In this presentation, I share my experience implementing community-based models of cancer care, focusing on how we extend the principles of the Hospice-Focused Palliative Outcome Index (HFPOI) and the CUP Model (Context, User, Provider) into non-hospital settings. As a case manager with a psychology background, I work with patients and families who often experience fragmentation or isolation once they leave the hospital system.
We’ve adapted the CUP framework to connect institutional care with community support systems, faith-based organizations, local clinics, and peer-support groups, ensuring continuity of care across transitions. I describe how we identify early signs of spiritual, emotional, or existential distress and make timely referrals to social workers, spiritual counselors, or bereavement teams.
Using compassionate community principles, we aim to cultivate a sense of accompaniment throughout illness, death, and grief. I also highlight our use of Holistic Care Quality Assessment Scales for Patients and Families (HCQAS-P/F) to structure joint care plans and monitor needs at both individual and population levels.
HFPOI offers us a common language for collaboration and a flexible yet grounded framework that empowers whole-person and whole-family care beyond the hospital. Through this model, we reaffirm dignity, compassion, and cultural resonance in every phase of the cancer journey.
Keywords: Community-based cancer care, Compassionate communities, CUP Model, HFPOI, Holistic Care Quality Assessment (HCQAS)