BackgroundThe communication process of preparing patients and families facing progressive neurodegenerative diseases for future illness has not been empirically elucidated; the goal of this qualitative study was to explore neurology interdisciplinary health professionals' communication experiences, including current approaches, facilitators, and challenges.MethodsThree focus groups were conducted with 22 clinicians representing a range of health professions from several multidisciplinary neurology outpatient clinics at a large academic medical center. A thematic analysis approach was used to develop a coding structure and identify overarching themes.ResultsNeurology clinicians highlighted that in their practice, (1) conversations are triggered by acute events and practical needs; (2) conversations occur routinely but are rarely documented; (3) loss of patient capacity and resultant surrogate decision-making can be ethically fraught, especially in times of family conflict; (4) prognostic uncertainty, unfamiliarity with disease trajectories, and patient or surrogate avoidance pose communication challenges; and (5) generalist- and specialty-level palliative care roles should be better defined.ConclusionsThere is a need for a systematic, structured approach to communication that can be applied early in the disease trajectory and considered when developing integrated neuro-palliative care programs.
208 Background: The American Society of Clinical Oncology practice guidelines recommend early palliative care integration for all patients with cancer. At UMass Memorial Medical Center from Sept. to Nov. 2020, only 16% (29/184) of patients on the inpatient oncology unit received a palliative care consultation. Of these consultations, 55% (16/29) were placed within 72 hours of admission. Results from a pre-pilot survey of nurses (n = 20) and providers (n = 14) about attitudes toward palliative care, team communication, and perceptions of barriers to palliative care consultation highlighted a lack of multidisciplinary communication and consensus on criteria for palliative care consultation. Methods: An evidence-based palliative care screening tool and multidisciplinary communication process was piloted to support team collaboration and early identification of oncology patients who may benefit from specialty-level inpatient palliative care. The primary objective was to increase the percentage of palliative care consultations placed within 72 hours of admission from 55% to 65%. Nurses screened patients upon unit arrival for palliative care needs. Patients who screened positive were discussed during daily multidisciplinary rounds, attended by the resource nurse, primary team, case manager and social worker. Results: In March 2021, the percentage of palliative care consultations placed by providers within 72 hours of inpatient admission increased to 68% (13/19). The proportion of patients who received palliative care consultation also increased to 29%. All the patients who screened positive for palliative care needs received a consultation. In a post-pilot survey of providers (n = 9) and nurses (n = 14), most providers (78%) reported that discussions of patients’ palliative care needs occurred more frequently during multidisciplinary rounds. A majority of nurses (57%) agreed the screening tool led to enhanced multidisciplinary communication. 63% of providers agreed that criteria for palliative care consultation was clearer as a result of the pilot; both nurse and provider perceptions of “lack of provider agreement on palliative care consultation criteria” as a barrier decreased compared to the pre-pilot survey. Although a majority of nurses (71%) found the screening tool easy to use, only half were comfortable with all the questions or understood them completely. All providers and 93% of nurses preferred to continue using the screening tool and communication process, and supported electronic medical record integration. Conclusions: The palliative care screening tool and workflow process had a positive impact on earlier identification of oncology patients who could benefit from specialty palliative care, and increased the total number of palliative care consultations. This improved process also enhanced team communication and collaboration. Next steps include refining the screening tool and EMR integration.
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