Interprofessional Palliative Care Research Articles

Finding Strengths in Our Differences: How Interprofessional Training Prepares Clinicians for Collaborative Practice (SA507)

•Describe the unique aspects of an interprofessional training model from the perspectives of fellowship directors and social work, nurse practitioner, and physician trainees.•Identify the benefits and challenges of an interprofessional training model in providing patient care and promoting self-care.•Devise strategies to develop interprofessional training experiences that attendees can implement in their own palliative care and hospice programs. Clinical practice guidelines for quality palliative care highlight the interprofessional nature of palliative care, recognizing that clinicians in each discipline must understand the unique perspectives and strengths of their colleagues in order to provide comprehensive collaborative care. Despite this, finding clinicians proficient in interprofessional collaborative practice proves difficult due to the lack of interprofessional training programs. Instead, palliative care clinicians often resort to learning to work with team members of different disciplines in the course of delivering complex clinical care to seriously ill patients and their families. One innovative solution to this problem is interprofessional palliative care training programs. Training physicians, nurses, psychosocial clinicians, and other disciplines in an interprofessional fellowship affords professionals insight into the distinct and shared roles of each discipline while allowing trainees dual roles as learner and teacher for their co-fellows. This model includes cross-training experiences, a shared didactic and experiential curriculum, and respectful appreciation of one another’s value. In this concurrent session, attendees will explore this interprofessional educational model through the lens of interprofessional trainees and fellowship directors. Presenters will summarize the literature of interprofessional education, highlight the benefits and challenges of each discipline’s role through case-based clinical scenarios, and examine how this model minimizes compassion fatigue and clinician burnout. Finally, presenters and attendees will explore financial, system, and staff limitations and generate strategies to implement interprofessional training experiences into their own programs. Interprofessional training provides unique benefits to patients, families, trainees, and clinical systems, and should be considered by programs nationwide.

Evolution of an Interprofessional Palliative Care Fellowship and Integration of a PGY-2 Pain Management and Palliative Care Pharmacy Resident (S840)

Evolution of an Interprofessional Palliative Care Fellowship and Integration of a PGY-2 Pain Management and Palliative Care Pharmacy Resident (S840)

Interdisciplinary palliative care communication for quality palliative care: Outcomes of a statewide train-the-trainer course.

83 Background: Expert communication skills are essential for the delivery of effective palliative care across the domains of care. However, few healthcare providers receive formal communication training. The purpose of this presentation is to describe a train-the-trainer course for interprofessional hospital-based palliative care teams to prepare them to teach other healthcare professionals palliative care communication skills. Methods: This project was organized by the eight domains of the National Consensus Project (NCP) guidelines for quality palliative care and provided communication skills training for California-based teams. Funded by the Archstone Foundation, this 2-day train-the-trainer course included skill-building exercises and interactive discussions to assist participants in integrating communication skills-building into their clinical settings. Using a goal-directed method of teaching, the faculty assisted teams in developing three institutional goals for providing palliative care communication training to other healthcare professionals. Evaluation of the course included immediate post-course evaluation and follow-up evaluation at 6 and 9 months. Results: The first statewide interprofessional communication training took place in January 2018 with 26 palliative care teams consisting of primarily nurses, followed by social workers, chaplains and physicians. The 46 course participants’ post-course evaluations demonstrated high satisfaction with the course. On a scale of 1 to 5 (1 = lowest), the course met participants’ expectations and objectives (4.8). The teams’ pre-course goals focused on: 1) staff education, training and mentorship, and 2) institution-wide system changes involving communication with palliative care. Conclusions: A 6 and 9 month follow-up will evaluate team progress on institutional goals (e.g. status and implementation) and provide an update on the additional healthcare professionals trained by course participants and changes implemented within their health system.

Pilot Qualitative Study of Informal Teachers in Interprofessional Collaboration and Practice

ContextNonphysician members of the interprofessional palliative care team often participate in teaching physicians and others in the context of workplace learning due to the interprofessional collaborative nature of the specialty. ObjectivesThis pilot study examines the beliefs of the nonphysician members of the interprofessional team about teaching physicians-in-training, the disciplinary training and expertise that informs their teaching, and approaches to teaching in the workplace. MethodsSemistructured interviews were conducted. All interviews were audio recorded and transcribed verbatim. Initial open coding by two researchers identified the codes, and then the constant comparative method was used to find patterns by axial coding, categories, and themes within the data. ResultsOf the 10 health care professionals involved with palliative medical education at one academic medical center, six enrolled in the pilot. Those who participated included chaplains, nurses, a social worker, and a physician assistant. Three major themes were identified from the informal teachers: 1) using professional identity as a foundation for teaching, 2) teaching through experiential learning or debriefing, and 3) teaching to perceived gaps in physician training. ConclusionNonphysician members of the interprofessional team interacted with physicians-in-training guided by their discipline-based skills and perspectives on patient care. They directed their informal teaching toward perceived educational gaps using reflection and debriefing. Future studies could explore the educational roles of health care professionals across diverse institutions and specialties.

"Sacred Work": Reflections on the Professional and Personal Impact of an Interdisciplinary Palliative Oncology Clinical Experience by Social Work Learners.

This study explored the impact of an oncology palliative care clinical experience with older adults on social work learners. A three-member research team conducted a qualitative content analysis of reflective writings. 27 Master of Science in Social Work students enrolled in an interprofessional palliative oncology curriculum and completed a reflective writing assignment to summarize the clinical scenario, analyze the patient/family care provided, and describe the impact of the experience. Using a constant comparison approach based on grounded theory, the research team analyzed the reflections to come to consensus related to the overall impact of the experience. Two overarching themes (professional and personal impact) and 11 subthemes (appreciation of interdisciplinary teams, recognition of clinical skills of other disciplines, insight into clinical skills of the social worker, perception of palliative care, embracing palliative care principles, centrality of communication, importance of social support, family as the unit of care, countertransference, conflict between personal values and patient/family values, and emotional reactions) were identified. Experiential learning opportunities for social work learners in interprofessional palliative care build appreciation for and skills in applying palliative care principles including teamwork, symptom control, and advanced care planning along with a commitment to embrace these principles in future practice.

Palliative care from cancer diagnosis for all: Memorial Sloan Kettering’s “One-Two-Three” program.

111 Background: Early, universal palliative care is an unmet need for cancer patients. Our new program aims to provide palliative care, by primary oncology teams with support from palliative care specialists, from diagnosis as an institutional standard. Methods: One-Two-Three is a structured program of assessment and response addressing palliative care needs regardless of cancer stage or prognosis starting with the first 3 visits after diagnosis. Assessments include patient physical/emotional/spiritual symptoms (10 symptoms, self-reported 0-10), communication needs (information preferences, illness understanding), and proactive care planning through exploration of core values. As first responders, oncology nurses are guided by “ready responses” in an empathic framework and coaching or direct patient consultation by palliative care specialists. Feasibility, acceptability, and impact on patient, caregiver, and utilization outcomes are evaluated quantitatively and qualitatively. Results: Assessments were piloted with 25 consecutive, newly-diagnosed patients in blood cancer and solid tumor clinics. Symptom and communication assessments each took < 5 minutes and showed high prevalence of moderate/severe distress ( > 50% for 8/10 symptoms, 144 assessments), variation in information preferences (76% wanting detail, 24% broad overview only), and unmet communication needs. All but 1 patient without a health care proxy chose one. Oncology nurses engaged patients in structured discussions ( < 15 minutes) of core values. Clinic workflow was maintained. Patients, families, and oncology clinicians endorsed the initiative. As palliative care skills of oncology teams improved, specialists focused on more complex issues. Conclusions: Routine interprofessional primary palliative care with specialist support from diagnosis is feasible and acceptable in our center’s high-volume outpatient oncology clinics. Ongoing evaluations will assess other outcomes (e.g., quality of life); impact on clinicians/ processes; and utilization (e.g., ED/hospital visits, hospice use).

Pilot Study of an Interprofessional Palliative Care Curriculum: Course Content and Participant-Reported Learning Gains.

The National Consensus Project for Quality Palliative Care Clinical Practice Guidelines recommend that palliative care clinicians work together as interprofessional teams. We created and piloted a 9-month curriculum that focused on 3 related domains: (1) patient-centered, narrative communication skills; (2) interprofessional team practice; and (3) metrics and systems integration. The multifaceted curriculum was delivered through 16 webinars, 8 online modules, 4 in-person workshops, reflective skill practice, written reflections, and small group online discussions. Report evaluations of the course content and skill self-assessments from 24 interprofessional palliative care clinicians. Participants rated each learning activity and completed a retrospective pre-post test skill assessment. Learning gains were measured as the difference in the percentage of participants reporting "strong" or "highly competent" skill levels at baseline and the end of the course. Participants also provided examples of how they used the skills in practice. Participants achieved an average learning gain of 50% across all domains, and in each domain communication (54%), interprofessional team practice (52%), and metrics and systems integration (34%). They also gave high ratings for the curriculum content (overall mean [standard deviation] rating of 5.5 (0.7) out of 6). Examples of practice impacts included improved skills in responding to emotions, understanding the equal importance of all professions on their team and incorporating different perspectives into their practice, and learning about outcome measurement in palliative care. This curriculum demonstrated success in increasing perceived skills for interprofessional palliative care clinicians in advanced communication, team practice, and metrics and system integration.

A pilot study of interprofessional palliative care education of medical students in the UK and USA

BackgroundEducating medical students to care for patients at the end-of-life is increasingly recognised as an essential component of training. Traditionally, medical student programmes are run by doctors, but patient care...

A Community Needs Assessment for the Development of an Interprofessional Palliative Care Training Curriculum.

There is a known shortage of trained palliative care professionals, and an even greater shortage of professionals who have been trained through interprofessional curricula. As part of an institutional Palliative Care Training Center grant, a core team of interprofessional palliative care academic faculty and staff completed a state-wide palliative care educational assessment to determine the needs for an interprofessional palliative care training program. The purpose of this article is to describe the process and results of our community needs assessment of interprofessional palliative care educational needs in Washington state. We approached the needs assessment through a cross-sectional descriptive design by using mixed-method inquiry. Each phase incorporated a variety of settings and subjects. The assessment incorporated multiple phases with diverse methodological approaches: a preparatory phase-identifying key informants; Phase I-key informant interviews; Phase II-survey; and Phase III-steering committee endorsement. The multiple phases of the needs assessment helped create a conceptual framework for the Palliative Care Training Center and developed an interprofessional palliative care curriculum. The input from key informants at multiple phases also allowed us to define priority needs and to refine an interprofessional palliative care curriculum. This curriculum will provide an interprofessional palliative care educational program that crosses disciplinary boundaries to integrate knowledge that is beneficial for all palliative care clinicians. The input from a range of palliative care clinicians and professionals at every phase of the needs assessment was critical for creating an interprofessional palliative care curriculum.

Assessment of a Statewide Palliative Care Team Training Course: COMFORT Communication for Palliative Care Teams.

Despite increased attention to communication skill training in palliative care, few interprofessional training programs are available and little is known about the impact of such training. This study evaluated a communication curriculum offered to interprofessional palliative care teams and examined the longitudinal impact of training. Interprofessional, hospital-based palliative care team members were competitively selected to participate in a two-day training using the COMFORT(TM SM) (Communication, Orientation and options, Mindful communication, Family, Openings, Relating, Team) Communication for Palliative Care Teams curriculum. Course evaluation and goal assessment were tracked at six and nine months postcourse. Interprofessional palliative care team members (n = 58) representing 29 teams attended the course and completed course goals. Participants included 28 nurses, 16 social workers, 8 physicians, 5 chaplains, and one psychologist. Precourse surveys assessed participants' perceptions of institution-wide communication performance across the continuum of care and resources supporting optimum communication. Postcourse evaluations and goal progress monitoring were used to assess training effectiveness. Participants reported moderate communication effectiveness in their institutions, with the weakest areas being during bereavement and survivorship care. Mean response to course evaluation across all participants was greater than 4 (scale of 1 = low to 5 = high). Participants taught an additional 962 providers and initiated institution-wide training for clinical staff, new hires, and volunteers. Team member training improved communication processes and increased attention to communication with family caregivers. Barriers to goal implementation included a lack of institutional support as evidenced in clinical caseloads and an absence of leadership and funding. The COMFORT(TM SM) communication curriculum is effective palliative care communication training for interprofessional teams.

Abstracts from Center to Advance Palliative Care National Seminar Palliative Care Everywhere: Bridging the Gaps November 12-14, 2015 San Antonio, TX.

Abstracts from Center to Advance Palliative Care National Seminar Palliative Care Everywhere: Bridging the Gaps November 12-14, 2015 San Antonio, TX.

An Interprofessional Palliative Care Oncology Rehabilitation Program: Effects on Function and Predictors of Program Completion

After treatment, patients with active cancer face a considerable burden from the effects of both the disease and its treatment. The Palliative Rehabilitation Program (prp) is designed to ameliorate disease effects and to improve the patient's functioning. The present study evaluated predictors of program completion and changes in functioning, symptoms, and well-being after the program. The program received referrals for 173 patients who had finished anticancer therapy. Of those 173 patients, 116 with advanced cancer were eligible and enrolled in the 8-week interprofessional prp; 67 completed it. Measures of physical, nutritional, social, and psychological functioning were evaluated at entry to the program and at completion. Participants experienced significant improvements in physical performance (p < 0.000), nutrition (p = 0.001), symptom severity (p = 0.005 to 0.001), symptom interference with functioning (p = 0.003 to 0.001), fatigue (p = 0.001), and physical endurance, mobility, and balance or function (p = 0.001 to 0.001). Reasons that participants did not complete the prp were disease progression, geographic inaccessibility, being too well (program not challenging enough), death, and personal or unknown reasons. A normal level of C-reactive protein (<10 mg/L, p = 0.029) was a predictor of program completion. Patients living with advanced cancers who underwent the interprofessional prp experienced significant improvement in functioning across several domains. Program completion can be predicted by a normal level of C-reactive protein.

A Comprehensive Palliative Care Program at a Tertiary Cancer Center in Jordan

The palliative care program in King Hussein Cancer Center (KHCC) is growing rapidly to serve the needs of patients with cancer and their families. To describe the KHCC palliative care program and its integration into the oncology care. Narrative review of our palliative care program. Patients with cancer at KHCC have access to an interprofessional palliative care at different settings. In 2012, the inpatient team saw 400 consultations and 979 referrals and admissions. The outpatient clinic had a total of 1133 patient visits. The home care program provided a total of 1501 visits. Our program is a regional center for education and training and actively conducts research. Our palliative care program may be a model for successful delivery of comprehensive cancer care in the Middle East.

Results from a structured interprofessional palliative care rehabilitation program in oncology.

e20598 Background: Post-treatment patients with active cancer face considerable burden from the effects of both disease and treatment. The Palliative Rehabilitation Program was designed to ease those challenges and to improve the patient’s functioning. The current study evaluated the changes in function scores of patients with advanced cancer upon completion of the structured program and examined the medical predictors of program completion. Methods: Referrals for 173 patients who were finished anticancer therapy were received. One hundred and thirty six patients were eligible and enrolled in the eight-week interprofessional palliative rehabilitation program. Of those, 84 completed the program. Measures of physical, nutritional, social and psychological functioning were evaluated at entry and completion of the program. Results: Significant improvements were experienced in physical performance (P =0.000), nutrition (P =0.000), symptom severity (P=0.005 to P= 0.000), symptom interference in functioning (P =0.001 to P=0.000), and fatigue (P=0.001 to P=0.000). Reasons for not completing the program were: disease progression, geographical inaccessibility, being too well, dying, and personal/unknown reasons. A normal CRP level (&lt;10mg/L; P=0.013) was a predictor of program completion. Conclusions: Patients living with advanced heterogeneous cancers who underwent an interprofessional palliative rehabilitation program experienced significant improvement in their functioning in many domains. Program completion can be predicted by normal CRP level.

Die interprofessionelle Zusammenarbeit als typisches Merkmal der Palliative Care - eine Falldiskussion

Interprofessional teamwork is a characteristic feature of palliative care. Palliative Care is a subspeciality/ discipline in health care that cares for patients with a life threatening illness. The patient determines individual goals and the extent of further treatment. The team supports patients in decision making, practical advice in symptom management and composition of the future care network. The case of a 58-year-old woman suffering from metastastic breast cancer is an extraordinary example of interprofessional teamwork in palliative care. The patient was hospitalized in a palliative care unit with a malignant bowel obstruction. She underwent ileostomy and chemotherapy. She required total parenteral nutrition and was suffering from anorexia-cachexia syndrome. During her stay in the palliative care unit, her condition deteriorated. Subsequently, her needs changed and she requested to leave the hospital for some days to see her daughter's new domicile. It was by the coordinated effort of the interprofessional palliative care team that this last wish got fulfilled and she died peacefully a few days after her return to the palliative care unit.

Participatory knowledge exchange to support palliative care in Chile: lessons learned through global health research.

The authors designed a participatory qualitative research study to develop a collaborative partnership between palliative care practitioners in Canada and in Chile. The research goal was to support the provision of palliative care in vulnerable settings through a participatory knowledge exchange process using qualitative and participatory methodologies. The study involved an interprofessional palliative care team from a primary health care centre in Chile and 5 adults receiving palliative care and their relatives. It also involved the participation of registered nurses and allied health professionals from a palliative home care team in Canada. Participatory knowledge exchange activities included teamwork with the primary health care team in Chile and a process of participatory knowledge exchange with palliative care clinicians in Chile and Canada. The study produced qualitative evidence on the efficacy of a process of participatory knowledge exchange with palliative care practitioners from 2 diverse settings.

Conscious Conversations: Managing Conflict and Collaboration in Interprofessional Palliative Care Teams (503)

1.Describe the evolution of the collaborative relationship of healthcare professionals working in palliative care.2.Identify factors that create barriers to effective team functioning.3.Describe strategies to strengthen interprofessional team functioning. Effective interprofessional team collaboration may be threatened by overlapping competencies, lack of role clarification, and unspoken hierarchical structures resulting in an undercurrent of resentment and inefficient use of team member time and expertise. Palliative care literature offers little guidance on how to minimize these threats in order to optimize team function. In this session we will provide a brief overview of the current literature on the evolution and known benefits for interprofessional collaboration and provide a practical framework for how to assess if your team is working effectively. Considering where our competencies and scopes of practice overlap, we will discuss potential contributors for intra-team turmoil as well as the enablers of enhanced collaboration. Vignettes will be used to illustrate situations that put the interprofessional team at risk for conflict or role confusion. Audience participation will be elicited to consider the varying perspectives of and approaches by a diverse set of team members. Using “conscious conversations” strategies will be offered for maximizing efficient team function and satisfaction. Structure and Processes of Care

Can sharing stories change practice? A qualitative study of an interprofessional narrative-based palliative care course

A series of six interprofessional palliative care meetings used narrative, with participants sharing stories from their professional experience in facilitated small groups. The course was attended by doctors, nurses, social workers and emergency care practitioners. The course was evaluated by telephone interview with 19 of the 28 participants. Respondents reported effects including changed behaviours and benefit to patients. The use of narrative, as a starting point for shared learning, discussion and evaluation is unusual. Five months after the end of the course, many participants described changed professional behaviour which they believed led to improved patient outcomes.

Integrating palliative care content into a new undergraduate nursing curriculum: The University of Notre Dame, Australia – Sydney experience

The majority of society's deaths occur in a health care environment. Regardless of whether a death occurs in acute care, hospice, residential aged care or community settings, nurses are the health professionals that will spend the largest proportion of time with the patient who has a terminal condition and their families. As few nurses have specialist palliative care qualifications it is essential that nursing education prepares graduates to achieve the core capabilities required for the delivery of best evidenced based palliative care. This reality makes the integration of palliative care content into the undergraduate nursing curricula an important priority. This paper aims to describe how palliative care content has been embedded throughout the three-year University of Notre Dame Australia, Sydney (UNDA) undergraduate nursing degree. The School of Nursing at the University of Notre Dame Australia, Sydney campus is committed to ensuring that students graduate with the capabilities to deliver appropriate care to people with requiring end-of-life care. The establishment of this new School of Nursing coincided with the release of the 'The Palliative Care Curricula for Undergraduates Program' (PCC4U) learning resources. These resources have been integrated into relevant units across the three-year nursing curricula. The nursing curriculum has been design to supports the integration of palliative care knowledge into clinical practice. The Palliative Care Curricula for Undergraduates Program Learning resources offer engaging palliative care case studies and scenarios for academics to utilise. Adopting an iterative approach where palliative care content is spiralled across multiple units provides opportunities for undergraduate nursing students to sequentially build and consolidate their palliative care capabilities. Developing a new curricular provided an ideal opportunity to integrate and embed palliative care content into the undergraduate nursing degree. The next stage of the curriculum development is to explore inter-professional palliative care education opportunities. Evaluating the palliative care capabilities of our nursing graduates is also an important consideration. This paper provides practical suggestions for integrating palliative care education into an undergraduate nursing curriculum.

Developing leadership in rural interprofessional palliative care teams

This project brought together community-based practitioners and academics to develop and deliver interventions designed to enhance the leadership abilities of the designated leaders of seven rural/small town-based palliative care teams. Members of these community-based teams have already gained recognition for their teams' leadership and service delivery in their communities. All of the teams had worked closely with most members of the academic team prior to this project. The team members participated in a needs assessment exercise developed by the Sisters of Charity of Ottawa Health Service and University of Ottawa academic team. Results of the needs assessment identified leadership qualities that had contributed to their success, as well as their needs to further enhance their individual leadership qualities. The team effort, however, was the most important factor contributing to the success of their work. The interventions developed to address the identified needs had to be adapted creatively through the collaborative efforts of both the community and academic teams. The educational interventions facilitated the integration of learning at the individual and community level into the busy work schedules of primary health care providers.