Interprofessional Palliative Care Research Articles

Career Impact of Palliative Care Fellowship Training for Nurse Practitioners.

Background: Postgraduate fellowship training for nurse practitioners (NP) in palliative care can ameliorate workforce shortages; however, currently there are few NP fellowships and little evidence about outcomes, such as retention in hospice and palliative nursing, job satisfaction, or professional contributions. Objective: To describe the impact of palliative care fellowship training on the careers of NP alumni. Methods: A survey was electronically distributed to all NP alumni of an interprofessional palliative care fellowship since adult and pediatric nursing cohorts were added (2009-2022). Results: Most respondents still worked in hospice and/or palliative care; a majority of them engaged in professional activities beyond clinical work and reported high career satisfaction. Alumni endorsed multiple benefits of postgraduate fellowship except for post-fellowship compensation. Conclusions: NP palliative care fellowship alumni reported multiple career benefits including job satisfaction, professional accomplishment, and ongoing employment at their training institutions.

Interprofessional Collaboration in Palliative Care—The Need for an Advanced Practice Nurse: An Ethnographic Study

ObjectivesThe literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context. Data SourcesA focused ethnographic approach was taken involving participant observation and semistructured interviews. ConclusionFrom the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse's role, and developments. Implications for Nursing PracticeThe study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need.

The Tapestry of Teamwork: Crafting a High Functioning Interprofessional Palliative Care Team

The Tapestry of Teamwork: Crafting a High Functioning Interprofessional Palliative Care Team

Psychosocial Distress Screening Among Interprofessional Palliative Care Teams: A Narrative Review

With increased need for palliative care and limited staffing resources, non-social workers are increasingly responsible for screening for urgent psychosocial distress. The National Consensus Project guidelines call for all palliative care team members to be competent in screening across domains. Yet, in contrast to an abundance of evidence-informed tools for palliative social work assessments, standardization for interprofessional psychosocial screening is lacking. This lack of standardized practice may lead to harmful disparities in care delivery. The purpose of this narrative review is to examine current literature on evidence-informed practices for psychosocial screening within palliative care. Google Scholar, a university Summon library search engine, and prominent palliative care journals were searched using the same phrases to locate articles for inclusion. Each article was reviewed and synthesized across common themes. Although an abundance of validated screening tools exists for outpatient oncology-specific settings, there is minimal guidance on psychosocial screening tools intended for specialty palliative care. The most oft-cited tools have been met with concern for validity across diverse palliative care populations and settings. Additional research is needed to operationalize and measure brief psychosocial screening tools that can be validated for use by interprofessional palliative care teams, a stepping-stone for increased equity in palliative care practice.

'Confidence and fulfillment': a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses.

To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC.

High-quality patient-centered palliative care: interprofessional team members’ perceptions of social workers’ roles and contribution

ABSTRACT A core tenet of interprofessional collaborative practice (IPCP) is that efficient and effective teams are critical for the delivery of high-quality, patient-centered care. Although palliative care has a history of excellent care, increasing demands and larger patient loads are challenging teams to adapt and strengthen team functioning in hospital settings. The purpose of this qualitative study was to better understand the IPCP contributions of advanced palliative social workers (PSWs) through the eyes of their colleagues. Twenty-four interprofessional palliative care (IPPC) team members from other professions (i.e. nurse practitioners, physicians, physician assistants) from 16 hospitals across the U.S. participated in 20-minute semi-structured interviews. The Patient-Centered Clinical Method (PCCM) was used as a conceptual model to aid in the interpretation of the data. This model illuminated the centrality of PSWs’ role in building and sustaining a therapeutic alliance between the patient and the IPPC team, through assessing and promoting care that centers the patient’s experience with illness, creating space to initiate, process and revisit difficult healthcare conversations and helping to modulate the pace and intensity of emotionally laden discussions. PSWs also support the therapeutic relationship with the IPPC team by providing continuity and connection across and during the hospital experience and supporting the well-being of the IPPC team. This study offers novel insights into how PSWs contribute to patient-centered IPPC and furthers the articulation of the role of PSWs in hospital settings.

A framework for integrating advanced practice palliative care competencies in nursing education

Introduction and objective: It is essential that nursing education prepares graduates to achieve the core skills required for the delivery of quality evidence-based palliative care. Hence, integrating advanced practice palliative care content into the nursing curriculum is an important priority. The objective of this study was to develop a framework and describe the process of integrating palliative care into the nursing curriculum to accelerate advanced practice palliative care competencies.Methods: Case-study methodology was used to describe an educational initiative. Through this initiative, palliative care education and skills-based resources have been integrated into the graduate nursing curriculum.Results: Varied palliative care learning resources have been incorporated and include sequential lectures, case studies, practice scenarios with identified palliative care needs, articles, and interprofessional palliative care simulations across multiple courses. To integrate palliative care content into the nursing curriculum a Framework for Integrating Palliative Care in Nursing Education was developed consisting of a cycle of five specific processes: 1) Assessment of curricular needs and goals, 2) Identification and development of resources, 3) Integration of teaching and learning activities, 4) Evaluation of content and learning, 5) Dissemination of resources and findings. A supportive organizational structure and an academic-practice partnership were identified as essential infrastructures for these processes.Conclusions: This educational initiative was vital in increasing the advanced practice nursing workforce with essential palliative care competencies to provide clinical leadership in a rapidly changing healthcare delivery system.

Implementing an interprofessional palliative care education program to speech-language therapy and dietetic students

ABSTRACT Palliative care education for allied health professionals has received minimal research attention. This longitudinal study followed the development of an education program for speech-language therapy (SLT) and dietetic (DT) students. The project comprised three stages. In Stage I, consenting SLT and DT graduates (n = 9) were interviewed 6 months after graduation exploring preparedness for working in palliative care. Interviews were transcribed, and topics were extracted through content analysis. In Stage II, a new palliative care curriculum was developed using the extant literature and gaps reported in Stage I. In Stage III, we implemented and evaluated the new curriculum. Students were surveyed before (n = 68) and after (n = 42) the new program and at 6-month post-graduation (n = 15) to capture student-reported changes in knowledge and confidence in palliative care. In Stage I, 10 topics were developed covering knowledge, roles, team, family-focused care, and feelings. In Stage II, a hybrid program was developed including e-learning modules, didactic lectures, and a simulated learning experience. In Stage III, student feedback demonstrated positive shifts in knowledge and confidence ratings from medians 3–6 to 5–8 (1 = none; 10 = excellent) across all domains. Gains in knowledge and confidence were consistently higher at 6-month post-graduation for final survey respondents. Mixed modality interprofessional palliative care education for allied health professionals has merit in improving knowledge, confidence, and perceived preparedness for practice.

A Systematic Review of Interprofessional Palliative Care Education Programs.

Interprofessional education (IPE) involving palliative and end-of-life content benefits learners by addressing interprofessional and palliative care (PC) competency needs. A synthesis of educational approaches promoting interprofessional PC in academic and clinical settings would address research gaps and promote effective teaching. A systematic review of interprofessional PC educational studies was conducted to summarize current approaches in PC IPE and to appraise teaching and research methods. Characteristics of excellence in interprofessional PC education established by Donesky et al. served as a framework for evaluating studies in this systematic review. A total of 39 articles met inclusion criteria for this review. Learners from medicine and nursing were the most included professions. University programs represented most studies, and evaluation methods demonstrated achievement of mostly self-reported outcomes like learner attitude and self-efficacy. While the effect of interprofessional collaboration on patient outcomes is well-documented, the effect of IPE on PC delivery is not. Although content spanned all interprofessional and PC domains, few studies addressed cultural aspects and fewer addressed well-being for the care provider. In light of the current healthcare landscape, there is an imminent need to address culture and provider well-being more directly through interprofessional PC education. Education and research must also move beyond university programs into health systems to support the professional development of clinicians for systems integration, sustainability, and impact on patient outcomes. Future evaluation of interprofessional PC education would be strengthened by multisite studies, randomized controlled trials, and repeated measures looking at outcomes over time.

The Third Annual US Celebration of World Hospice and Palliative Care Day: A virtual coming together to unify the global palliative care community.

On 3-4 October 2022, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the Third Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to reflect on the event within the broader context of the international WHPCD theme: "healing hearts and communities." We describe lessons learned in anticipation of the fourth annual conference to be held on 3-4 October 2023. Description of the third annual event, conference planning team reflection, and attendee evaluation responses. The Worldwide Hospice Palliative Care Alliance launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care globally. Since 2020, the conference has attracted an increasing number of attendees from around the world. Two primary aims continue to guide the event: community building and wisdom sharing. Fifty-two interprofessional palliative care experts, advocates, patients, and caregivers provided 13 unique interactive sessions. Four hundred and fifty-eight multidisciplinary registrants from at least 17 countries joined the program. Free registration for colleagues in low- and middle-income countries, students and trainees, and individuals experiencing financial hardship remains a cornerstone of inclusion and equitable access to the event. The US WHPCD celebration provides a virtual platform that offers opportunities for scientific dissemination and collective reflection on hospice and palliative care delivery amid significant local and global changes in clinical practice, research, policy and advocacy, and population health. We remain committed to ensuring an internationally relevant, culturally diverse, and multidisciplinary agenda that will continue to draw increased participation worldwide during future annual events.

Top Ten Tips Palliative Care Clinicians Should Know About Delivering Specialty-Aligned Palliative Care.

Specialty-aligned palliative care (SAPC) refers to interprofessional palliative care (PC) that is delivered to a specific population of patients in close partnership with other primary or specialty clinicians. As evolving PC models address physical, psychosocial, and spiritual suffering across illnesses and settings, PC clinicians must acquire advanced knowledge of disease-specific symptoms, common treatments, and complications that impact prognosis and outcomes. The tips provided in this article draw on the experience and knowledge of interprofessional PC and other specialist clinicians from diverse institutions across the United States who have developed and studied SAPC services across different disease groups. Recommendations include focusing on approaching specialty team partnerships with humility, curiosity, and diplomacy; focusing on patient populations where PC needs are great; clarifying how work and responsibilities will be divided between PC and other clinicians to the extent possible; using consults as opportunities for bidirectional learning; and adapting workflows and schedules to meet specialty team needs while managing expectations and setting limits as appropriate. Furthermore, to provide effective SAPC, PC clinicians must learn about the specific symptoms, prognoses, and common treatments of the patients they are serving. They must also build trusting relationships and maintain open communication with patients and referring clinicians to ensure integrated and aligned PC delivery.

Fostering Humanism Through Stories: A Plea for Narrative Medicine in Palliative Care Education.

My gloved hand eased open the hospital room door. Wearing layers of personal protective equipment, I swished into the room to find Eli*, a one-year-old with leukemia, sitting in a rocking chair tucked into the arms of his mother. With practiced speech, I introduced myself as the fellow on the interprofessional palliative care team. Eli's mom explained that she had been expecting our team, and waved our group into the room. I smiled and pulled an extra chair across the floor, ready to absorb a story.

Ambulatory palliative care among patients with hidradenitis suppurativa: A qualitative study

Patients with hidradenitis suppurativa (HS) experience high physical and emotional symptom burden and may benefit from palliative care interventions, though no studies have explored the unmet palliative care needs in this population. This case series aimed to qualitatively evaluate unmet needs and palliative care interventions among patients with HS who were referred to palliative care. We reviewed medical records of patients with HS who were referred from an HS specialty clinic and seen in an interprofessional palliative care ambulatory clinic. Palliative care notes were qualitatively analyzed inductively and deductively to identify themes characterizing unmet needs and palliative care interventions. Thirteen patients with HS (median [IQR] age, 38 [31-45] years; 11 [85%] women; 11 [85%] Black) were referred and seen in a palliative care specialty clinic. Topics discussed included uncontrolled HS pain, housing insecurity, and emotional distress. Palliative care interventions included a thorough assessment of pain, multimodal pain management approaches, social worker weekly check-ins, and management of psychotropic medications. Small study at a single tertiary center. Care models integrating palliative care approaches with multidisciplinary support services may reduce disease burden in a subset of patients with HS.

Specialty-Aligned Palliative Care: Responding to the Needs of a Tertiary Care Health System.

Expanding specialty palliative care within complex health systems involves consideration of patients' unmet needs, clinicians' perceptions of palliative care, and the availability of palliative care resources. Prior to this quality improvement (QI) project, palliative care services in our health system primarily served oncology patients. We undertook a prospective strategic planning process that included executive sponsorship and engagement of institutional leaders and clinicians to help define which palliative care services were most needed by the health system. We interviewed and surveyed a broad range of clinicians including physicians, nurse practitioners, and social workers. The two most prominent themes that emerged from the stakeholder engagement process were clinicians' wish for specialty-aligned interprofessional palliative care teams and for expansion of nononcology palliative care access. Careful needs assessment and stakeholder engagement can result in goal-directed and data-driven expansion of palliative care services within tertiary health care systems.

Creating KidneyPal: A Specialty-Aligned Palliative Care Service for People with Kidney Disease.

Patients with kidney disease have notable unmet palliative care needs and represent an underserved population for specialty palliative care teams. We designed a specialty-aligned interprofessional palliative care service called KidneyPal that is aimed at improving delivery of palliative care to patients with kidney disease through focus groups and iterative improvement cycles. We iteratively measured the development of KidneyPal through clinical process metrics: percent of the inpatient nephrology census followed by KidneyPal, patient demographics, consult origin, clinician feedback, and self-reported team interventions. KidneyPal saw 314 unique patients from January 2019 to January 2021. The majority of consultations came from nephrology services though the source of consultation changed over time. We consulted on an average of 13.5% of the entire inpatient nephrology patient hospital census with highest involvement with patients on the inpatient nephrology hemodialysis service (mean of 29.9%). KidneyPal was rated highly by surveyed nephrology clinicians and provided high rates of psychosocial support and goals of care interventions. The creation of KidneyPal led to us to serve a new cohort of patients with specialty palliative care. We grew over time to serve the full range of patients with kidney disease as defined by our nephrology service lines. We succeeded in doing so by embedding in nephrology and building relationships with those caring for people with kidney disease while tailoring our service and interventions over time.

Care Intensity and Palliative Care in Chronically Critically Ill Infants.

Increasingly, chronically critically ill (CCI) infants survive to discharge from Neonatal Intensive Care Units (NICUs). Little is known about their care intensity and the primary and specialty palliative care families receive at and following discharge. To describe care intensity and primary and specialty palliative care received by NICU CCI infants at discharge and one year. Chart abstraction of CCI infants at three academic centers discharged at ≥42 weeks corrected gestational age with medical technology between 2016 and 2019, including demographics, care intensity, and primary and specialty palliative care received at discharge and one year. Among 273 infants, NICU median stays were 45 [IQR 23-92] days. Primary diagnoses included congenital and/or genetic conditions (68.5%), prematurity (28.2%), and birth events (3.3%). At discharge, surgical feeding tubes (75.1%) and tracheostomies (24.5%) were the most common technologies. Infants received a median of 6 [IQR 4-9] medications and were followed by a median of 8 [IQR 7-9] providers. At one year, 91.4% continued with one or more technologies, similar numbers of medications and specialty providers. In the NICU, nearly all families had social work involvement, 78.8% had chaplaincy and 53.8% child life; 19.8% received specialty palliative care consultation. At one year, only 13.2% were followed by palliative care. CCI infants receive intensive medical care including multiple medical technologies, medications, and specialty follow up at discharge and remain complex at one year of life. Most receive primary interprofessional palliative care in the NICU, however these infants and their families may have limited access to specialty palliative care in the short- and long-term.

Development of PharmPAL: A Collaborative Practice Pharmacy Clinic in Ambulatory Palliative Care.

Increased access to interprofessional palliative care is needed in ambulatory oncology settings. To achieve this, Dana-Farber Cancer Institute launched a collaborative drug therapy management clinic, PharmPAL, where credentialed advanced practice pharmacists lead independent patient visits. As part of a pilot project focused on clinical innovation, we analyzed PharmPAL referrals and pharmacist interventions between July 2020 and June 2021. We extracted referral patterns, patient hospitalizations, and deaths from the electronic medical record. Outpatient palliative care clinicians completed a survey to determine pharmacist needs and overall satisfaction with PharmPAL. From July 2020 to June 2021, PharmPAL constituted 4.7% (299/6305) of all outpatient palliative care encounters. Most palliative care clinicians (86% [6/7]) reported a desire to increase PharmPAL availability. No patient hospitalizations or deaths were attributed to PharmPAL visits. PharmPAL increased access to palliative care services. All clinicians reported satisfaction with PharmPAL. We continue to assess the impact PharmPAL has on clinic operations and provider satisfaction.

Building interprofessional team competence through online synchronous simulation of palliative care scenarios

Simulation-enhanced interprofessional education (Sim-IPE) is increasingly used in health professional programs to promote team competence. Sim-IPE using online technology incorporating palliative care (PC) scenarios may be an attractive option for including distance learners, overcoming clinical-site restrictions, and increasing proficiency in difficult conversations. To evaluate outcomes of Sim-IPE using a web-conferencing platform in an interprofessional (IP) PC course. Repeated measures were used to evaluate self-efficacy and competent performance in IP PC scenarios among enrolled students (N = 24) during a two-part simulation in two separate semesters. Student health professions included nursing, medicine, pharmacy, social work, occupational therapy, and physical therapy. Significant self-efficacy increases were found between Simulations 1 and 2 in both course offerings, with competent student team performance in each simulation. Distance Sim-IPE using PC scenarios are effective pedagogy for IP students to develop competence in how to engage, collaborate, and communicate among teams for patient-centered care.

Development of an Innovative Interprofessional Palliative Care Student Learning Collaborative.

Training all clinicians in primary palliative care has been proposed as one solution to hospice and palliative care workforce challenges. With palliative care's focus on interprofessional practice and collaboration, interprofessional education is optimal to teach foundational palliative care principles. To develop, pilot, and evaluate an innovative interprofessional primary palliative care student learning collaborative. An interprofessional faculty and clinician team developed a semester-long palliative care interprofessional learning collaborative program that was delivered in a hybrid format. The National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care were used as the framework for the program content. Pre-post measures of palliative and end-of-life care-specific educational needs and post-program evaluation were used to evaluate the program. The program was piloted with 25 student participants from 10 health professional programs. Participants reported gains in knowledge post-program participation. Post-program evaluation comments were positive and the interprofessional design was regarded as a strength of the program. Incorporating interprofessional learning into a palliative care curriculum may be an effective way to strengthen palliative care teams, as greater exposure to the diverse approaches of each team member can increase the appreciation and understanding of everyone's critical role to play in providing excellent palliative care.

Evaluating the Effectiveness of an African American Community-Developed Training Program in Providing Culturally Concordant Care to Elders to Interprofessional Palliative Care Providers in the Deep South (GP724)

Evaluating the Effectiveness of an African American Community-Developed Training Program in Providing Culturally Concordant Care to Elders to Interprofessional Palliative Care Providers in the Deep South (GP724)