Study results serve as ‘call to action’ to increase investment in palliative care

Only one-fourth of U.S. hospitals complied with established quality standards for having a fully staffed palliative care team, according to study results published in Health Affairs.

“What we wanted to do with this study was underscore the gap between what this patient population needs based upon consensus quality guidelines and what is actually happening in hopes it will be a call to action for health system leaders to appropriately invest in staff training and capacity for these programs,” Diane E. Meier, MD, director of the Center to Advance Palliative Care and a HemOnc Today Editorial Board member, said during an interview.

Diane E. Meier

Meier and colleagues pooled data from the National Palliative Care Registry on staffing of palliative care programs in hospitals during 2012 and 2013. Data indicated that nearly 18,000 additional palliative care physicians would be needed to meet the needs of existing palliative care programs in the United States.

Meier spoke with HemOnc Today about the findings and the impact she hopes they will have on palliative care programs across the country.

Question: How did the idea for this study come about?

Answer: The Center to Advance Palliative Care has an established National Palliative Care Registry whose business is to gather data on both the prevalence and the characteristics of palliative care programs across the country. Our registry initially solely focused on hospitals, and it more recently expanded to community settings like home care and nursing home care. Our study was based upon hospital data alone. The purpose of the registry is not only to say how many programs are out there and where they are, but also what the quality of these programs is. Do they need national quality guidelines? Are they adequately and appropriately staffed to meet the needs of such a seriously ill and complex population? Does the staff have the appropriate training? The purpose of our study was to look at staffing levels within hospital palliative care programs and assess the extent to which they were concordant with national quality guidelines.

Q: Were you surprised by the results ?

A: I was not surprised by these findings because palliative care remains an under-resourced and underinvested field. Our hope in analyzing and reporting these data is that it will draw attention to the importance of adherence to quality standards and quality guidelines in any clinical program. The analogy in my mind is if you were setting up an operating room suite and you decided not to include a scrub nurse because you were trying to save money. Well, what kind of quality surgery would you get out of this? No hospital or health system would consider understaffing their operating rooms, their bone marrow transplant units or their ICUs for fear of poor-quality outcomes and harm to vulnerable patients. Palliative care teams care for the most complex and seriously ill patients in any health system. Understaffing these teams is equally unacceptable.

Q: What needs to be done to improve palliative care programs ?

A: We need to know the percentage of staff that are well trained and certified in the field. The next step would be to show the impact of the team on the care of patients. It is not enough to say that you have a palliative care team, you have to show that it is actually a full team and is fully staffed, available 24/7, and actually reaching the 5% to 10% of patients in the system who need this added layer of support. These are the future priorities and agendas for improving quality of, as well as access to, palliative care. Identifying if facilities even have the necessary core discipline on their team is the first step.

Q: How might these findings change the way patients with cancer are cared for?

A: Many palliative care programs are understaffed and not adequately resourced to have staff that meet national quality standards for high-quality palliative care. Because many patients with cancer suffer from significant symptom, practical and family caregiver burdens both during and after cancer treatment, the Commission on Cancer and ASCO have established concurrent palliative care as the standard of care, especially for patients with advanced disease. Multiple studies have demonstrated better quality of life and survival, and lower rates of preventable emergency department visits and hospitalizations — both in patients with solid tumors and hematologic malignancies. The question is, given these research findings, why is not every patient with cancer receiving concurrent palliative and cancer care?

Q: Are you and colleagues planning additional research on this topic?

A: We will be using this and other registries to shine a light on both the growth, strength, weaknesses and the gaps confronting this rapidly expanding field. Our goal is to ensure that all people living with a serious illness — and their families — not only have access to palliative care, but that the palliative care they do receive is of the highest possible quality. – by Jennifer Southall

For more information:

Diane E. Meier, MD, can be reached at Center to Advance Palliative Care, 55 W. 125th St., Suite 1302, New York, NY 10027;email: diane.meier@mssm.edu.

Reference:

Martin AB, et al. Health Aff. 2016;doi:10.1377/hlthaff.2016.0113.

Disclosure: Meier reports no relevant financial disclosures.