Palliative Care Training Can Help Clinicians With Tough Conversations

Training boosts quality of care for people with chronic diseases, researchers say

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Palliative care training for all clinicians on an interdisciplinary team can increase the number of discussions about advanced care planning for people with Huntington’s disease, a new study shows.

“To our knowledge, this is the first description of primary palliative care for Huntington’s disease in which all interdisciplinary team members received formal training in communication skills and actively participate in goals of care and advance care planning discussions. … We hope that sharing our experience to date will support continued development of this expanded model of practice,” the researchers wrote.

The study, “Primary Palliative Care in Huntington’s Disease,” was published in Movement Disorders. It was funded by the Huntington’s Disease Society of America.

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What is primary palliative care?

Palliative care is a field of medicine that focuses on improving comfort for people living with chronic conditions such as Huntington’s. Making plans for the future is an important aspect of palliative care, though this type of care can also offer numerous benefits to people with Huntington’s well before they’re in the final stages of the disease.

However, many people diagnosed with Huntington’s and other chronic diseases do not access palliative care until late in their disease, if they get this care at all. One reason is that patients often do not have access to specialists trained in delivering palliative care.

In this study, researchers described a model to deliver palliative care using what’s known as a “primary” approach — essentially, rather than referring patients to specialists for palliative care, the primary care team receives training in how to deliver palliative care and integrate it into their day-to-day practice.

“Primary palliative care proposed several potential benefits: maintaining existing therapeutic relationships, reducing fragmentation of care, enhancing clinical skills and provider satisfaction, and improving quality of care,” the researchers wrote.

“However, conversations about end-of-life can be difficult for patients, families, and clinicians,” they added. “Most clinicians lack training in the communication skills needed for effective conversations about goals of care.”

Therefore, developing communication skills to have these difficult conversations was a key component of the researchers’ model. To this end, the team partnered with the organization VitalTalk to deliver training to clinicians.

“Our goal was to enable each team member to begin a goals of care conversation at any time during the course of [Huntington’s] if the need for advance care planning was identified during their clinical assessment,” they wrote.

Eight clinicians were surveyed about their perceptions before and after undergoing the training. After the training, the number of clinicians who felt they had a better-than-average understanding of palliative care increased (62.5% to 87.5%), as did the proportion who felt well-prepared to handle serious conversations (12.5% to 50%).

“After the training, more participants felt prepared to engage in these conversations and the number of advance care planning discussions increased,” the researchers wrote.

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The program also included modifications to clinical workflow, such as designating a specific clinician to initiate discussions during pre-clinic team meetings. Assessments of clinic records showed that the number of documented discussions about advance care planning also increased following the implementation of the program (12.5% to 30.6%).

“By identifying issues ahead of time and developing a plan to address them, we were able to increase the number of advance care planning discussions during clinic,” the scientists wrote.

“Our preliminary results support the potential benefit of a primary palliative care approach to increase engagement in advance care planning,” they concluded.