Future of the Palliative Care Workforce: Preview to an Impending Crisis

Kamal, Arif H.; Bull, Janet; Swetz, Keith M.; Wolf, Steven; Shanafelt, Tait D.; Myers, Evan R.

doi:10.1016/j.amjmed.2016.08.046

Cited by 188 publications

(112 citation statements)

References 2 publications

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“…A survey of palliative care clinicians by the American Academy of Hospice and Palliative Medicine revealed that almost half intend to leave the field by 2023 secondary to retirement, burnout, and dissatisfaction with organization/practice. [18] Current estimates reveal 6600 board-certified palliative care physicians in practice and fewer than 250 fellowship-trained physicians entering the field every year. [18] There is a cap on the number of CMS-funded graduate medical education positions, leaving programs to rely on philanthropy and other mechanisms to fund palliative care fellows.…”

Section: Cancer and Palliative Care Workforcementioning

confidence: 99%

“…[18] Current estimates reveal 6600 board-certified palliative care physicians in practice and fewer than 250 fellowship-trained physicians entering the field every year. [18] There is a cap on the number of CMS-funded graduate medical education positions, leaving programs to rely on philanthropy and other mechanisms to fund palliative care fellows. [19] The projected shortage of palliative care physicians to meet the current demands is substantial.…”

Section: Cancer and Palliative Care Workforcementioning

confidence: 99%

“…In addition, similar shortages in advanced practice providers, nurses, chaplains, and social workers trained in palliative care are predicted. [18]…”

Section: Cancer and Palliative Care Workforcementioning

confidence: 99%

See 2 more Smart Citations

Cancer and palliative care in the United States, Turkey, and Malawi: Developing global collaborations

Walker

Edwards

Bağçıvan

et al. 2017

Asia-Pacific Journal of Oncology Nursing

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As the global cancer burden grows, so too will global inequities in access to cancer and palliative care increase. This paper will describe the cancer and palliative care landscape relative to nursing practice, education, and research, and emerging global collaborations in the United States (U.S.), Turkey, and Malawi. It is imperative that nurses lead efforts to advance health and strengthen education in these high-need areas. Leaders within the University of Alabama at Birmingham School of Nursing, through a Pan American Health Organization/World Health Organization Nursing Collaborating Center, have initiated collaborative projects in cancer and palliative care between the U.S., Turkey, and Malawi to strengthen initiatives that can ultimately transform practice. These collaborations will lay a foundation to empower nurses to lead efforts to reduce the global inequities for those with cancer and other serious and life-limiting illnesses.

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Section: Cancer and Palliative Care Workforcementioning

confidence: 99%

Section: Cancer and Palliative Care Workforcementioning

confidence: 99%

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Cancer and palliative care in the United States, Turkey, and Malawi: Developing global collaborations

Walker

Edwards

Bağçıvan

et al. 2017

Asia-Pacific Journal of Oncology Nursing

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“…Improving integrated PC is critical because there are limited PC fellowship training programs for physicians in the US, with fewer than 250 graduates per year and an estimated shortage of 18,000 PC physicians [3]. To address the need for more integrated PC, many leaders, academics, and organizations have called for the institution of high-quality PC across the health care spectrum.…”

Section: Improving Palliative Care Deliverymentioning

confidence: 99%

“…PC clinicians are tasked with reducing the suffering of these patients and face daily challenges, such as treating patients with intractable pain, facilitating end-of-life (EOL) decision making, and collaborating with other health care specialists to ensure that PC is sufficiently integrated [2]. A recent survey found that PC physicians who were planning to leave the profession commonly cited burnout or dissatisfaction with their organization or practice as the reason [3], and another study found that high moral distress is linked to clinicians' intentions to leave their current position [4]. Moral distress has been described as "one or more negative self-directed emotions or attitudes that arise in response to one's perceived involvement in a situation that [one] perceives to be morally undesirable" [5].…”

Section: Introductionmentioning

confidence: 99%

Strategies for Promoting High-Quality Care and Personal Resilience in Palliative Care

Heinze

Holtz

Rushton³

2017

AMA Journal of Ethics

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Palliative care (PC) clinicians are faced with ever-expanding pressures, which can make it difficult to fulfill their duties to self and others and lead to moral distress. Understanding the pressures that PC clinicians face and the resources that could be employed to ease their moral distress is crucial to maintaining a healthy PC workforce and to providing necessary PC services to patients. In this paper, we discuss recommendations related to two promising pathways for supporting PC clinicians in providing high-quality PC: (1) improving systemic PC delivery and (2) strategies to promote ethical practice environments and individual resilience. Enacting these recommendations holds promise for sustaining higher-quality and accessible PC and a more engaged PC workforce. IntroductionPalliative care (PC) clinicians are faced with ever-expanding pressures, which can make it difficult to fulfill their duties to self and others. In 2008, more than 90 million Americans were living with serious illness, and this number was projected to double in 25 years [1]. PC clinicians are tasked with reducing the suffering of these patients and face daily challenges, such as treating patients with intractable pain, facilitating end-of-life (EOL) decision making, and collaborating with other health care specialists to ensure that PC is sufficiently integrated [2]. A recent survey found that PC physicians who were planning to leave the profession commonly cited burnout or dissatisfaction with their organization or practice as the reason [3], and another study found that high moral distress is linked to clinicians' intentions to leave their current position [4].

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Patient and Family Outcomes of Community Neurologist Palliative Education and Telehealth Support in Parkinson Disease

Kluger,

Katz,

Galifianakis

et al. 2024

JAMA Neurol

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ImportanceParkinson disease and related disorders (PDRD) are the fastest growing neurodegenerative illness in terms of prevalence and mortality. As evidence builds to support palliative care (PC) for PDRD, studies are needed to guide implementation.ObjectiveTo determine whether PC training for neurologists and remote access to a PC team improves outcomes in patients with PDRD in community settings.Design, Setting, and ParticipantsThis pragmatic, stepped-wedge comparative effectiveness trial enrolled and observed participants from 19 community neurology practices supported by PC teams at 2 academic centers from March 8, 2017, to December 31, 2020. Participants were eligible if they had PDRD and moderate to high PC needs. A total of 612 persons with PDRD were referred; 253 were excluded. Patients were excluded if they had another diagnosis meriting PC, were receiving PC, or were unable or unwilling to follow study procedures. Patients received usual care or the intervention based on when their community neurologist was randomized to start the intervention. Data were analyzed from January 2021 to September 2023.InterventionThe intervention included (1) PC education for community neurologists and (2) team-based PC support via telehealth.Main Outcomes and MeasuresThe primary outcomes were differences at 6 months in patient quality of life (QOL; measured by the Quality of Life in Alzheimer Disease Scale [QOL-AD]) and caregiver burden (Zarit Burden Interview) between the intervention and usual care.ResultsA total of 359 patients with PDRD (233 men [64.9%]; mean [SD] age, 74.0 [8.8] years) and 300 caregivers were enrolled. At 6 months, compared with usual care, participants receiving the intervention had better QOL (QOL-AD score, 0.09 [95% CI, −0.63 to 0.82] vs −0.88 [95% CI, −1.62 to −0.13]; treatment effect estimate, 0.97; 95% CI, 0.07-1.86; P = .03). No significant difference was observed in caregiver burden (Zarit Burden Interview score, 1.19 [95% CI, 0.16 to 2.23] vs 0.55 [95%, −0.44 to 1.54]; treatment effect estimate, 0.64; 95% CI, −0.62 to 1.90; P = .32). Advance directive completion was higher under the intervention (19 of 38 [50%] vs 6 of 31 [19%] among those without directives at the beginning of the study; P = .008). There were no differences in other outcomes.Conclusions and RelevancePC education for community neurologists and provision of team-based PC via telehealth is feasible and may improve QOL and advance care planning. Overall treatment effects were small and suggest opportunities to improve both the intervention and implementation.Trial RegistrationClinicalTrials.gov Identifier: NCT03076671

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Future of the Palliative Care Workforce: Preview to an Impending Crisis

Cited by 188 publications

References 2 publications

Cancer and palliative care in the United States, Turkey, and Malawi: Developing global collaborations

Cancer and palliative care in the United States, Turkey, and Malawi: Developing global collaborations

Strategies for Promoting High-Quality Care and Personal Resilience in Palliative Care

Patient and Family Outcomes of Community Neurologist Palliative Education and Telehealth Support in Parkinson Disease

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