier to implementing the quality improvement practice, as discussing palliative care with patients who appeared relatively unaffected by their disease was considered a sensitive issue. Additionally, differing perspectives on integrating palliative care and individual roles influenced the practice's success. Organisational differences regarding who led palliative care provision within the two healthcare teams also played a role. It became clear that the quality improvement practice was not fully tailored to meet the specific needs of the patient population and could not adequately address gaps in the surrounding healthcare system.
Implications: On a micro level, healthcare practitioners must unpack their perspectives on central concepts and carefully assess organisational processes in conjunction with patients’ care needs. Involving patients in the development phase of such practices would be ideal. On a macro level, politicians and policymakers should develop clear guidelines that remain flexible enough to adapt to the specific needs of individual healthcare settings.