This month’s Journal of Oncology Practice features a special series of articles on palliative care and end-of-life issues in the oncology practice setting. Articles explore the integration of palliative care services in ambulatory settings; unique delivery mechanisms for palliative care; the impact of public policy and reimbursement on palliative care services; measurement of outcomes and quality measures; and more. Articles of interest include:

• Documentation and Discussion of Preferences for Care among Patients with Advanced Cancer: In a prospective study, researchers explored the frequency, timing and the documentation of conversations about end-of-life preferences between physicians and patients with advanced cancer, to identify patterns of palliative care and hospice use at a Veterans Administration facility in Los Angeles. They found that the majority of patients had some documentation of care preferences recorded. In addition, more than half of all patients and almost three-quarters of decedents had a palliative care consultation. However, just 47 percent of patients had a formal advance directive documented in their medical records – a rate higher than other previous studies have reported, but one that still leaves opportunity for improvement. Researchers concluded that physicians may benefit from more prompts to advise patients about appropriate palliative care services earlier in the course of their care, and that future efforts should focus on developing alternatives to formal advance directives that would help improve documentation of specific patient preferences.
• Palliative Care Needs of Patients with Cancer Living in the Community: The authors of this study explore palliative care needs of patients with advanced cancer who are treated in the community setting and are not yet ready to transition to hospice care. They identified several important gaps in care, including the management of severe symptoms, development of advanced directives, and identification of healthcare surrogates. The authors conclude that early palliative care intervention could improve outcomes, but will require a clearer understanding of this population’s needs and greater care coordination between inpatient and outpatient settings, and between oncologists and palliative care providers.
• Building on Individual State, and Federal Initiatives for Advance Care Planning, an Integral Component of Palliative and End-of-Life Cancer Care: Researchers explore recent federal and state policies that focus on advance care planning and suggest care delivery improvements and solutions to overcome barriers to quality end-of-life care. They describe examples of legislation in New York and Massachusetts that empower patients to engage in advance care planning, uphold patient autonomy and support optimal care delivery. The writers also urge a greater emphasis on doctor-patient communication as part of medical training, as a way to ensure that care aligns with patients’ individual goals and preferences.