Current clinical education models do not sufficiently prepare medical professionals to either understand or deliver the full scope of palliative care services, according to researchers from the University of Michigan.
Most clinicians receive little to no exposure to palliative care during their training. This lack of exposure to palliative care has led to widespread misunderstanding of these services among many health care professionals, according to Heidi Mason, Mary Beth Derubeis and Beth Hesseltine, researchers at the University of Michigan and authors of a recent study.
The researchers engaged 38 advanced practice nurse practitioners (APRNs) at at a large Midwest cancer center in 2021 to determine their level of awareness and assess their knowledge gaps in palliative care. They found that the lack of training hinders palliative access, utilization and integration into care models, the authors indicated.
“In our current health-care system, early palliative care is not being integrated due to a lack of education of providers and nurses, an infrastructure that does not support palliative medicine, and poor communication skills among practitioners,” the authors wrote. “All providers should feel comfortable initiating discussions regarding prognosis and goals of care.”
Mason is a registered nurse and clinical assistant professor at the University of Michigan School of Nursing. Derubeis and Hesseltine are both nurse practitioners at the University of Michigan Rogel Cancer Center.
In the research, 15 nurse practitioners responded. About 93% of those indicated they understood that palliative care is appropriate for all seriously ill patients, according to the study published in the Journal of the Advanced Practitioner in Oncology. However, only 38% stated they understood that palliative care and curative treatment can be offered simultaneously.
Researchers utilized the Palliative Care Quiz for Nursing (PCQN) to determine clinicians’ level of understanding. The test includes questions that address the physical, psychological, spiritual and social aspects of care.
“Although this specific survey was completed by a small sample, the results are consistent with the literature and clearly demonstrate the need for oncology APRNs to take a lead in making early palliative care available to all oncology patients,” Mason, Derubeis and Hesseltine wrote in the study. “As evident in the literature, the lack of education, inadequate PC infrastructure, and poor communication skills are barriers in oncology that need to be addressed in order to promote early PC.”
Meanwhile, more medical schools are investing in palliative care education amid growing recognition of an increased need for these health care professionals.
The University of Michigan has hospice and palliative medicine fellowship programs that includes training in adult and pediatric serious and terminal illness care, as well as pharmaceutical pain management.
The Perelman School of Medicine at the University of Pennsylvania in 2022 launched the CARE-7 program, a four-year palliative care curriculum to teach clinicians essential care and communication skills in these services.
A spate of universities have independently developed new programs focused on hospice and palliative care including the University of New Mexico, the University of Nebraska and the University of Maryland.
Health systems are also forming partnerships to increase palliative education.
Case in point, last year Nashville-based HCA Healthcare Inc. (NYSE: HCA) and the University of Central Florida (UCF) added a new graduate fellowship in hospice and palliative care medicine to their existing repertoire of training programs.