Bringing Palliative Care to More Patients

(HealthNewsDigest.com) – Though palliative care has proven benefits for managing symptoms and supporting well-being, many seriously ill patients do not have access to it because there are too few palliative care specialists. Primary palliative care has emerged as a new strategy for meeting core palliative care needs. With primary palliative care, generalist physicians develop the basic skills to assist patients and their families in numerous ways that do not require specialist consultation, such as discussing prognosis and goals of care and managing pain and other symptoms.

To help bring palliative care to more patients, The Hastings Center and the Society of Hospital Medicine have launched Improving Communication about Serious Illness—Implementation Toolkit, an online resource geared to hospitalists — physicians specializing in the general medical care of hospitalized patients — as well as nurses and other hospital clinicians.

The toolkit is the product of a two-year project, which received major funding from the Milbank Foundation and additional support from the Donaghue Foundation. The project was codirected by Nancy Berlinger, a Hastings Center research scholar, and Dr. Howard Epstein, of the Society of Hospital Medicine. Together the two organizations convened a hospitalist workgroup to explore needs, develop professional standards, and create tools to support practice. Mildred Z. Solomon, president of The Hastings Center, served as an investigator on an interprofessional team, which included leaders from the Association of Critical-Care Nurses, representing the bedside nurses who closely collaborate with hospitalists.

Hospital medicine is the fastest-growing medical specialty in the United States. Hospitalists are the physicians who direct most of the care for seriously ill adults in hospitals, especially community hospitals. “When we revised the landmark The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life, we wanted to make sure that this work reached those health care professionals who didn’t yet identify with palliative care or end-of-life care, but whose typical patients were seriously ill,” says Berlinger, who directed the Guidelines revision. “Hospitalists were our target audience. They are on the frontlines of serious illness care, but for them to be effective primary palliative care providers, they needed to weave these tasks into their normal work. And we needed to understand what they found ethically challenging, emotionally draining, or technically difficult about talking with patients about prognosis and goals.”