10023- COT-4 THE LANDSCAPE OF REGIONAL COLLABORATION OF MEDICAL NETWORK IN SUPPORTIVE CARE FOR BRAIN TUMOR PATIENTS

Abstract The physical and mental burden suffers patients and their families in the treatment of malignant brain tumors, which needs close collaboration and intervention by multiple local medical professionals. What both patients and their families want to know is “prognosis,” and healthcare providers need to promptly integrate the information obtained through Advanced Care Planning for patients and their families, identify physical and social problems, and prepare for a quick and smooth transition from core hospital to home health care or local hospital. In our hospital, many professionals participate in the grand conference of Department of Neurosurgery to understand patient’s condition and share goals and challenges interactively. Attending physicians hold ward conferences twice a month with the nurses to share information on the patient’s treatment plan, general condition, discharge issues, and family background. At the same time, while setting a discharge date with the nurses at the patient support center, preparations are made from various angles regarding the patient’s issues and necessary home care support. It should be noted that the attending physician here is also engaged in home health care, enabling close and intimate collaboration between the university hospital and the local community. We report here how we are making a seamless transition from center hospital to community medical network collaboration, based on our clinical experience.