title: Integrating Palliative Care to Promote Earlier Conversations and to Increase the Skill and Comfort of Nonpalliative Care Clinicians: Lessons Learned From an Interventional Field Trial.
abstract: While the uptake of palliative care in the United States is steadily improving, there continues to be a gap in which many patients are not offered care that explicitly elicits and respects their personal wishes. This is due in part to a mismatch of supply and demand; the number of seriously ill individuals far exceeds the workload capacities of palliative care specialty providers. We conducted a field trial of an intervention designed to promote the identification of seriously ill patients appropriate for a discussion of their goals of care and to advance the role of nonpalliative care clinicians by enhancing their knowledge of and comfort with primary palliative care skills. At 3 large Midwestern academic medical centers, a palliative care physician or nurse clinician embedded with a selected nonpalliative care service line or unit on a regularly scheduled basis for up to 6 months. Using agreed-upon criteria, patients were identified as being appropriate for a goals of care conversation; conversations with those patients and/or their families were then conducted with the palliative care specialist providing education, coaching, and mentoring to the nonpalliative care clinician, when possible. All of the sites increased the presence of palliative care within the selected service line or unit, and the nonpalliative care clinicians reported increased comfort and skill at conducting goals of care conversations. This intervention is a first step toward increasing patients' access to palliative care to alleviate distress and to more consistently deliver care that honors patient and family preferences.
authors.affiliation: 1 Vizient, Inc, Chicago, IL, USA.
authors.forename: Marilyn K
authors.initials: MK
authors.lastname: Szekendi
authors.affiliation: 1 Vizient, Inc, Chicago, IL, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Vaughn
authors.affiliation: 2 UH Cleveland Seidman Cancer Center, Cleveland, OH, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: McLaughlin
authors.affiliation: 3 University of Kansas Health System, Kansas City, KS, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Mulvenon
authors.affiliation: 3 University of Kansas Health System, Kansas City, KS, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Porter-Williamson
authors.affiliation: 2 UH Cleveland Seidman Cancer Center, Cleveland, OH, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Sydenstricker
authors.affiliation: 4 University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Williamson
mesh_terms: D000046:Academic Medical Centers; D003142:Communication; D006739:Hospital Administration; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D010166:Palliative Care / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D010817:Physician-Patient Relations; D014481:United States
keywords: coaching nonpalliative care clinicians; embedding palliative care; expanding access to palliative care; multisite field trials; palliative care integration; primary palliative care