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Gelfand SL, Lakin JR, Sciacca KR, Rivkin ER, Eves JC, Anderson S, Mandel EI, Desai AS, Jain N, Landzberg MJ, Lever NM, Schaefer KG, Leiter RE, Tulsky JA. Specialty-Aligned Palliative Care: Responding to the Needs of a Tertiary Care Health System. J Pain Symptom Manage 2022; 64:e341-e346. [PMID: 36031081 DOI: 10.1016/j.jpainsymman.2022.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Expanding specialty palliative care within complex health systems involves consideration of patients' unmet needs, clinicians' perceptions of palliative care, and the availability of palliative care resources. Prior to this quality improvement (QI) project, palliative care services in our health system primarily served oncology patients. INTERVENTION We undertook a prospective strategic planning process that included executive sponsorship and engagement of institutional leaders and clinicians to help define which palliative care services were most needed by the health system. MEASURES We interviewed and surveyed a broad range of clinicians including physicians, nurse practitioners, and social workers. OUTCOMES The two most prominent themes that emerged from the stakeholder engagement process were clinicians' wish for specialty-aligned interprofessional palliative care teams and for expansion of nononcology palliative care access. CONCLUSION Careful needs assessment and stakeholder engagement can result in goal-directed and data-driven expansion of palliative care services within tertiary health care systems.
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Affiliation(s)
- Samantha L Gelfand
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Renal Medicine (S.L.G, E.I.M.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA.
| | - Joshua R Lakin
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
| | - Kate R Sciacca
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily R Rivkin
- Dana-Farber Cancer Institute (E.R.R., J.C.E.), Boston, Massachusetts, USA
| | - Jessica C Eves
- Dana-Farber Cancer Institute (E.R.R., J.C.E.), Boston, Massachusetts, USA
| | - Shelly Anderson
- Brigham and Women's Hospital (S.A.), Boston, Massachusetts, USA
| | - Ernest I Mandel
- Division of Renal Medicine (S.L.G, E.I.M.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
| | - Akshay S Desai
- Division of Cardiovascular Medicine (A.S.D., M.J.L.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
| | - Nelia Jain
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
| | - Michael J Landzberg
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Cardiovascular Medicine (A.S.D., M.J.L.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
| | - Natasha M Lever
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kristen G Schaefer
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
| | - Richard E Leiter
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
| | - James A Tulsky
- Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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