Generalist plus Specialist Palliative Care - Creating a More Sustainable Model

From the Department of Medicine, Palliative Care Division, University of Rochester Medical Center, Rochester, NY (T.E.Q.)
New England Journal of Medicine (Impact Factor: 55.87). 03/2013; 368(13). DOI: 10.1056/NEJMp1215620
Source: PubMed


Palliative care, a medical field that has been practiced informally for centuries, was recently granted formal specialty status by the American Board of Medical Specialties. The demand for palliative care specialists is growing rapidly, since timely palliative care consultations have been shown to improve the quality of care, reduce overall costs, and sometimes even increase longevity.1,2 The field grew out of a hospice tradition in which palliative treatment was delivered only at the end of life, but its role has expanded so that palliative care specialists now also provide palliative treatment in the earlier stages of disease alongside disease-directed . . .

    • "Nurse case managers with specific expertise in palliative care have been introduced to help patients and their informal carers obtain the palliative care that matches their preferences. Primary palliative care in the Netherlands is an example of a model of care where generalist and specialist palliative care providers work together (Quill & Abernethy 2013). "
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    ABSTRACT: Aims. To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. Background. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Design. Cross-sectional questionnaire study. Methods. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011–December 2013. Results. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. Conclusion. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses.
    No preview · Article · Sep 2015 · Journal of Advanced Nursing
    • "With the majority of people dying outside of specialised palliative care units, there is increasing emphasis on a palliative approach to care (Stajduhar, 2011). A palliative approach emphasises the important role that primary palliative care plays in relation to specialist palliative care (Quill and Abernethy, 2013). The supportive principles of palliative care are applied early in the disease trajectory and adapted for those living with life-limiting chronic illnesses across contexts of care (e.g. "
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    ABSTRACT: The aim of this mixed-method study was to evaluate the outcomes of an educational intervention in a palliative approach for rural nurses and health-care workers (HCWs) using a team-based method. Pre- and post-test measures using the Palliative Care Nursing Self-Competence (PCSNC) scale and the Self-Perceived Palliative Care Knowledge instrument were used to evaluate learning outcomes. Participant post-test scores were also compared to normative provincial data. At post-test, HCWs showed statistically significant improvements across 7 of 10 domains in self-perceived competence and 6 of 12 domains in self-perceived knowledge; all scores were equivalent to or better than provincial normative data. Nurses' self-perceived knowledge showed statistically significant improvements in 3 of 12 domains; all post-test scores were equivalent to provincial normative data. Qualitative data indicated improvements in familiarity with the resources available for palliative care and in communication among the nursing team. An educational intervention can improve the competence and knowledge of rural HCWs and nurses in a palliative approach.
    No preview · Article · Mar 2015 · International journal of palliative nursing
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    • "A growing body of evidence suggests that educating staff about the value of proactive palliative care delivered throughout a continuum of care and not just at the end of life will promote quality of life, enhance symptom management, and enable care providers to better address the biopsychosocial-spiritual aspects of a patient's illness experience (Dahlin, 2013; Temel et al., 2010). Given the shortage of available palliative care-certified physicians, recent literature has focused on potential strategies to meet the expected needs of a growing population of patients with serious illness, including cancer patients (Cheng et al., 2013; Quill & Abernethy, 2013; Weissman, 2012). These authors strongly suggest that the solution likely lies in raising the above-noted skills of all oncology practitioners in ''generalist'' palliative care, while simultaneously establishing access to ''specialist'' palliative care and defining appropriate guidelines for referral to this care. "
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    ABSTRACT: The Institute of Medicine (IOM) Report—Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs—provided recommendations for meeting the palliative care needs of our growing population of older Americans. The IOM report highlights the demand for social work leadership across all aspects of the health care delivery system. Social workers are core interdisciplinary members of the health care team and it is important for them to be well prepared for collaborative leadership roles across health care settings. The ExCEL in Social Work: Excellence in Cancer Education & Leadership education project was created as a direct response to the 200815. Institute of Medicine. (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: National Academies Press.View all references IOM Report. This article highlights a sampling of palliative care projects initiated by outstanding oncology social work participants in the ExCEL program. These projects demonstrate the leadership of social workers in palliative care oncology.
    Full-text · Article · Oct 2014 · Journal of Social Work in End-of-Life & Palliative Care
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