Palliative care addresses pain and control of symptoms, seeking to improve quality of life during a treatable illness and during the dying process. Palliative care joins patients, healthcare professionals and families in a partnership to anticipate, prevent and treat suffering. More than pain control, palliative care should encompass physical, intellectual, emotional, social, and spiritual needs to promote a patient’s self-sufficiency.
HealthTeamWorks recently developed a clinical guideline on palliative care that is intended for, but not limited to primary care providers. This two-page, convenient reference is free for download or in hard copy form. As with all HealthTeamWorks guidelines, it is not meant to replace a clinician’s judgment or establish a standard of care.
Palliative care can begin in primary care setting
Palliative care can begin in the primary care setting, as early as diagnosis of a potentially life-limiting illness. It can be delivered along with curative or disease-modifying treatment. Because palliative care focuses on identifying treatment goals and managing pain and symptoms, primary care clinicians are ideally suited to initiate and coordinate it. Noting the importance of specialists, however, the guideline gives indicators for referral to specialty-level palliative care or hospice.
The guideline differentiates between palliative care and hospice care. It suggests questions that providers can use, adapt and revisit throughout the progress of illness to address the key elements of palliative care. These are:
• Advance care planning;
• Pain and symptom management;
• Emotional-social-spiritual needs and challenges;
• Caregiver burden; and
• Coping with decline and eventual death.
Expert panel developed guideline
HealthTeamWorks developed the palliative care guideline by convening a committee of physicians, advanced-practice nurses, and professionals in behavioral science, health communication and social work. Participants represented 11 Colorado organizations, including private practices, hospitals, hospices, the University of Colorado and healthcare insurers.
The committee identified existing evidence-based guidelines on palliative care and conducted a literature review on the topic. Its members built the guideline around key issues that providers need to know to deliver appropriate care, as well as what is not now being done that could make the most difference to improve care.
Following HealthTeamWorks’ usual procedure, a focus group of primary care physicians reviewed the guideline draft and made suggestions. HealthTeamWorks’ board of directors and membership reviewed the revised guideline, made further revisions and then gave final approval. The result is a carefully crafted, closely evaluated clinical tool in an easy-to-use format.
A beginning palliative-care tool set for clinicians accompanies the guideline.