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3 Things All Clinicians Should Know About Palliative Care

Analysis  |  By Debra Shute  
   October 20, 2016

Patients with serious illness don't always get the help managing symptoms that they could, but broadened awareness and skills development throughout healthcare teams can help.

Palliative care specialists are expert in providing patients and their family members with relief from the symptoms, pain, and stress of a serious illness. Despite this seemingly narrow focus, however, the goals of palliative care are best achieved when all members of the healthcare team are well-informed.

End-of-Life Care in Hospitals Has a Long Way to Go

Here are three concepts about palliative care that all clinicians should understand.

1. Palliative care is not just for the dying.

The overwhelming majority of surveyed adults—about 80%—admit they don't know what palliative care means, according to R. Sean Morrison, MD, director of the Hertzberg Palliative Care Institute at the 1,171-bed Mount Sinai Hospital in New York City and director of the National Palliative Care Research Center.

"When you ask the same question of physicians, they say they know what it is, but they get it wrong because they equate it with hospice or end of life."

Palliative care encompasses much more than care provided during patients' final moments. Nonetheless, it's common for physicians to feel anxious that patients or family members may misinterpret a referral for palliative care, says Mohana Karlekar, MD, medical director of palliative care at Vanderbilt University Medical Center in Nashville, TN.

"I explain to patients and families that this specialty is focused on taking care of people who have a serious illness at any point in their life," she says.

"Some individuals are facing a brand-new diagnosis, others have been on treatment for some time, while other folks might be nearing the end of life."

Palliative care means maximizing a patient's quality of life through symptom control, or developing a plan of care consistent with a patient's values, also referred to as goals of care. Palliative care can also be considered in discharge planning for patients receiving hospice services.

2. Palliative care often occurs too late, if at all.

There is no universal, standardized screening for problems such as poorly controlled pain, repeat hospitalizations, or caregiver exhaustion that could trigger an evaluation for palliative care. Therefore, patients usually get this type of help (when it's available) later in the care trajectory than necessary.

"Right now, access to palliative care depends almost entirely on your treating physician thinking about making the referral," says Diane Meier, MD, FACP, a professor of geriatrics and palliative medicine at the School of Medicine at Mount Sinai in New York, NY.

"If your treating physician doesn't do that, you almost certainly will not access the care," says Meier, who is also director of the Center to Advance Palliative Care, which provides tools and training in palliative care.

Despite New Funding, Few Docs Discuss Advanced Care Planning

Another barrier to palliative care is the discomfort it elicits among clinicians not trained in the field, notes Karlekar.

"We're trying to create a culture change in which everyone understands that a goals-oriented conversation is important, and that these conversations happen throughout the disease trajectory, not just at the end of life. In this manner, treatment plans should better align with an individual's goals."

3. All clinicians need core palliative care skills.

There is a shortage of palliative care services in the U.S. because of limited residency slots in this relatively new field, among other reasons.

To help address the problem, experts advocate strongly for enhanced mid-career training in core palliative care skills, such as communication and pain management, for all clinicians. Vanderbilt, for example, has created a series of courses in these skills for its nurses and midlevel providers.

Educating the current workforce is just as important for health systems as building out formal palliative care programs, according to Morrison. What's more, these skillsets can benefit anyone involved in patient care.

"If you're 35 and come in with pneumonia, you'd like to know that the team taking care of you knows how to treat breathlessness," he says.

For more on palliative care integration across the care continuum, patient satisfaction, and quality improvement, attend the HealthLeaders Media webcast, Palliative Care to Drive Healthcare Value: Mount Sinai Hospital, on November 3, from 1PM to 2PM ET.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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