Physicians from the New York City-based Memorial Sloan Kettering Cancer Center have shared insights on how to better manage care when an oncology patient transfers from the hospital to a skilled nursing facility setting. Their guidelines, which include strategies for addressing communication barriers between care teams and documenting patient progress expectations, were shared in an editorial published Sept. 3 in JCO Oncology Practice.
The authors are oncologist Daniel Lage, MD, palliative care physician Craig Blinderman, MD, and emergency medicine physician Corita Grudzen, MD.
The editorial is in response to a study published June 10 in JCO Oncology Practice in which researchers analyzed feedback from 37 physicians, nurses, physical therapists and social workers about the challenges they encounter when cancer patients are discharged to a skilled nursing facility.
The study identified four key concerns from the surveyed clinicians: oncology patients are often discharged to a skilled nursing facility when their prognosis is worsening, divisions within facilities and health systems create communication barriers, caregivers experience increased distress during care transitions, and communications over prognosis or treatment changes are limited due to patient-oncologist relationship.
In the editorial, Dr. Lage, Dr. Blinderman and Dr. Grudzen laid out prospective solutions on how to address oncology patients' transition to a skilled nursing facility setting.
"These are fundamentally system issues requiring system-based solutions, including better communication, prognostic assessment, and care coordination across multiple clinicians and care settings," they wrote.
Here are 10 recommendations from the editorial:
- Medical teams should discuss patient prognosis and the expected progress to be made or goal to be achieved at the skilled nursing facility before transition. Additionally, contingency plans should be put in place if progress or goals are not met by a certain time after transitioning to the skilled nursing facility.
- Rehabilitative progress metrics needed to be met for future cancer treatment eligibility should not only be discussed between the patient, caregiver and oncology team but also documented for the skilled nursing facility team.
- Similarly, documentation should be provided to the skilled nursing facility team if an oncologist believes harm from future cancer treatment outweighs potential benefits or believes the patient has a poor prognosis. This will allow palliative care or hospice conversations to occur more urgently.
- The resources available at a skilled nursing facility should be communicated to cancer patients before being transferred to give a "realistic expectation" of possible progress.
- Structured, asynchronous communication between oncology and skilled nursing facility teams should be established to promote clear, effective communication.
- Oncologists and palliative care clinicians can schedule, with hopeful reimbursement for, telehealth visits for patients in skilled nursing facilities.
- Care navigators can be trained to lead treatment coordination, expectations and communication between facilities.
- Skilled nursing facility teams should be trained and encouraged to identify and communicate lack of progress to an advanced cancer patient and their oncologist.
- AI can be utilized to identify patients who are not progressing and may need rehospitalization.
- Home-based care with telehealth visits should be considered as a discharge option to avoid multiple facility transfers near a patient's end of life.