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Center to Improve Veteran Involvement in Care (CIVIC)

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Workforce Shortages and Palliative Care: Doing What's Best for Patients

Written by Alison Eckhardt

Stock image of a health care professional talking to an older man.

All of us will, at some point, require end-of-life care. However, workforce shortages both within and outside VA mean that many patients who live with serious or terminal illness don’t have access to the care they need. When started early, palliative care is associated with longer survival and improved patient-reported mood, symptom severity, and treatment side-effects. “There is a critical supply-demand mismatch between the workforce of palliative care specialists and the multitude of people living with serious illnesses,” says Dr. Don Sullivan, a pulmonologist who recently concluded a retrospective cohort study of 23,142 patients with advanced lung cancer. “In lay terms, this study helps to discern what is in the ‘palliative care syringe’ or what may be the important components of palliative care that clinicians that are not trained in this specialty should consider.”

Results were published in a recent paper in the American Journal of Hospice and Palliative Medicine titled Association of Patient-Centered Elements of Care and Palliative Care Among Patients With Advanced Lung Cancer. Dr. Liana Schweiger, along with PI Dr. Sullivan and CIVIC Co-Investigators Drs. Kelly Vranas and Chris Slatore, makes a strong case that the essential elements of palliative care could become part of routine care among non-palliative clinicians. By looking at the elements of care that fall under the ‘palliative care umbrella,’ the authors sought to uncover specific ways primary care providers could improve patient quality of life and end-of-life care without relying on specialists.

Patients who received palliative care were more likely to receive symptom-management therapies like pain medication, constipation regimens, and antidepressants, compared to similar advanced lung cancer patients who did not receive palliative care . The study also found that patients who received palliative care were more likely to complete advance care planning documents, and more likely to enroll in hospice. Advanced care planning and hospice enrollment increases the likelihood that patients will receive end-of-life care that is consistent with their priorities, which often include dying in a non-hospital setting and receiving medications to manage symptoms. It also increases the availability of caregiver support and bereavement resources for families.

“The benefits of palliative care in lung cancer and other forms of serious illness are well-established,” says Dr Sullivan. “We need to better understand what are the essential elements of palliative care, and invest more resources in education and training opportunities to help clinicians deliver primary palliative care.” Further research could increase our understanding of the most effective models for delivering patient-centered palliative treatment in multiple care settings. While more resources are also needed to improve access to palliative care specialists, understanding the elements of palliative care associated with the most benefit to patients creates opportunities for other providers to fill the gap. Offering palliative care treatments in other care settings can help understaffed hospitals offer important resources to patients who don’t have access to a specialist. This research helps to illuminate opportunities to provide high-quality, evidence-based care to the patients in most need.