Integrating Palliative Care to Promote Earlier Conversations and to Increase the Skill and Comfort of Nonpalliative Care Clinicians: Lessons Learned From an Interventional Field Trial

Abstract

While the uptake of palliative care in the United States is steadily improving, there continues to be a gap in which many patients are not offered care that explicitly elicits and respects their personal wishes. This is due in part to a mismatch of supply and demand; the number of seriously ill individuals far exceeds the workload capacities of palliative care specialty providers. We conducted a field trial of an intervention designed to promote the identification of seriously ill patients appropriate for a discussion of their goals of care and to advance the role of nonpalliative care clinicians by enhancing their knowledge of and comfort with primary palliative care skills. At 3 large Midwestern academic medical centers, a palliative care physician or nurse clinician embedded with a selected nonpalliative care service line or unit on a regularly scheduled basis for up to 6 months. Using agreed-upon criteria, patients were identified as being appropriate for a goals of care conversation; conversations with those patients and/or their families were then conducted with the palliative care specialist providing education, coaching, and mentoring to the nonpalliative care clinician, when possible. All of the sites increased the presence of palliative care within the selected service line or unit, and the nonpalliative care clinicians reported increased comfort and skill at conducting goals of care conversations. This intervention is a first step toward increasing patients' access to palliative care to alleviate distress and to more consistently deliver care that honors patient and family preferences.

Development and preliminary evaluation of a communication skills training programme for hospital physicians by a specialized palliative care service: the ‘Teach to Talk’ programme

“…These difficulties were similar with problems raised by the haematologists in our study, for instance, with regard to the appropriate time to communicate with patients regarding the turning point of an illness (e.g., the end of active treatment or disease leading to poor prognosis). An international trial by Szekendi et al [62] highlighted the impact of embedding a palliative care team with a selected non-palliative care service: non-palliative care physicians report an increase in comfort as well as in their skills in conducting care conversations.…”

Common Items on a Bucket List

“…Recent research has endorsed the importance of conducting goals-of-care conversations [5][6][7][8][9][10] in patients with chronic and serious illnesses as a vital part of the advance care planning process. However, patients may not have the requisite medical knowledge to understand the potential impact that their treatment choices may have on their life and life goals.…”

Shifting palliative care paradigm in primary care from better death to better end-of-life: a Swiss pilot study

“…Training and coaching of non-palliative care clinicians such as PCPs can increase the practice of palliative care for the patients. Trained PCPs identify more palliative patients than do untrained PCPs and the non-palliative care clinicians report increased comfort and skill at conducting goals of care conversations [ 27 ].…”