Developing the workforce to improve serious illness care


By Turner West

The shortcomings of the U.S. healthcare delivery system in meeting the needs of the seriously ill and their families is well documented. Seriously ill patients often experience intractable pain; bothersome symptoms; exacerbation in anxiousness, confusion, and helplessness; emotional, psychological, spiritual and existential pain; isolation and loneliness. Moreover, rather than providing relief from suffering, our healthcare delivery system often adds to the burden.

Recently, The Harvard T.H. Chan School of Public Health, the New York Times, and the Commonwealth Fund surveyed almost 1,500 Americans with serious illness and their caregivers and asked about experiences with the healthcare delivery system.

The responses show a healthcare system that is fragmented, expensive and burdensome. Respondents described receiving conflicting information on prognosis and treatment recommendations; duplicative tests and diagnostic procedures; receiving medical care discordant with goals, preferences, and values; and difficulty paying medical bills.

Improvements Being Made

While our healthcare delivery system continues to fail the seriously ill, improvements are being made. Specifically, the appreciable increase in palliative care services has been shown to dramatically improve the quality of life of seriously ill patients and their families. The Center to Advance Palliative Care defines palliative care as follows:

Palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

Numerous studies show expert palliative care teams reduce pain and symptom burdens, enhance the quality of life of the patient and family, increase advance care planning, and diminish non-beneficial utilization of healthcare services.

Ensuring Access

Bluegrass Care Navigators understands that patients, their families, referral sources, and partner organizations value our clinician’s expertise in pain and symptom management and ability to conduct skilled conversations about prognosis and goals of care.

In order to ensure our clinical teams are providing the highest quality palliative care, we set the following expectations:

  • 100 percent of physicians are board-certified or board eligible in hospice and palliative medicine.
  • 100 percent of nurses have advanced certification in hospice and palliative care or receive the designation in pain management through the Center to Advance Palliative Care.
  • 100 percent of social workers and chaplains have advanced certification in hospice and palliative care or receive designation in communication skills through the Center to Advance Palliative Care.

While Bluegrass Care Navigators is committed to increasing access to specialist level palliative care, there will not be enough palliative specialists to meet the growing number of seriously ill patients. More must be done to improve the skills of all clinicians encountering seriously ill individuals.

Enhancing Training and Education

In 2014, the Institute of Medicine released a report titled, Dying in America: Improving Quality and Honoring Individual Preferences Near End of Life. This consensus report included a range of key recommendations to improve serious illness care including a call to enhance the palliative care skills of the healthcare workforce.

Among these recommendations, the report urged that “educational institutions, professional societies, accrediting organizations, certifying bodies, healthcare organizations and medical centers take measures to increase the number of palliative care specialists and support the knowledge base of all clinicians caring for seriously ill persons.”

To improve the primary palliative care skills for all clinicians encountering seriously ill persons, the Center to Advance Palliative Care created an incredibly rich and engaging online curriculum on pain and symptom management and communication skills.

Healthcare organizations and academic institutions should consider investing in improving the primary palliative care skills of their workforce and students as high-quality curriculum are readily accessible.

-Turner West is associate vice president of Health Policy and director of the Palliative Care Leadership Center at Bluegrass Care Navigators.