Table 1.

Components of Office-Based Primary Oncology Palliative Care

Ask, tell, ask. Always ask people how much they want to know, and what they do know. Then tell them, in understandable words. Ask “What is your understanding of your situation now, after our discussion? What are some key points you take away from our conversation?” At each transition point (when changing treatments or prognosis) ask, “What are you hoping for?” and “What is your understanding of your situation?” Always do a symptom assessment. At least some of the time, do a spiritual assessment. Make a hospice information referral when the patient still has 3-6 months left to live. Audit hospice referrals, as QOPI does. Set up best practices for seriously ill patients who have less than 1 year to live. Take advantage of decision aids to provide accurate prognosis to patients who want to know their prognosis. Use some palliative care “pearls” in your practice, such as olanzapine for nausea, ginger for nausea and fatigue, and dexamethasone for fatigue and better quality of life.

Abbreviation: QOPI, Quality Oncology Practice Initiative.