Leadership
Needs Assessment
Writing A Business Plan
Reimbursement
Delivery Models
Inter-Disciplinary Team
Physician
Nursing
Social Work
Pastoral Care/Chaplaincy
Program Operations
Quality Assessment






Recruiting an Interdisciplinary Team

Seriously ill patients and their families need a team of skilled professionals.

Because the needs of seriously ill patients and their families are typically complex and multidimensional, a palliative care program requires an interdisciplinary team of professionals. Skills include medical evaluation and decision-making, pain and symptom management, professional to patient and family communications, an ability to address difficult decisions about the goals of care, sophisticated discharge planning and an ability to deliver continuity and reliable access. Equally important is the team's ability to work well and communicate effectively with other health professionals. The respect and positive regard of colleagues on the hospital staff are prerequisite to a successful palliative care program.

For consultation and/or for staffing of a dedicated inpatient unit, the core interdisciplinary team typically consists of a physician, nurse and social worker. In addition, the ideal interdisciplinary team includes dedicated staff time from a bereavement or pastoral care counselor. Fiscal constraints may prevent the program from hiring its own social work and bereavement staff. Alternatively, social service and bereavement staff support may be available through a shared arrangement with the hospital social work and pastoral care departments.

The interdisciplinary team should have special training and/or work experience in palliative medicine and in hospice or nursing home settings, as well as familiarity with the demands and standards of the acute hospital culture. Team clinicians will become the professional representatives both of palliative care as a general discipline and of the hospital's palliative care program in particular. They will provide assessment and care to patients and families and handle professional-to-professional communications - both inside and outside the hospital - that are vital to a successful program.

Other interdisciplinary palliative care staff who provide important clinical and support services to the core staff, patients and families include patient advocates, anesthesia pain experts, rehabilitation (physical and occupational) therapists and psychiatry consultants. Again, depending upon available resources, full-time dedicated staff from these areas may not be possible, but shared arrangements with the "home" departments for these services are an acceptable and commonly used alternative.

Related References

1. Karlawish JH, Quill T, Meier DE for the ACP-ASIM End-of-Life Care Consensus Panel. A Consensus-Based Approach To Providing Palliative Care to Patients Who Lack Decision-Making Capacity. Annals of Internal Medicine 1999;130:835-840.
http://www.annals.org

2. Kee F, Wilson RH, Harper C, Patterson CC, McCallion K, Houston RF, Moorehead RJ, Sloan JM, Rowlands BJ, Shields R. Influence of hospital and clinician workload on survival from colorectal cancer: cohort study · Commentary: How experienced should a colorectal surgeon be? BMJ 1999;318:1381-1386.
http://bmj.com/cgi/content/full/318/7195/1381

3. Lo B, Snyder L, Sox H. Care at the End of Life: Guiding Practice Where There Are No Easy Answers. Ann Intern Med 1999;130:772-774.
http://www.annals.org

4. Lynn J, Teno JM, Phillips RS, Wu AW, Desbiens N, Harrold J, et al. Perceptions by family members of the dying experience of older and seriously ill patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 1997;126:97-106.

5. Lynn J. Learning to Care for People With Chronic Illness Facing the End of Life. JAMA 2000;284:2508.
http://jama.ama-assn.org

6. O'Neill B, Rodway A. ABC of palliative care: Care in the community. BMJ 1998;316:373-377.
http://bmj.com/cgi/content/full/316/7128/373

7. Pellegrino ED. Emerging Ethical Issues in Palliative Care. JAMA 1998;279:1521.
http://jama.ama-assn.org

8. Quill TE. Initiating End-of-Life Discussions With Seriously Ill Patients: Addressing the Elephant in the Room. JAMA, 2000;284:2502.
http://jama.ama-assn.org

9. Ramirez A, Addington-Hall J, Richards M. ABC of palliative care: The carers. BMJ 1998;316:208-211.
http://bmj.com/cgi/content/full/316/7126/208

10. Steinhauser KE, Clipp EC, McNeilly M, Christakis NA, McIntyre LM, Tulsky JA. In Search of a Good Death: Observations of Patients, Families and Providers. Ann Intern Med 2000;132:825-832.
http://www.annals.org

11. Stephenson J. Palliative and Hospice Care Needed for Children With Life-Threatening Conditions. JAMA 2000;284:2437.
http://jama.ama-assn.org

12. von Gunten CF, Ferris FD, Emanuel LL. Ensuring Competency in End-of-Life Care: Communication and Relational Skills. JAMA 2000;284:3051.
http://jama.ama-assn.org

PubMed, a service of the National Library of Medicine, provides access to over 11 million citations from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.  Visit:  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed


Additional Resources

Identifying Stakeholders (session 1 worksheet 2)
Creating an array that broadly identifies people who may be stakeholders is an important step in developing a program design, an approval strategy, and an implementation strategy. The above sheets focus on a “first cut” to help identify players.

Drafting your “dream teams” (session 1 worksheet 3)
Planning for Structure: Committees and Workgroups. This 3 page form builds upon the Identifying Stakeholders worksheet by asking the user to identify appropriate people for a Steering Committee, a Design Workgroup and a Proposed Team.

Changing Physician Behavior -Grand Rounds
Andrew Epstein, MD, partner, and Mark Wenneker, MD, MPH, Senior Consultant, discusses changing physician behavior about palliative care. The audio file is available for download.

Impact of Palliative Care Education on Students
Pull Up Three Chairs: Teaching Palliative Care at Mount Sinai School of Medicine, NY

This video download shows physicians, physicians-in-training and nurse practitioners discussing their rotation in palliative care.

Education and Training as Catalysts to Forming a Palliative Care Service
A CAPC Fall Forum 2001 Workshop
October 2001, Chicago, IL
PowerPoint Presentation

Broaching the Topic of Palliative Care Consultation with Patients and Families

Last Acts Diversity and End-of-Life Care Literature Review
Annotated Bibliography

CAPC State Palliative Care Networks

Palliative Care Consultation Sample Eligibility Criteria

JCAHO Education Event: Essential Elements of Effective Pain Management
This one day educational event provides you and your colleagues with all the information you will need to implement the new Joint Commission pain management standards. This program is offered many times throughout the year at varied locations.

Staffing a Palliative Care Service
Recruiting an Interdisciplinary Care Team
A CAPC Fall Forum 2000 Workshop
PowerPoint Presentation

Personnel Performance Evaluation:
Standards for all professionals who provide End Of Life Care


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