• Mary Lesperance, Robert Shannon, Phyllis K Pumphrey, Erin Dunbar, Renee Genther, C Lynn Coleman, Margaret Tabano, Jennifer Maurer, Adrienne Vazquez, Elizabeth Capp, Jessica McMillan, Katie Wilkerson, Gerald Robbins, Dorothy Green Phillips, Priscilla Howick, Catherine Solaun, Jeff Sloan, and Gerardo Colón-Otero.
• 1Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA.
• Am J Hosp Palliat Care. 2014 May 1;31(3):237-43.

AbstractPalliative care services are not available in most outpatient oncology practices. A program training 11 mid-level providers from oncology practices on advanced directive discussions and supportive symptom assessment and management performed by palliative care specialists was completed. A follow-up session 9 months later identified barriers to implementation. Of the 11 mid-level providers, 8 participated in the follow-up session, and 9 of the 11 providers implemented advanced directive's discussions and symptom assessment and management for patients with metastatic cancer. Main barriers included uncertainties about reimbursement, patients' lack of knowledge about palliative care, and lack of access to supportive services. This program successfully promoted advanced directive discussions and supportive/palliative care symptom assessment and management to community oncology practices, which will hopefully translate into improved quality of life for patients with metastatic cancer.

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