Palliative Care Workforce: Team Composition Across Settings

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.

For more information, contact: Joanne Spetz, PhD, Director, UCSF Health Workforce Research Center on Long-Term Care, [email protected]


Spetz, J, Dudley, N, Trupin, L, Rogers, M, Meier, DE, Dumanovsky, T. Few Hospital Palliative Care Programs Meet National Staffing Recommendations. Health Affairs, September 2016, 35(9): 1690-1697.

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.

Dudley, N, Chapman, S, Spetz, J. Community-Based Palliative Care Leader Perspectives on Staffing, Recruitment, and Training. Journal of Hospice and Palliative Nursing, 2018, 20(2): 146–152.

To assess perspectives of US community-based palliative care program leaders on staffing, recruitment, and training, a qualitative descriptive study was conducted. Leaders (n = 20) from academic medical centers, large integrated and community health systems, home health and hospice organizations, and the Veterans Administration were recruited. Three major categories emerged that influence community-based palliative care workforce team composition across settings: (1) staffing models and recruitment are influenced by setting and workforce experience, (2) training varies by setting, and (3) demand exceeds supply of trained workforce. Participants described a hybrid approach used in academic and community settings to complete an interdisciplinary team by leveraging social work and chaplaincy from inpatient departments and home health and hospice. Physician-led interdisciplinary teams in academic settings and teams more often led by nurse practitioners in community settings were reported. Community program leaders expressed the desire to recruit nurses with home health and hospice experience because of the ability to work independently. Training was described as more often on-the-job in community settings. Turnover related to the lack of a properly trained workforce was described as one of the biggest barriers to palliative care development.