10 Things Hospitalists Need to Know about Palliative Care

The Hospitalist. 2016 October;2016(10):

October 19, 2016 | The Hospitalist

Different palliative-care programs provide different services.

It is important for hospitalists to learn their local palliative-care programs and what they emphasize and are able to offer—or not, says Dr. Sinclair.

“There are so many different models,” he says. “Spend some time reaching out to them, outside of actual consults, and find out what their comfort level is on various issues. Hospitalists and palliative-care teams should get to know each other better.”

Access to palliative care and the comprehensiveness of the team and services can vary between hospitals, while access to community-based palliative care outside of the hospital is even more variable.

“Palliative-care teams often have a better sense of our partners in the community and access to community-based palliative care,” Dr. Fischberg says.

Hospitalists Are Important Providers of Basic Palliative Care

Palliative care experts see a growing role for hospitalists and primary-care physicians in addressing basic palliative-care needs in their patients, reserving the palliative-care specialist for more challenging cases.

“Hospitalists should be competent in basic pain and symptom management, the ability to discuss code status, and the shift to focusing on comfort care. They should be able to give prognosis and make recommendations. If you do that first and it doesn’t work, then call us,” says Robert Crook, MD, FACP, associate medical director of Mount Carmel Hospice and Palliative Care in Columbus, Ohio.

—Larry Beresford

Where to Learn More

Experts recommend seeking the mentorship of a specialist such as a palliative care program’s medical director and shadowing the palliative care team for a few days to observe the process of breaking bad news and clarifying patient and family goals for care.

There are a lot of other places for hospitalists to learn more and refine their palliative care skills, including at SHM’s annual meeting and other hospitalist conferences.

“SHM has been a good supporter of palliative-care education,” says Christian Sinclair, MD, assistant professor in the division of palliative medicine at the University of Kansas Medical Center in Kansas City.

Other resources that hospitalists might find helpful:

AAHPM offers a variety of resources for physicians and information. Its next annual assembly is February 22–25, 2017, in Phoenix.
The EPEC Project (Education in Palliative and End-of-Life Care), based at Northwestern University, offers several curricula for professional education in palliative care.
Four new Palliative Care Leadership Centers were announced last year by the Center to Advance Palliative Care, joining seven existing sites that offer training for hospital palliative-care teams.
Harvard Medical School’s Center for Palliative Care offers an intensive two-and-a-half-day course, “Palliative Care for Hospitalists and Intensivists,” for those who are interested in improving their palliative-care skills. The next course will be March 16–18, 2017.

–Larry Beresford

References

Morrison RS, Meier DE. America’s Care of Serious Illness: 2015 State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals. New York, NY: Center to Advance Palliative Care; 2015.
American Academy of Pediatrics. Policy statement: pediatric palliative care and hospice care commitments, guidelines, and recommendations. Pediatr. 2013;132(5):966-972.
Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783-1790.
Temel JS, Greer JA, Muzikansky et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.