Larry Beresford

The opportunities—and the imperatives—for the palliative care field to collaborate with other physicians, and with oncologists in particular, are detailed in an article I wrote for the latest issue of AAHPM’s Quarterly newsletter. The Academy is partnering with oncology groups on a number of fronts, including a joint project with the American Society of Clinical Oncology to test technological approaches for getting the latest palliative care research into the hands of working oncologists. The Academy was also represented at a recent meeting hosted by the American Cancer Society’s Cancer Action Network to talk about how to advocate for palliative care in Washington. This kind of collaboration increasingly points toward the largely uncharted realm of out-patient and community-based palliative care where many of the patients we want to reach receive their care from oncologists and other physicians.

As this article was being finalized, a similar exploration of the palliative-oncology interface was offered in a June audio-conference from the Center to Advance Palliative Care on “embedding palliative care in the oncology clinic” by palliative care leaders from Massachusetts General Hospital. These examples reflect the growing consensus that there simply won’t be enough trained, board-certified palliative care specialists to go around in a rapidly reforming healthcare system that is finally starting to recognize their intrinsic value for patients with serious illness.

Given current and anticipated hospice and palliative medicine workforce shortages, there needs to be some way to leverage this precious resource for maximum impact. And that would seem to demand better integration with other providers through a kind of two-tiered system of palliative care. Primary care physicians, oncologists, and other specialists would be oriented to the basics of providing palliative care for their patients, while cued to when a more specialized approach is needed via referral of their more difficult cases to palliative care specialists.

Oncology is a logical place to start experimenting with this approach, as the quarterly article describes. We’d love to hear how your palliative care program is pursuing greater integration with oncologists and other specialists and involving them in providing primary-level palliative care. Perhaps the next great arena for collaboration, coordination and integration is with the more than 30,000 hospitalists now practicing in U.S. hospitals. They, too, are centrally located to identify patients who need palliative care and to provide the palliative care basics for the majority of such patients.