Palliative care clinical education avenues have expanded in recent years, but providers say the well may not be filling up quickly enough to meet demand. Communication and peer support elements are among the key training elements for palliative workforce sustainability and growth.
Recruiting and retaining palliative care professionals can be a difficult feat for organizations, in part because not enough medical and nursing students are exposed to palliative care during their education.
Though the needle is moving, it lags behind the pace needed to keep up with demand, according to Dr. Monisha Pujari, hospice and palliative care physician and medical director at Georgia-based Longleaf Hospice.
“There are increased spots in medical education rotation programs and nonacademic institutions having palliative programs with more recognition of the need for it,” Pujari told Palliative Care News. “Nonetheless, we have a long way to go. What’s out there is still relatively insufficient. It’s going to require a high level, top-down approach on why illness and dying matter and what skills we should be trying to push forward.”
Emerging training models
More palliative care education pathways have emerged in recent years, including a virtual reality-based training program that Brigham and Women’s Hospital launched into developing in November 2023. Last year also brought the announcement of the fist palliative fellowship graduate of St. Luke’s Hospice & Palliative Medicine’s program.
In 2022 Nashville-based HCA Healthcare Inc. (NYSE: HCA) and the University of Central Florida (UCF) launched a graduate fellowship program in palliative medicine, which closely followed a similar program rolled out by Ohio’s Hospice and Kettering Health in 2021.
Palliative training programs like these are designed to prepare professionals with the clinical and administrative skills needed to sustain careers in the field.
Honing palliative skills can be a constantly moving target when considering patient populations needs, according to Dr. Shellie Williams, geriatric and palliative medicine physician and associate professor of medicine at the University of Chicago. Williams is also a fellow of the American Academy of Hospice and Palliative Medicine (AAHPM).
Clinical palliative care education is undergoing an evolution in response to the various needs of patients with diverse ranges of serious and chronic illness, according to Williams.
“Palliative care is going through the same era that geriatrics are going through with an increasing number of individuals with serious illness who could benefit from palliative care skills,” Williams said. “It becomes increasingly important that we are able to train more people with interprofessional training in palliative skills.”
Palliative care professionals need to have a deep understanding about the different diagnoses and disease trajectories within the scope of serious illness, according to Pujari.
“A skill set that really needs to be developed in training is diagnosing and prognosticating well, because these are critical skills in managing a decline in a patient,” Pujari said. “Those skills really help palliative clinicians make things go smoother for a patient’s care management and make a difference in meeting patients and families where they are in the illness. When you have that palliative standpoint on understanding what you’re dealing with, then you know how to move that patient along in different disease trajectories.”
Communication is among the most significant skills to include in palliative care education, according to Shekinah Eliassen, CEO of George Mark Children’s House. The pediatric palliative and hospice care provider is based in California.
Honing communication and collaboration capabilities is vital for professionals to thrive in the interdisciplinary environment of palliative care, Eliassen indicated. These skills are even more important when it comes to communicating with patients and families and delivering quality care, she said.
“Communication is paramount, whether it’s speaking with patients and families or collaborating in interdisciplinary care team meetings,” Eliassen said. “It’s about working together to assess the needs with wraparound care.”
George Mark Children’s House in 2023 piloted a specialized pediatric palliative care nurse training program in partnership with the CSU Shiley Haynes Institute for Palliative Care. The program has helped the hospice and palliative care provider double its census with more clinical capacity, Eliassen
The organization also works with two local pediatric physician residency programs at the University of California San Francisco (UCSF) Health and Stanford Medicine Children’s Health.
Recognition is growing that the skills and strategies commonly used in palliative care are useful in other areas of medicine, Eliassen added.
“Palliative care skills are so valuable in all areas of health care, including skillful communication about difficult topics, careful symptom assessment, a whole-person care approach, interdisciplinary collaboration, partnership with patient and family and clinical expertise in symptom management,” she said. “Those skills are especially valuable in hospital-based care, home health or any area of practice where patients are living with serious illness or a life-limiting condition.”
Developing strong communication structures in palliative training involves having peer support models, according to Williams. Having the insight from palliative professionals in the field as well as from other students can help set the future workforce for success in understanding the expectations and realities of delivering serious illness care, she said.
“There are large triumphs and sometimes the lowest of lows when we’re privileged enough to work with seriously ill individuals,” Williams told Palliative Care News. “Being able to share experiences with colleagues and experts in the field gives an additional layer of understanding of what to expect and how to manage care. The interprofessional peer support component is so important.”