The Cancer Plan

Expand Access to Palliative  and Support Care 

 

Cancer care isn’t just about treatment—it’s about quality of life. Palliative care focuses on relieving pain, managing symptoms, supporting families, and improving comfort for people with serious illnesses, including cancer. It can begin at diagnosis and continue throughout treatment—not just at the end of life.

The Georgia Cancer Plan aims to ensure that every Georgian—regardless of where they live—has access to high-quality palliative care services when they need them.

Background

Palliative care is an approach to patient, family, and caregiver-centered healthcare that focuses on optimal management of serious illness, such as cancer. Palliative care focuses on improving the quality of life and alleviating the symptoms of an illness while helping patients and caregivers understand their treatment choices. Palliative care aims to provide a heightened quality of life by incorporating psychosocial and spiritual care that parallels the patient’s values, needs, and cultures. 1

Integrating palliative care into routine cancer care can lead to better patient and caregiver outcomes by mitigating symptoms, improving quality of life, lessening caregiver burden, and improving survival. 2 Palliative care differs from facility to site. Additionally, palliative care access is not equal and universal to all.

Disparities, especially along racial and socioeconomic lines, continue to affect fair access to and use of palliative care negatively.

Several factors contribute to access, including the type of hospital that a patient can access, the geography and location of the hospital/care center, and the patient’s race, ethnicity, and socioeconomic background. 3

The value of palliative care and its recognition as a necessary part of medical and end-of-life care has grown in recent years. The National Comprehensive Cancer Network (NCCN), American Academy of Hospice and Palliative Medicine (AAHPN), the Commission on Cancer (CoC), and the American Society of Clinical Oncology (ASCO) all offer guidance on standards of palliative care, which include some of the following elements. 4

  • All cancer patients are to be screened for palliative care needs at their initial visit, at appropriate intervals, and when determined clinically necessary. The time to start palliative care is as soon as a patient’s cancer becomes advanced.
  • Institutions and facilities should develop processes and policies for integrating palliative care into cancer care as part of usual oncology care for patients with specialty palliative care needs.
  • Palliative care should include relationship building with patients and their caregivers; symptom management including (but not limited to) nutrition assistance, pain management, clarification of treatment goals, support of coping needs, and assistance with medical decision-making through collaboration with the patient and other care providers.
  • Palliative care specialists and interdisciplinary palliative care teams, including board-certified palliative care physicians, advanced practice nurses, physician assistants, social workers, chaplains, and pharmacists, should be readily available to provide consultative or direct care to patients/ families/caregivers and/or health care professionals who request or require their expertise.
  • Quality of palliative care should be monitored by institutional quality improvement programs that focus on improving access to on-site and off-site palliative care services, having a policy or procedure in place regarding palliative care services that includes all the elements of quality palliative care, and a process for providing and referring palliative care services to patients that are monitored, evaluated, and reviewed for improvement at regular intervals.

    Objectives

    Objective 1

    Comprehensively document and monitor the landscape of oncological palliative care in Georgia.

    Objective 2A

    Improve clinician awareness, skills, and use of oncological palliative care best practices and quality standards.

    Objective 2B

    Increase patient knowledge and awareness about oncological palliative care best practices and quality standards, focusing on burdened, underserved, and vulnerable populations.

    Objective 3

    Improve access to palliative oncological care and services for adults and children living in underserved communities in Georgia.

    Strategies

     

    Strategy

    Strategic Actions

    Target Populations

    Key Collaborators

    Ensure Quality Data and Continuous LearningDevelop and maintain a palliative care resource inventory to better understand the baseline of palliative care services in GA so that areas with inadequate access can be addressed. To be available in multiple languages.The whole state of GA, but the result will show where (geographically) access to Palliative Care is lacking.
    • Winship at Emory
    • GHPCO
    • Georgia Center for Oncology Research and Education (GA CORE)
    • Piedmont Health Systems
    • WellStar Health Systems
    • Georgia Health Care Association (GHCA)
    Broaden Awareness and EngagementImprove access to palliative care resources and education for cancer patients and their families.All Georgians will focus on low socioeconomic status peoples, immigrants, non- English speaking, Black/AA and Latinx communities.
    • Winship at Emory
    • Piedmont Health Systems
    • WellStar Health System
    Improve Provider Education, Clinical Training and Practice

    Utilize ECHO to its fullest potential to educate, connect, and track involvement by contacting big health systems/organizations (DPH, WellStar, Winship, etc.) to promote ECHO meetings.

    Encourage the identification/ Increase in the number of interprofessional palliative care providers.

    		Interdisciplinary professionals, patients, organizations, and institutions in Georgia.
    • Winship at Emory
    • Piedmont Health Systems
    • WellStar Health Systems
    • Georgia Department of Public Health
    Facilitate Policy Action and Advocacy

    Collaborate with health insurers and legislators to increase the number of Georgians whose insurance covers x services or covers the standard of care for palliative care.

    Improve telemedicine as a point of access.

    		Medical/ clinical professionals in Georgia, legislators, and community leaders.
    • Georgia Medical Directors Association (GMDA)

     

    Measures

     

    5 Year Success Measure

    Baseline Values

    Target Values

    A completed “heat map” that shows where there are disparities in terms of access to care.*Not applicable (N/A)A completed heatmap representation of the state of palliative care in Georgia based on where palliative care providers and facilities are available.
    Creation of a website/resource that lists all existing Palliative Care providers in the state, with the resource available in the top 3 most frequently spoken languages in GA (English, Spanish, KoreanNot applicable (N/A)A completed searchable dashboard/website that contains all the palliative care providers and centers in the state of GA, which is translatable/available in 3 languages (English, Spanish, Korean).
    Tracking attendance (i.e., people who show up consistently, newcomers, demographic data, etc.) to ECHO meetings.*Not applicable (N/A)A tracking sheet that contains ECHO attendance data.
    Pre/Post surveys will be used to gauge whether the ECHO training is effective.*Not applicable (N/A)Surveys distributed to ECHO attendees that ask questions relevant to the training, how participants heard about ECHO, etc.
    Number of new presenters (and demographics).*Not applicable (N/A)Number of new speakers and their demographic information.
    Number of activities/events focusing on these communities and attending events/seminars.*Not applicable (N/A)To Be Determined (TBD)
    Number of hits/metrics on social media for community events.*Not applicable (N/A)To Be Determined (TBD)
    Communications/partnership with the Composite Medical Board (CMB) to advocate for expanding telemedicine for palliative care.Not applicable (N/A)A solidified partnership or working agreement with the CMB that centers on expanding telemedicine for palliative care.
    The number of providers increased (%) (baseline comparison to end-of-cycle comparison).1.9 certified prescribing palliative care providers (MDs or APRNs) per 100,000 residents in GATo Be Determined (TBD)

     

    1. S. Department of Health and Human Services, National Institute on Aging. (2021, May 14). What Are Palliative Care and Hospice Care? Retrieved August 24, 2023, from https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care.
    2. Dans, , Kutner, J. S., Agarwal, R., Baker, J. N., Bauman, J. R., Beck, A. C., Campbell, T. C., Carey, E. C., Case, A. A., Dalal, S., Doberman, D. J., Epstein, A. S., Fecher, L., Jones, J., Kapo, J., Lee, R. T., Loggers, E. T., McCammon, S., Mitchell, W., Ogunseitan, A. B., … Campbell, M. (2021). NCCN Guidelines® Insights: Palliative Care, Version 2.2021. Journal of the National Comprehensive Cancer Network: JNCCN, 19(7), 780–788. https://doi.org/10.6004/jnccn.2021.0033
    3. American Cancer Society, Cancer Action Network. (2021, February 4). Disparities in Palliative Care. Retrieved on August 24, 2023, from https://fightcancer.org/sites/default/files/ Disparities%20in%20Access%20to%20Palliative%20Care%2020th%20Anniversary_.pdf.
    4. American College of Surgeons. (2023). Optimal Resources for Cancer Care: 2020 Standards. Retrieved on August 24, 2023, from https://facs.org/quality- programs/cancer-programs/commission-on-cancer/standards-and-resources/2020/.

      * There is a dearth of publicly available data to measure palliative care. This plan aims to generate a baseline for measurement, which can be reported and measured in the future.