The federal government should work with stakeholders to develop a national strategy for palliative care, similar to those developed to combat smoking, H.I.V., the opioid epidemic and pandemic influenza, according to Diane Meier, M.D., director of the Center to Advance Palliative Care.
A national strategy would bring together government agencies, health care organizations, the private sector and other stakeholders to develop a multifaceted plan to improve the state of palliative care in the United States, addressing issues such as public awareness of and access to palliative care, addressing staff shortages, establishing payment models, and expanding utilization.
A lack of public awareness is a significant barrier to expanding the use of palliative care in the United States. A recent study found that 71% of people in the United States do not know what palliative care is.
“[A national strategy] is a way of thinking about the needs of the whole society and the diverse needs of different populations in different age groups, with different diagnoses, in rural areas and urban areas and hospital and non-hospital palliative care,” Meier said in a GeriPal podcast. “It would bring key stakeholders together that have influence, power and audiences, that have a stake in what this policy might be, and try to come to some agreement—and ideally this is associated with some financial investment from the government.”
Though patients receive palliative care in a variety of settings, including the hospital, hospices are providing community-based palliative care in growing numbers.
“More and more hospices are realizing that they have to diversify their portfolio and go beyond reliance on the Medicare Hospice Benefit, because they recognize that there are a lot of patients out there who are not yet eligible for hospice, or who opt out of it, and their needs are not being met,” Meier told Hospice News in May.
A number of other countries have developed such palliative care strategies, including Canada, Australia and New Zealand. The World Health Organization in 2014 called on its members to implement policies to ensure access to evidence-based, effective and equitable palliative care.
Many of the national strategies worldwide focus on public education, clinician training, research, and in some instances requiring health care organizations to provide palliative care.
Individual U.S. states have taken action to expand palliative care in their regions. As of Dec. 2018, 27 states have laws on their books designed to promote palliative care, according to the National Academy of State Health Policy (NASHP). Though details of the legislation vary among the states, they each serve the goal of bringing palliative care to more patients with serious, chronic, or life-limiting conditions.
Ohio recently enacted a law mandating that hospitals, ambulatory surgery centers, nursing homes, and other health care organizations in the state to develop systems to identify patients or residents who are in need of palliative care and inform them about the benefits and availability of those services.
Kentucky in March approved legislation creating a Palliative Care Interdisciplinary Advisory Council and a professional information and education program to help foster palliative care awareness. New Jersey is currently considering similar legislation.
Evidence is mounting for the clinical and economic benefits of palliative care, which is non-curative care designed to manage symptoms and improve patients’ quality of life. Unlike hospice, patients can receive palliative care concurrently with curative treatments.
Palliative care has been shown to be effective at improving quality of life, mood, coping, managing pain, and facilitating earlier conversations about hospice. Research indicates that palliative care could reduce societal health care costs by $103 billion within the next 20 years.
The political climate might be ripening for a discussion of a national palliative care strategy. Meier in the podcast proposed a community-based model with palliative care health workers making home visits, supervised by a nurse-social worker team. These in turn would be supervised by a physician’s assistant or nurse practitioner, and then ultimately a physician.
“Across the Obama administration and the Trump administration there has been increased attention to the importance of value-based care—care that is focused on improving the quality of care and in so doing reducing unnecessary spending,” Meier said. “To have a principle like that across very polarized political parties and polarized leadership is an opportunity, and that’s why I think this is the time.”