Palliative Care for Providers

Palliative Care for Providers

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• Communicating with Patients and Families about Palliative Care
• Palliative Care in Texas
• Patient Qualifications for Palliative Care Services
• Pediatric Palliative Care
• Working With an Interdisciplinary Team

Whether caring for a patient who has been recently diagnosed with an advanced illness or standing by the bedside of a patient living their last moments, providing patient-centered, quality care is a fundamental role as a provider.

Palliative care is a patient-centered and family-focused care that provides an adult or child, of any age, with relief from symptoms, pain and stress of a serious illness. It addressespain management as well as social, spiritual and behavioral emotional health.complex symptom management including assistance with the emotional, social and spiritual suffering often associated with serious illness.It Palliative care may be offered to patients at the same time as treatments intended to cure or otherwise improve the underlying disease or may replace those treatments and even serve as a transition to hospice services. in hospice care or accompanied by other medical interventions during other attempts at curative medical interventions.

Two Branches of Palliative Care

[accordion]Supportive Palliative Care

This team-based care, a recognized specialty in the medical field, is designed to relieve suffering and improve the quality of life for patients and families facing a serious though not necessarily life-ending limiting illness. Supportive palliative care includes receiving curative,or remission-oriented or non-curative forms of treatment which include and comfort care at the same time.

Referral for Supportive Palliative Care

Supportive palliative care services may be offered from the first day of a patient's serious, chronic or life limiting diagnosis, and has been associated with improved survival with early referral in the setting of metastatic cancers..Even if survival is not improved, Bbeing able to discuss what is important to you and what your wishes are, also known as goals of care discussionsis are critical. For more information on how to get the conversation started, visit The Conversation Project, an Institute for Healthcare Improvement website about end-of-life care.

Hospice Care

Hospice, or end-of-life care, addresses the life-endinglast stage of a serious illness when no further curative or life-prolonging therapy is available or desired to be pursued by an adult patient or family member.

Referral for Hospice Palliative Care

Hospice referral services should be considered when the patient's life expectancy is six months or less. Studies have shown, should a patient meet criteria for hospice, the sooner they can receive hospice services, hospice services can greatly improve the quality of life for both patient, caregiver and family.

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To Learn More

For more information on the types of care that can be offered, visit HHSC's Palliative Care website. Guidelines for offering palliative care are available at the National Coalition for Hospice and Palliative Care website.

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Palliative Care in Texas

In 2014, only 43 percent of Texas hospitals with 50 or more beds offered organized specialized palliative care services, which was far below the national rate of 67 percent.

Through the work of thePalliative Care Interdisciplinary Advisory Council and other key stakeholders, the need to expand services and the number of palliative care providers has been brought to the attention of the Texas Legislature. The council assesses the availability of palliative care services and advises the Texas Health and Human Services Commission about matters related to palliative care so thatmore Texans can access quality care.

Benefits of Providing Palliative Care

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Benefits for Patients

Patients receiving palliative care:

• Experience less pain and other types of symptoms and perceived suffering. associated with serious illness.
• May desire to Hhave fewer hospital readmissions with adequate extra layers of support available at home.
• Often live longer after being diagnosed with metastatic cancer.
• Receive treatments that the patient feels is most consistent with desired goals and accommodate their wishes.[C(1]

Patients with serious illnesses often are not the only ones affected by pain and stress. Family members of patients also take on the demand of finding and providing care.Evidence-based benefits of palliative care for family members include:

• Less conflict and emotional distress.
• Improved family and patient satisfaction.
• Less depression.
• Better coping.
• Fewer post-traumatic stress symptoms.

Benefits for Providers

Benefits of palliative care for providers include:

• Help with extensive patient-family communications, coordination of care across settings and comprehensive discharge planning.
• Help with pain management and the comfort of patients with highly symptomatic and complex cases, in support of the treatment plan of the attending physician clinician.
• Promotion of patient and family satisfaction with the clinician’s quality of care.

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Working With an Interdisciplinary Team

Collaboration with other professionals and placing the patient at the center of treatment and comfort care makes palliative care an effective service. The following people can be part of palliative care teams:

• Physicians.
• Psychologists and psychotherapists.
• Advanced practice providers such as:advanced practice registered nursespractitioners and physician assistants.
• Social workers.
• Nurses.
• Pharmacists.
• Dieticians
• Chaplains.
• Child life specialists.
• Family members of the patient.
• Other health care providers such as respiratory therapists, physical therapists andoccupational therapists.

Working within an interdisciplinary team requires approaching treatment holistically. Aspects of health care that providers consider include:

• Providing emotional and spiritual support.
• Developing and maintainingopen communication with patients and families.
• Coordinating care among providers.

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Patient Qualifications for Palliative Care Services[C(2]

Based on theclinician referral guide from the Center to Advance Palliative Care’s website, Get Palliative Care, your patientpatients may qualify for palliative care servicesin one or more of the following situations:

Presence of a Serious or Chronic Illness

• Weight loss.
• Multiple hospitalizations.
• Do-not-resuscitate order conflicts.
• Limited social support due to factors such as homelessness or chronic mental illness.
• Patient or family psychological or spiritual distress.

Intensive Care Unit History

• Two or more ICU admissions within the same hospitalization.
• Multi-organ failure.
• Family distress that impairs surrogate decision making.
• Prolonged or difficult ventilator withdrawal[C(3].
• Consideration of patient transfer to a long-term ventilator facility.
• Oncology criteria.[C(4]
• Metastatic or locally advanced cancer [C(5]progressing despite systemic treatments with or without weight loss and functional decline.

Emergency Department Criteria

• Multiple recent prior hospitalizations with the same symptoms and problems.
• Long-term-care patient with do not resuscitateor comfort care orders.
• Patient preciously enrolled in a home or residential hospice program.
• Consideration of ICU admission or mechanical ventilation in a patient.

A more detailedlist can be found in theclinician’s section of the Get Palliative Care website.

Communicating with Patients and Families about Palliative Care

Having a conversation about palliative care services can be a challenge depending on the severity of the patient's health. It is important to understand and differentiate the types of services offered when recommending palliative care. Some guidelines are offered in the Center to Advance Palliative Care video, Palliative Care and the Human Connection: Ten Steps for What to Say and Do.

Quick Guideline for Palliative Care Communications

The acronym COMFORT, developed through the Pain and Palliative Care Resource Centerat City of Hope, is an easy way to remember seven key principles when having conversations with patients and their families:

• Communication is patient-centered and family-focused.
• Orientation and Opportunity takes into account health literacy and stresses cultural competency.
• Mindfulness emphasizes empathy and actively listening to the patient and family.
• Family takes into consideration family dynamics and their needs.
• Opening up allows for free and open communication.
• Relating to the patient and families helps a clinician work alongside families.
• Team values include clinical collaboration.

Various publications on COMFORT principles and palliative care communication skills can be found on the City of Hope website.

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Pediatric Palliative Care

Pediatric palliative care is a unique area of practice. Unlike adult palliative care, pediatric palliative care focuses on both quality of life and thedevelopmental stage of the child.

For more information and tips on communicating about pediatric palliative care, visit the National Institute of Health website Palliative Care: Conversations Matter and download the customizable tear-off pad, available in both English (PDF) and Spanish (PDF).The Center to Advance Palliative Care offers a Field Guide (PDF) with pediatric palliative care resources, tools and training.

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[C(1]Comment made: “It would be more accurate to say “Are more likely to receive treatments consistent with patient preferences and goals of care.”

[C(2]Comment made: “What seems to be missing from this list is the presence of severe symptom burdens associated with any serious illness. SPC teams spend at least half their time improving symptom burdens.”

[C(3]Comment made: Perhaps you mean “prolonged or difficult mechanical ventilation”?”

[C(4]Comment made: “I think Oncology criteria should be separate from ICU criteria.”

[C(5]Comment made: “Note that the American Society of Clinical Oncology recommends palliative care consultation within 8 weeks of a diagnosis of metastatic cancer. “