Providing hospital palliative care services to our nation′s most seriously ill patients is a critical component of health care. People with serious illness need relief from debilitating physical and emotional symptoms and better overall quality of care. To that end, they must be able to access a palliative care program in their local hospital, and medical trainees—our future doctors—must receive training within well-established hospital palliative care programs.
Following are recommendations for the public, policymakers and the health care community.
Recommendations for Elected Officials and Policymakers
Palliative care has become the model for how high-quality, fiscally responsible care can be provided to the sickest, most vulnerable patients and their families, and is emerging as a critical component of health reform. State governments and legislators need to be concerned about how their jurisdictions are performing (based on this report)—and should take action. To ensure that your constituents facing serious illness have access to the highest-quality medical care, you should:
- Fund palliative care team training and technical assistance for all hospitals in your state.
- Include palliative care indicators in your state′s quality programs for your state health plan and Medicaid programs.
- Ensure the development of palliative care programs in public and sole community provider hospitals, as these hospitals provide care to the underserved and most vulnerable patient populations.
- Promote and pass legislation requiring all hospitals to offer palliative care services as a condition of Medicare and Medicaid reimbursement.
- Promote and pass legislation requiring all state-supported medical schools to have affiliations with hospital palliative care programs.
- Create loan-forgiveness programs for nurses and physicians seeking postgraduate palliative care training.
- Create a statewide resource center for promotion of access to quality palliative care services (see New York Palliative Care Training Act–Public Health Law Article 28 at http://public.leginfo.state.ny.us/menuf.cgi)
- Support congressional initiatives that increase NIH and Veteran's Health Administration funding for palliative care research.
- Promote and pass legislation that requires physicians take continuing medical education (CME) courses on pain management and care of the terminally ill. An example of legislation can be found at California′s Business and Professions Code section 2190.5. http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2190-2196.5
Policymakers can also play a key role in promoting legislation that ensures access to high quality care that respects patients′ wishes and autonomy. We recommend the following:
- Visit the American Bar Association′s Commission on Law and Aging′s website for legislative updates and legal information on state health decisions and other topics that impact the quality of care received by elders. www.abanet.org/aging
- Promote the Uniform Health-Care Decisions Act (UHDA.) The UHDA provides a simple model for ensuring that patients′ wishes are honored. Recommended by the National Conference of Commissioners on Uniform State Laws, this act replaces living will, health care power of attorney and family health-care consent statutes. www.nccusl.org.
- Support legislation that improves care across health care settings such as the Physician Orders for Life-Sustaining Treatment (POLST). The POLST form is designed to reflect a patient′s wishes regarding treatment preferences and must be honored by all health care providers regardless of setting. www.ohsu.edu/ethics/polst. Examples of recent legislation include New York′s Medical Orders for Life-Sustaining Treatment (MOLST) (http://www.compassionandsupport.org/index.php/legislation) and California′s POLST legislation (http://www.finalchoices.org/ccccchcf_polst_grant%20update.htm)
For a directory of hospital palliative care programs by state, visit getpalliativecare.org
Recommendations for Patients and Families
If you are living with a serious or life-threatening illness:
- Ask your doctor to refer you to a palliative care specialist.
- Go to the Palliative Care Directory of Hospitals at getpalliativecare.org to see which hospitals in your area have a program.
- Let your doctor(s) and family caregivers know that you want palliative care specialists to be a part of your treatment team and care.
- If your hospital does not have a palliative care program, write to your hospital CEO and your state and federal representatives and ask them to ensure that palliative care becomes a core component of your hospital′s services.
Recommendations for the Health Care Community
If you are a hospital administrator or clinician:
- Implement a palliative care program in your hospital that meets the quality standards published by the National Quality Forum (NQF) in its report: A National Framework and Preferred Practices for Palliative and Hospice Care Quality (www.qualityforum.org/publications/reports/palliative.asp). Access comprehensive training tools, including a CAPC crosswalk with NQF preferred practices for palliative care at www.capc.org
- Provide comprehensive information about palliative care to your patients. Patients and families often wait for their physician to recommend palliative care services. They don′t know when to ask for palliative care, whom to ask, or what kinds of services to request.
- Educate your clinical staff in the principles and practices of palliative medicine through continuing medical and nursing education programs.
Recommendations for Medical Schools
If you are an administrator or clinician in a medical school:
- Include education in pain and symptom management, communication training (e.g., “breaking bad news,” establishing goals of care, deciding on treatments), and working in an interdisciplinary team in the first and second years of medical school.
- Include mandatory clinical rotations in palliative medicine in the third and fourth years of undergraduate training for all medical students.
Recommendations for Teaching Hospitals
If you are an administrator or clinician in a teaching hospital:
- Increase opportunities for medical residents to train on hospital palliative care teams and outpatient hospice programs.
- Increase the number of postgraduate fellowship training programs in palliative care.
