Team: Joanne Spetz (UCSF), Laura Trupin (UCSF), Jeff Newman (UCSF), Christine Ritchie (UCSF), Nancy Dudley (UCSF), and Tamara Dumanovsky (Center to Advance Palliative Care)
Palliative care is specialized care for people with serious illness that focuses on improving quality of life for patients and their families. It provides patients of any age with relief from the symptoms, pain, and stress of a serious illness— whatever the diagnosis. Palliative care is provided by a team of physicians, nurses, social workers, pharmacists, chaplains, and other clinical and non-clinical specialists who work together with primary care providers to provide an extra layer of support. Palliative care can be provided along with curative treatment. A large share of U.S. hospitals offer palliative care services. In 2012, 61% of hospitals with 50 or more beds had a palliative care program. Up to this time, little had been known about the extent to which palliative care is available elsewhere, or the extent to which the workforce is prepared to meet palliative care needs. There had been little attention to the national palliative care workforce, apart from research on the supply of palliative care specialist physicians.
This project produced a detailed analysis of the data available on hospital-based programs, and also produced qualitative findings that could be used to guide a national survey of community-based programs. This study was being conducted in collaboration with the Center to Advance Palliative Care.
The predominant model for palliative care delivery, outside of hospice care, is the hospital-based consultative team. Although a majority of US hospitals offer palliative care services, there has been little research on the staffing of their program teams and whether those teams meet national guidelines, such as the Joint Commission’s standard of including at least one physician, an advanced practice or other registered nurse, a social worker, and a chaplain. Data from the 2012–13 annual surveys of the National Palliative Care Registry indicate that only 25 percent of participating programs met that standard based on funded positions, and even when unfunded positions were included, only 39 percent of programs met the standard. Larger palliative care programs were more likely than smaller ones to include a funded physician position, while smaller programs were more reliant upon advanced practice and registered nurses. To meet current and future palliative care needs, expanded and enhanced education, as well as supportive financing mechanisms for consultations, are needed.