Interdisciplinary team, ‘loved-one standard’ can improve equitable access to palliative care
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Advancing equitable access to palliative care will require interdisciplinary collaboration and effective communication, according to several leaders in the field.
Further incorporation of palliative care into medical training also is essential, members of an Association of Cancer Care Center (ACCC) panel emphasized.
ACCC president Nadine J. Barrett, PhD, MA, MS, FACCC, moderated the session, in which internationally recognized palliative care specialists discussed barriers to access for underserved populations and how the emerging specialty can become better integrated into oncology practice.
“In its reach of underserved populations — particularly minoritized racial and ethnic groups — palliative care is not very different from anything else in our continuum of health care,” said panelist Kimberly S. Johnson, MD, MHS, Brenda E. Armstrong, MD, distinguished professor of medicine in the division of geriatrics and palliative care at Duke Health. “We see the same kinds of disparities that we see starting from birth all the way to the end of life. As we think about interventions to improve equitable access and delivery of palliative care, we have to remember it occurs in a continuum and, really, a context in which some groups of people receive poorer quality of care. We are not exempt from that in our field.”
The ‘loved-one standard’
When developing and implementing a palliative care program within an institution, the panelists emphasized the need to create a high-quality interdisciplinary program that provides patient-centered care across the cancer journey.
Panelist Ramona Rhodes, MD — associate professor of internal medicine at The University of Texas Southwestern Medical Center — discussed some of her observations as a health services researcher who has studied palliative care utilization and access among Black patients and those who receive care in safety net hospitals.
“I’ve seen organizations attempt to create palliative care programs that don’t really recognize the emphasis and the importance of the interdisciplinary team in helping to craft a plan of care for patients and their caregivers that helps them to move across the continuum of their lives,” Rhodes said. “Those are the things I would think about in terms of palliative care, [which] I still believe is an emerging specialty.”
Panelist Declan Walsh, MD, chair of the department of supportive oncology at Atrium Health’s Levine Cancer Institute, discussed another unique concept that can guide the development of palliative care programs.
“One of the concepts that has recently come to the fore in our own cancer center has been the idea of the ‘loved-one standard,’” he said. “In other words, if it was a family member of yours who was affected by a particular illness, what would you want for them?”
Institutions need to make these standards an organizational priority, and they must be willing to make the necessary investment to achieve these goals, Walsh said.
“It’s not enough to have a physician — we need others on the interdisciplinary team, such as chaplains, social workers and so on,” he said. “Making that commitment to achieving the highest possible standards — and internationally recognized standards — for interdisciplinary care has to be part of that commitment.
“This is an investment in whole-person cancer care,” he added. “That really should drive what any modern health care system is hoping to accomplish.”
To truly provide the best palliative care, institutions need to adopt a wider approach to a patient’s serious illness, Walsh said. They also must prioritize providing high-quality palliative care regardless of the outcome of the illness.
“That is the ‘secret sauce’ in getting palliative care to the forefront of modern health care,” he said.
Normalizing palliative care
The panelists also emphasized the need to normalize palliative care as a part of quality oncology care, rather than presenting it as a separate phenomenon associated with the end of life.
Walsh discussed the importance of discussing palliative care early, and characterizing it as an addition to the care plan rather than a subtraction or loss.
“For vulnerable or underserved populations, the idea that you would take away certain aspects of medical care in order, for example, to access hospice, was an unwelcome message,” he said. “For those in the population who may have had adverse interactions in the past with the health care system, that raises questions in their minds about what they are being offered.”
Black patients and those from other racial or ethnic minority backgrounds are less likely to receive adequate pain and symptom management, Johnson said. They also have lower rates of advanced care planning, and Black patients also report lower levels of satisfaction with provider communication and shared decision-making, she added.
In her initial interactions with patients, Johnson is careful to present palliative care as providing benefit rather than signaling the end of life.
“As a physician, I certainly find myself spending that introductory time explaining what I do and refraining from using anything that suggests that there are things they will not be able to access because of my presence,” she said. “I highlight that we will work with their team, and that we can still improve quality of life even while the patient is still receiving curative therapy.”
Johnson said she would like to see physicians in all specialties become more conversant in palliative care, especially in the context of underserved populations.
“There is an opportunity for providers to recognize that not all patients will have the opportunity to see someone who has training in palliative care,” she said.
There is a need to consider “the basic skills in pain management or communication that all providers should be trained to deliver, so they can reinforce issues of quality and equity when they see patients in front of them,” she added.
Reference:
- Palliative care in oncology: Challenges and opportunities. Available at: https://vimeo.com/1029788148. Published Nov. 14, 2024. Accessed Nov. 19, 2024.
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