Palliative Care Leadership Research Articles

Using the consolidated framework for implementation research to evaluate facilitators and barriers to early outpatient specialty palliative care in patients with advanced cancer.

12105 Background: Prior studies have shown that integration of early outpatient specialty palliative care (OSPC) with oncologic care improves patient’s symptom burden and quality of life. As a result, the American Society of Clinical Oncology (ASCO) recommends that OSPC be offered within 8 weeks of diagnosis of an advanced solid malignancy. Over the past decade, there has been an increase in the availability of OSPC services, particularly at National Cancer Institute (NCI)-designated cancer centers; however, the majority of OSPC referrals still occur late in the disease course. The aim of this study was to evaluate the facilitators and barriers to implementation of early OSPC. Methods: To assess the contextual determinants of early OSPC implementation, we developed a survey based on constructs from the Consolidated Framework for Implementation Research (CFIR), an implementation meta-framework. Using input from subject-matter experts, we tailored the survey to include a total of 18 relevant constructs from the 5 CFIR domains. The survey was distributed to the ambulatory palliative care (PC) clinical leader at NCI-designated cancer centers. The survey assessed each CFIR construct using a 5-point Likert Scale, where +2 represented the strongest facilitators, and -2 represented the strongest barriers. We inquired about respondent sociodemographics and OSPC clinic characteristics and used descriptive statistics to summarize responses to survey items. Results: Survey responses were collected between 12/15/21 and 1/18/22. Of the 63 NCI-designated cancer centers invited to participate, 40 (63%) completed the survey, while 3 (5%) did not due to not having an ambulatory program. All respondents were physicians. Half of the OSPC clinics were established for more than 10 years, and the majority (75%) provided care to more than 300 distinct outpatients annually. The most commonly agreed upon facilitators (Likert score = 1 or 2) to early OSPC included PC clinicians’ awareness of the ASCO recommendation for early OSPC (100%), informal communication between PC and oncology clinicians (100%), PC clinicians’ belief that OSPC improves the quality of oncology care (100%) and access to telemedicine (93%). The most commonly agreed upon barriers (Likert score = -1 or -2) included inadequate number of OSPC providers (73%) and lack of performance metric goals relating to early OSPC set by PC leadership (65%). Conclusions: Although OSPC clinics at NCI-designated cancer centers have grown over the last ten years, the utilization of early OSPC is impacted by the implementing institution’s resource availability, interdepartmental communication, stakeholder beliefs, and leadership engagement. Future studies should compare the barriers and facilitators of early OSPC identified by PC clinicians and oncologists to inform implementation strategies.

Palliative Care Nursing Development in the Middle East and Northeast Africa: Lessons From Oman.

Nurses are on the frontline of palliative care, and in some countries, are the only contact for patients and families facing life-threatening illness. The Oman Cancer Association in the Sultanate of Oman, in collaboration with the Middle Eastern Cancer Consortium and the Oncology Nursing Society, led a palliative care initiative over the past decade to better integrate palliative care into the health care system. Components of this initiative include integrating palliative care into the health care curricula and providing palliative care education to over 400 nurses and other health care professionals within Oman. The four-part education series includes the following courses: (1) Foundations of Palliative Care, (2) Advanced Concepts in Palliative Care, (3) Palliative Care Leadership, and (4) Palliative Care Research. Additional participants from 17 different countries in the Middle East and northern Africa also attended the training. Twenty of the trainees who were considered palliative care leaders in their countries then participated in a Train the Trainer course. This group trained the last cohort of health care professionals in Oman and then took learned concepts and strategies back to their respective countries in order to provide country-wide education and build palliative care capacity in the region. Outcomes include the development of palliative care units, quality improvement projects that improved care, and advocacy projects to increase opioid availability within some countries. The collaborative continues its work and connections through social medial, email, and virtual collaboration. Other countries can use this model to permeate palliative care within their regions.

Women Physicians in Palliative Care Leadership.

Women Physicians in Palliative Care Leadership.

The Cambia Sojourns Scholars Leadership Program: Projects and Reflections on Leadership in Palliative Care.

Background: Effective leadership is necessary to meet the complex care needs of patients with serious, life-limiting illness. The Cambia Health Foundation Sojourns Scholars Program is advancing leadership in palliative care through supporting emerging leaders. The 2016 Cohort has implemented a range of projects to promote their leadership development. Objective: To describe the leadership themes emerging from individual project implementation of the 2016 Sojourns Leadership. Methods: We summarize the synthesized leadership themes derived from both remote and in-person meetings and written reflections of the 2016 Cambia Sojourn Leadership Cohort. Results: The 2016 Cambia Sojourn Leadership Scholar Cohort projects are described. We identified three leadership themes related to palliative care initiatives: openness and flexibility, partnership and team building, and leveraging expertise and risk. Discussion: Unprecedented challenges in a rapidly changing health environment demand palliative care leadership to influence care quality, delivery, policy, and clinical care. Flexibility and openness; partnership and team building; and expertise to implement change emerged as critical themes to advancing the care of patients with serious, life-limiting illness. These leadership themes are consistent with both previous Cambia Sojourns Scholar cohorts and the literature, are essential for the next generation of leaders to implement new models of quality palliative care, payment for palliative care, and education for patients, caregivers, and health care providers. Conclusion: In order to design and implement quality palliative care, leadership development is essential. Use of flexibility and openness; partnership and team building; and expertise to implement change are important themes for success. Whether through the Cambia Health Foundation Sojourns Leadership Program or opportunities within professional organizations, cultivation of the next generation of leaders is critical.

The palliative APRN leader.

Advanced practice registered nurses (APRNs) are leaders in clinical practice, systems-level care delivery, nursing practice, and policy. The challenge is that in the current environment, their leadership is not highlighted. With the national shortage of palliative care clinicians, APRN leaders will be necessary to care for all the patients and their families with serious illness. While many programs describe their APRNs as leader in clinical care, there is not much written about their leadership in other areas. This paper provides a description of APRN palliative care leadership and opportunities across all domains of clinical care, education, advocacy/policy, research, and administration/management.

Palliative Care Leadership in Long-Term Care: Who Are the Leaders and What Are Their Capabilities?

Palliative Care Leadership in Long-Term Care: Who Are the Leaders and What Are Their Capabilities?

Palliative Care Leadership.

Palliative care is one of the newer health specialties and continues to mature. While there has been remarkable progression of clinical skills and education, there has been a lack of focus on palliative care interdisciplinary leadership or development of leadership skills. This article highlights the importance of interdisciplinary palliative leadership within the 5 realms of clinical practice, research, education, policy/advocacy, and administration. A definition of leadership is offered and discussion of successful leadership skills is described. A current review of leadership opportunities is provided.

Palliative Care Leadership Centers Are Key To The Diffusion Of Palliative Care Innovation.

Between 2000 and 2015 the proportion of US hospitals with more than fifty beds that had palliative care programs tripled, from 25percent to 75percent. The rapid adoption of this high-value program, which is voluntary and runs counter to the dominant culture in US hospitals, was catalyzed by tens of millions of dollars in philanthropic support for innovation, dissemination, and professionalization in the palliative care field. We describe the dissemination strategies of the Center to Advance Palliative Care in the context of the principles of social entrepreneurship, and we provide an in-depth look at its hallmark training initiative, Palliative Care Leadership Centers. Over 1,240 hospital palliative care teams have trained at the Leadership Centers to date, with 80percent of them instituting palliative care services within two years. We conclude with lessons learned about the role of purposeful technical assistance in promoting the rapid diffusion of high-value health care innovation.

Leadership Development Initiative: Growing Global Leaders… Advancing Palliative Care

The International Palliative Care Leadership Development Initiative (LDI) was a model demonstration project that aimed to expand the global network of palliative care leaders in low- and moderate-resource countries who are well positioned to apply their new leadership skills. Thirty-nine palliative medicine physicians from 25 countries successfully completed the two-year curriculum that included three thematic residential courses, mentorship, and site visits by senior global palliative care leaders and personal projects to apply their new leadership skills. The focus on self-reflection, leadership behaviors and practices, strategic planning, high-level communication, and teaching skills led to significant personal and professional transformation among the participants, mentors, and the LDI team. The resulting residential course curriculum and the personal leadership stories and biosketches of the leaders are now available open access at IPCRC.net. Already, within their first-year postgraduation, the leaders are using their new leadership skills to grow palliative care capacity through significant changes in policy, improved opioid/other medication availability, new and enhanced educational curricula and continuing education activities, and development/expansion of palliative care programs in their organizations and regions. We are not aware of another palliative care initiative that achieves the global reach and ripple effect that LDI has produced.

Pathways, partners and payers: The trifecta of palliative care integration.

129 Background: Moffitt Cancer Center has developed proprietary oncology clinical pathways. Multiple external partnership agreements which require adoption of these pathways have been completed. Our Center has enacted new cancer care delivery and payment arrangements with payers to foster cost and quality balance via use of the pathways and earlier involvement of palliative care (PC). Methods: Executive and PC leadership collaborated with the clinical pathways and strategic alliance teams to identify high priority disease states for integration of PC. Working with oncologist pathway developers, critical junctures in the pathways for inclusion of PC consultation were proposed and refined. EHR mechanisms to promote pathway adherence by clinicians were initiated. The value of pathway utilization and care coordination to involve PC was promoted to prospective oncology partners and payers. Results: PC has been mandated in oncology clinical care pathways, with a focus on thoracic, breast, gastrointestinal, prostate, gynecologic and hematologic malignancies, as directed by specific payer arrangements. Partnerships have expanded, resulting in greater utilization of PC by other centers as well. Increased referral volumes to PC, broader symptom control, and enhanced advance care planning have resulted. Conclusions: Incorporation of PC in oncologic clinical care pathways, with dissemination to internal providers, external partners and as part of novel payment models, optimizes PC integration. [Table: see text]

Culture Change at the Systems Level: Implementing a Palliative Care “Bundle” (TH301)

1.Know key elements of bundle construction.2.Define palliative care in the context of a bundle project.3.Apply the bundle method to a key hospital palliative care initiative. The Greater New York Hospital Association (GNYHA) Palliative Care Leadership Collaborative (PCLC) brought together 35 hospitals across the greater NY region to implement and measure the impact of a standardized set of best practices for palliative care. Participating hospitals selected a cohort of patients on which to focus their efforts, develop and institute a process for identifying those patients, apply a set of actionable care and treatment guidelines, and document the provision of key palliative care services. These elements of the palliative care “bundle” were consensus-derived by an advisory group comprised of a subset of GNYHA's Palliative Care Leadership Network, a forum of regional palliative care experts. Hospital teams, with the support of GNYHA staff, shared best practices and educational resources, as well as supported one another in overcoming common challenges and barriers, through didactic learning sessions, conference calls, data collection, and analysis to measure progress. The aim of the PCLC is to help hospital teams build sustainable and entrenched palliative care programs, increase their capacity to identify and provide palliative care services to all appropriate patients, and comply with laws regarding palliative care, and to poise them to seek advanced certification status from The Joint Commission. During this session, we will share methodology, results, and lessons learned from this 2-year initiative.

Report of the Geriatrics – Hospice and Palliative Medicine Work Group: American Geriatrics Society and American Academy of Hospice and Palliative Medicine Leadership Collaboration

Although the fields of hospice and palliative medicine and geriatrics have developed from separate origins, they share much in common. They share concerns for optimizing care of older adults with advanced illness. They both seek to address the common problem of care fragmentation for those with chronic illness. Both subspecialties see the patient and their loved ones as a unit requiring thoughtful, integrated care, rather than seeing the patient as a cluster of organ systems and conditions. The fields also share many core principles, including an emphasis on interdisciplinary care and care coordination. As increasing emphasis is placed on the medical home, chronic and advanced illness care, and systems changes to decrease care fragmentation, geriatrics and hospice and palliative medicine stand to benefit by blending efforts and common interests to improve care for patients and their loved ones. In 2009, a collaborative effort was begun involving the leadership of the American Geriatrics Society, the American Academy of Hospice and Palliative Medicine, and the John A. Hartford Foundation. The goal of the collaboration was to convene leaders in geriatrics and hospice and palliative medicine to identify areas of potential synergy between the two subspecialties and to design a plan for exploring and developing these areas of common interest. This article describes the progress of the collaborative effort to date.

A role for spirituality in palliative care leadership

A role for spirituality in palliative care leadership

Networking Opens Doors for Palliative Care, Say Doctors in Rural Practices

Networking Opens Doors for Palliative Care, Say Doctors in Rural Practices

Palliative care pharmacists consider patients’ psychosocial issues

The ASHP Statement on the Pharmacist’s Role in Hospice and Palliative Care declares social workers the team member responsible for the psychosocial care of patients and their families. But some pharmacists practicing on palliative care teams have found that managing the medication needs of these patients necessitates knowing their psychosocial issues. “I do not think of being a pharmacist on the palliative care team as just being a pharmacist or just drug management,” said Thomas Bookwalter, pharmacist for the palliative care service at Long Hospital, part of the medical center of the University of California, San Francisco (UCSF). One of six Center to Advance Palliative Care-designated Palliative Care Leadership Centers, the UCSF service provides training for hospitals starting such a program. The service received a 2007 Circle of Life Award from the American Hospital Association for innovation in palliative and end-of-life care. “People make long ambulance rides from San Francisco to where they originally came from and [have] anxiety and concern about the pain during the trip, for example, or the anxiety during the trip,” Bookwalter said. “As a pharmacist, I have to recognize that and do what I can to alleviate the situation, make it better, because the patient’s comfort is the goal.”

A Quality Improvement Intervention to Increase Palliative Care in Nursing Homes

Death is common in nursing homes, but access to palliative care is limited. To test whether a quality improvement (QI) intervention in nursing homes increases hospice, pain management, and advance care planning. The QI intervention was tested in seven nursing homes using a prepoststudy design. Two additional nursing homes served as control sites. Nine nursing homes serving 1169 residents. The intervention included recruitment and training of Palliative Care Leadership Teams in each facility, followed by six technical assistance meetings for team members. Hospice providers delivered six educational sessions for all nursing home staff using a structured curriculum. Teams received feedback of performance data on hospice enrollment, pain management, and advance care planning at 0, 3, and 6 months. Percentage of residents receiving hospice or palliative services, pain assessment, pain treatment among residents in pain, and documented advance care planning discussions. Intervention facilities increased hospice enrollment from 4.0% of residents at baseline to 6.8% postintervention (p = .01) and increased pain assessments from 18% to 60% (p < .001). Among resident in pain, orders for nonpharmacologic pain treatments increased from 15% to 35% (p < .001), but pain medication use did not change. Residents with in-depth discussions about end-of-life care increased from 4% to 17% (p < .001). There were no significant changes in control sites. A quality improvement intervention was effective in increasing hospice enrollment, pain assessment, nonpharmacologic pain treatment, and advance care planning discussions.