A National Survey of Palliative Care Team Compositions

Purpose: It is unclear how well palliative care teams are staffed at US cancer centers. Our primary objective was to compare the composition of palliative care teams between National Cancer Institute (NCI)-designated cancer centers and non-NCI-designated cancer centers in 2018. We also assessed changes in team composition between 2009 and 2018. Methods: This national survey examined the team composition in palliative care programs at all 61 NCI-designated cancer centers and in a random sample of 60 of 1252 non-NCI-designated cancer centers in 2018. Responses were compared to those from our 2009 survey. The primary outcome was the presence of an interprofessional team defined as a palliative care physician, nurse, and psychosocial member. Secondary outcomes were the size and number of individual disciplines. Results: In 2018, 52/61 (85%) of NCI-designated and 27/38 (71%) non-NCI-designated cancer centers in the primary outcome comparison responded to the survey. NCI-designated cancer centers were more likely to have interprofessional teams than non-NCI-designated cancer centers (92% vs 67%; P = .009). Non-NCI-designated cancer centers were more likely to have nurse-led teams (14.8% vs 0.0%; P = .01). The median number of disciplines did not differ between groups (NCI, 6.0; non-NCI, 5.0; P = .08). Between 2009 and 2018, NCI-designated and non-NCI-designated cancer centers saw increased proportions of centers with interprofessional teams (NCI, 64.9% vs 92.0%, P < .001; non-NCI, 40.0% vs 66.7%; P = .047). Conclusion: NCI-designated cancer centers were more likely to report having an interprofessional palliative care team than non-NCI-designated cancer centers. Growth has been limited over the past decade, particularly at non-NCI-designated cancer centers.

Download Full-text

An Active In-Home Physician Model of Palliative Care and Its Resulting Performance Indicators Related to Home Deaths, Unplanned Emergency Department Visits and Unplanned Hospital Admissions

Journal of Palliative Care ◽

10.1177/0825859720951368 ◽

2020 ◽

Vol 36 (1) ◽

pp. 46-49

Author(s):

Colleen Webber ◽

Aurelia Ona Valiulis ◽

Peter Tanuseputro ◽

Valerie Schulz ◽

Tavis Apramian ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Hospital Admissions ◽

Case Series ◽

Palliative Care Team ◽

Emergency Department Visits ◽

Care Team ◽

Retrospective Case ◽

Palliative Care Teams ◽

Unplanned Hospital Admissions

Background: Limited research has characterized team-based models of home palliative care and the outcomes of patients supported by these care teams. Case presentation: A retrospective case series describing care and outcomes of patients managed by the London Home Palliative Care Team between May 1, 2017 and April 1, 2019. Case management: The London Home Palliative Care (LHPC) Team care model is based upon 3 pillars: 1) physician visit availability 2) active patient-centered care with strong physician in-home presence and 3) optimal administrative organization. Case outcomes: In the 18 month study period, 354 patients received care from the London Home Palliative Care Team. Most significantly, 88.4% ( n = 313) died in the community or at a designated palliative care unit after prearranged direct transfer; no comparable provincial data is available. 21.2% ( n = 75) patients visited an emergency department and 24.6% ( n = 87) were admitted to hospital at least once in their final 30 days of life. 280 (79.1%) died in the community. These values are better than comparable provincial estimates of 62.7%, 61.7%, and 24.0%, respectively. Conclusion: The London Home Palliative Care (LHPC) Team model appears to favorably impact community death rate, ER visits and unplanned hospital admissions, as compared to accepted provincial data. Studies to determine if this model is reproducible could support palliative care teams achieving similar results.

Download Full-text

Supportive care day hospital: A new tool for palliative care in cancer centers.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.170 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 170-170

Author(s):

Carole Bouleuc

Keyword(s):

Palliative Care ◽

Home Care ◽

Supportive Care ◽

Palliative Care Team ◽

Care Team ◽

Care Plan ◽

Day Hospital ◽

Cancer Centers ◽

Advance Care ◽

At Home

170 Background: In May 2005, the Curie Institute in Paris opened the first supportive care day hospital in France. This type of new ward is now very frequent in the French comprehensive cancer centers. Methods: Patients are managed by the palliative care team with a two-part team of a physician and a nurse in order to address their supportive care needs: advanced-care symptoms, psychosocial distress, medical questions and concerns, support need in decision making, end of life care preference and advance care plan when patients or caregivers when needed. Depending of the needs identified by the palliative care team assess, at least 2 of the following healthcare professionals will intervene: oncologist, pain physician, psycho-oncologist, dietitician, social worker, physiotherapist. Coordination with the home care team takes systematically place (with general practitioner, nurse and home palliative care team). New symptoms occurrence are explored with biological test or radiographic examination when necessary. Medical procedures are sometimes performed like venous perfusion therapy, blood transfusions, or draining effusion after ultrasonic tracking. It is possible to offer the patient hypnosis, relaxation or sophrology consultation. Eventually at the end of the in-patient stay, the patient is given a medical synthesis with therapeutic recommendations and personalized care plan. 1 Physician and two nurses are needed to manage 4 patients every day. Results: In 2016 we have admitted 350 patients and performed 948 stays in our supportive rand 55% of them have breast cancer. Median survival since the first day at supportive care day hospital is 65 days. Death at home occurred in 15% of patients and in hospice for 62%. Home death is more often when patients don’t have any dyspnea are included in a home palliative care network and when they receive the last chemotherapy more than 30 days before death. More date will be shown. Conclusions: Supportive care day hospital is really a good tool for integrated palliative care, promoting collaboration with oncologists, coordination with home care teams, and advance care planning, so that patients can longer stay at home as they often hope so.

Download Full-text

Integration of spiritual care into palliative care service delivery models

10.1093/med/9780198821328.003.0101 ◽

2021 ◽

pp. 1072-1080

Author(s):

Yvan Beaussant ◽

Alexandra Nichipor ◽

Tracy A. Balboni

Keyword(s):

Palliative Care ◽

Spiritual Care ◽

Care Delivery ◽

Palliative Care Team ◽

Care Team ◽

Clear Understanding ◽

Care Provision ◽

Serious Illness ◽

Palliative Care Teams ◽

Religious Dimensions

Addressing spirituality within serious illness is a core dimension of palliative care delivery. However, spiritual care frequently lacks integration within the care of patients and families facing serious illness. This chapter discusses the integration of spiritual care into palliative care delivery. Requisite to this integration is a clear understanding of definitions and palliative care guidelines informing spiritual care provision. Furthermore, integration is informed and motivated by a large body of evidence showing how spiritual and religious factors frequently play salient roles in serious illness and influence palliative care outcomes. The integration of spiritual care into palliative care practice relies on a generalist–specialist model, within which all members of the interdisciplinary palliative care team are responsible for spiritual care provision. Non-spiritual care specialist members of the palliative care team are responsible for generalist spiritual care delivery, including taking spiritual histories and screening for spiritual needs. The care team also includes spiritual care specialists, typically board-certified chaplains, who provide in-depth spiritual care delivery to patients and families and aid the care team in understanding the spiritual and religious dimensions of care. Additionally, data regarding tested spiritual care interventions are discussed as potential tools palliative care teams can employ to improve patient care and outcomes. Finally, the integration of spiritual care into palliative care teams presents both opportunities and challenges that must be considered as efforts needed to foster more seamless spiritual care delivery within palliative care.

Download Full-text

Models of Palliative Care Team Composition: Nurse Practitioner-Only versus Interdisciplinary Teams that Include Specialist Physicians

Journal of Palliative Medicine ◽

10.1089/jpm.2017.0380 ◽

2017 ◽

Vol 20 (12) ◽

pp. 1313-1313

Author(s):

Kim Kousaie ◽

Charles F. von Gunten

Keyword(s):

Palliative Care ◽

Nurse Practitioner ◽

Interdisciplinary Teams ◽

Palliative Care Team ◽

Care Team ◽

Team Composition

Download Full-text

Implementation of early will directives: facilities and difficulties experienced by palliative care teams

Revista Gaúcha de Enfermagem ◽

10.1590/1983-1447.2020.20190399 ◽

2020 ◽

Vol 41 ◽

Author(s):

Aline Carniato Dalle Nogario ◽

Edison Luiz Devos Barlem ◽

Jamila Geri Tomaschewski-Barlem ◽

Rosemary Silva da Silveira ◽

Silvana Bastos Cogo ◽

...

Keyword(s):

Palliative Care ◽

Implementation Process ◽

Palliative Care Team ◽

Legal Issues ◽

Care Team ◽

Rio Grande Do Sul ◽

Palliative Care Teams ◽

The Family ◽

The Subject ◽

Difficult Situations

ABSTRACT Objective: To know the facilities and difficulties the palliative care team professionals experience in the implementation process of advance healthcare directives. Method: Exploratory-descriptive study with a qualitative approach, involving 51 professionals from seven palliative care teams in the state of Rio Grande do Sul, Brazil. The data were collected between December 2018 and April 2019 and discursive textual analysis was applied. Results: The facilities found were: the approach by the palliative care team; listening and respecting patients' wishes; effective communication between professionals, patients, and family members and resolution of difficult situations. The difficulties reported were: legal issues; the lack of knowledge of professionals about the subject; the lack of institutional protocols; the difficulty in talking about death and the family barrier. Conclusion: Despite the perceived facilities and difficulties, palliative care professionals intend to work based on the patients' desires and will, aiming to offer dignity in the dying process.

Download Full-text

Interdisciplinary Palliative Care Teams

Oxford Textbook of Palliative Nursing ◽

10.1093/med/9780190862374.003.0007 ◽

2019 ◽

pp. 89-97

Author(s):

Polly Mazanec ◽

Rebekah Reimer ◽

Jessica Bullington ◽

Patrick J. Coyne ◽

Herman Harris ◽

...

Keyword(s):

Palliative Care ◽

Care Delivery ◽

Medical Center ◽

Academic Medical Center ◽

Interdisciplinary Team ◽

Palliative Care Team ◽

Care Team ◽

Patient Centered ◽

Team Members ◽

Palliative Care Teams

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.

Download Full-text

Confidence and skills for cystic fibrosis end-of-life care

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002274 ◽

2020 ◽

pp. bmjspcare-2020-002274

Author(s):

Eva Harris-Skillman ◽

Stephen Chapman ◽

Aoife Lowney ◽

Mary Miller ◽

William Flight

Keyword(s):

Cystic Fibrosis ◽

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Further Education ◽

Palliative Care Team ◽

Care Team ◽

Life Care ◽

Team Members ◽

Palliative Care Teams

ObjectivesOptimal cystic fibrosis (CF) end-of-life care (EOLC) is a challenge. There is little formal guidance about who should deliver this and how CF multi-disciplinary teams should interact with specialist palliative care. We assessed the knowledge, experience and preparedness of both CF and palliative care professionals for CF EOLC.MethodsAn electronic questionnaire was distributed to all members of the Oxford adult CF and palliative care teams.Results35 of a possible 63 members responded (19 CF team; 16 palliative care). Levels of preparedness were low in both groups. Only 11% of CF and 19% of palliative care team members felt fully prepared for EOLC in adult CF. 58% of CF members had no (21%) or minimal (37%) general palliative care training. Similarly, 69% of the palliative care team had no CF-specific training. All respondents desired additional education. CF team members preferred further education in general EOLC while palliative care team members emphasised a need for more CF-specific knowledge.ConclusionsFew members of either the CF or palliative care teams felt fully prepared to deliver CF EOLC and many desired additional educations. They expressed complementary knowledge gaps, which suggests both could benefit from increased collaboration and sharing of specialist knowledge.

Download Full-text

Response to Research Brief Vol. 20(12):1313: Models of Palliative Care Team Composition

Journal of Palliative Medicine ◽

10.1089/jpm.2018.0026 ◽

2018 ◽

Vol 21 (5) ◽

pp. 586-587

Author(s):

Shreda Pairé ◽

Kathleen Broglio ◽

Margaret I. Wallhagen ◽

Kristi A. Acker ◽

Susan M. Beidler ◽

...

Keyword(s):

Palliative Care ◽

Palliative Care Team ◽

Care Team ◽

Team Composition

Download Full-text

Evaluating the use of video communication technology in a hospital specialist palliative care team during the COVID-19 pandemic

AMRC Open Research ◽

10.12688/amrcopenres.12969.1 ◽

2021 ◽

Vol 3 ◽

pp. 5

Author(s):

Benjamin Crosby ◽

Sarika Hanchanale ◽

Sarah Stanley ◽

Amara Callistus Nwosu

Keyword(s):

Palliative Care ◽

Communication Technology ◽

Healthcare Professionals ◽

Palliative Care Team ◽

Video Communication ◽

Care Team ◽

Published Data ◽

Specialist Palliative Care ◽

Hospital Specialist ◽

Palliative Care Teams

Background: Healthcare professionals’ use of video communication technology has increased during the novel coronavirus disease (COVID-19) pandemic, due to infection control restrictions. Currently there is little published data about the experiences of specialist palliative care teams who are using technology to communicate during the COVID-19 pandemic. The aim of this evaluation was to describe the experience of a UK based hospital specialist palliative care team, who were using video communication technology to support care during the COVID-19 pandemic. Methods: An online survey was distributed to the specialist palliative care team at a University teaching hospital in the North West of the UK. We asked participants to provide their views on the scope of use, barriers and future opportunities to use technology for communication in hospital palliative care. Results: The survey was completed by 14 healthcare professionals. Participants indicated that the most common reasons for using the technology was to receive team updates (n= 14, 100%), participate in multidisciplinary team meetings (n=14, 100%), for education (n=12, 86%) and to facilitate cross-site working (n=9, 64%). We identified barriers to using the technology, which were summarised as: (1) user-based difficulties; (2) inadequate technological infrastructure; (3) data security, privacy and ethical concerns; and (4) concerns regarding staff wellbeing. Participants stated that technology can potentially improve care by improving communication with hospital and community teams and increasing access to education. We have used these findings to develop recommendations to help palliative care teams to implement this technology better in clinical practice. Conclusion: Video communication technology has the potential to improve specialist palliative care delivery; however, it is essential that healthcare organisations address the existing barriers to using this technology, to ensure that these systems work meaningfully to improve palliative care for those who are most vulnerable beyond the COVID-19 pandemic.

Download Full-text