Palliative Care
1. Are the Palliative Care Unit and hospice frequently overcapacity? The PCU is always full (beds are filled with off service patients if there is no palliative patient needing the bed), but if you call the palliative physician on call, we can at least have these patients on our radar and transfer them to our unit if appropriate (the beds frequently turnover) or see in consultation if MRP agrees. Also, the palliative physician on call may be aware of a bed at Hospice that may be able to access urgently a patient actively dying in the ED.
2. How big of a deal is hospice registration for getting patients seen both as inpatients or outpatients? Not necessary and no big deal at all. Call the palliative care physician on call or fill out the community referral form for any patient who you think could use our services, regardless of hospice registration.
3. For referral to the Pain and Symptom Management Clinic, do these patients all have to have cancer and be on active treatment? Yes, these patients must all have cancer and therefore have a BC cancer agency ID. There are situations where the PSMPC can see patients without a cancer agency ID if they have not yet been registered (recent cancer diagnoses), but this is done on a case-by-case basis. And no, they do not need to be on active treatment.
4. Can patients who have the likely diagnosis of cancer but no tissue diagnosis be seen at the PSMPC before a biopsy has been done? Ideally, order for the appropriate biopsy to be done after ED visit, and have these patients follow up with UMAC (or take the thoracics route for lung masses). If these patients have poorly controlled symptoms like pain or nausea not managed primary care provider, you can also fill out a community referral form for consideration of being seen at the PSMPC vs. seen by a palliative physician in the community etc. so we can concurrently manage these issues while they are waiting to be seen by oncology.
5. Should I be filling out palliative care benefit forms for palliative patients? Usually, no. Palliative care benefits is a form of pharmacare (i.e. Plan P) and will help patients get medications, equipment and services covered, but this can usually be done by primary care, and will not be a barrier to care from the palliative team either in hospital or in the community.
6.When would a liaison nurse consult be a better option than a community palliative referral? If a patient has symptoms that are usually controlled and would benefit from nursing oversight or other supports in the home, consult the liaison nurse. Home care nursing can always request a palliative physician consult in the community or refer to the BC Cancer Pain and Symptom Management Clinic (PSMPC) as they see fit. If you are certain they would benefit from a palliative physician consult or care through the PSMPC, please fill out the community referral form.