A Tuscaloosa, Alabama, community hospital has begun a novel partnership offering interdisciplinary palliative care training to hundreds of nurses, clinicians and caregivers.
The supportive care clinic provides interdisciplinary palliative assessment and care to patients with advanced disease and high symptom burden, such as those with stage three and four lung cancers, advanced breast cancer and pancreatic cancer.
It will also train more than 350 fifth-semester nursing students, offering immersion in a complex and growing specialism before they enter the workforce. They will train alongside interdisciplinary teams that include patients’ medical oncologists, social workers, dieticians, pharmacists and chaplains.
“It’s an ideal situation with the palliative clinic model, where the patients are receiving that holistic assessment and working in accordance with the interdisciplinary team. I think that you teach by real life interactions and experiences,” Dr. Kristi Acker, associate professor at the Capstone College of Nursing and Oncology and a palliative certified nurse practitioner, told Palliative Care News. Acker leads the clinic.
The clinic is hosted by the Lewis and Faye Manderson Cancer Center at DCH Regional Medical Center, a community hospital across the street from the Capstone College of Nursing where many students go through their clinical inpatient rotations.
The establishment of outpatient palliative clinics is a growing trend among health systems and hospices, with Yale University’s health system setting up a clinic for heart failure patients in April this year, and the University of Connecticut adding an palliative outpatient clinic last year.
“This is so novel to us because we’re not an academic medical center. We are a community hospital partnering with higher education. So it’s one of those situations that we’re learning as we go,” Acker said.
The decision to open the Tuscaloosa clinic was driven by both unmet patient need and a competency-based framework published in 2021 by the American Association of Colleges of Nursing, which includes palliative care as one of the four “spheres of care” in which nursing graduates must have competency in.
The clinic is reimbursed through a fee-for-service model, although many insurance companies are starting to recognize the cost savings and improved patient outcomes outpatient palliative clinics can provide. It aims to reduce hospital readmissions by helping patients and caregivers stay on top of complex symptom management. Another priority is the timely identification of when patients need to transition to end-of-life care.
“Being in the South and having limited resources and clinical experiences, it was one of the drivers for us to sit back and think of how we could partner and meet the needs of students, while meeting the needs of patients with advanced cancer,” Acker said.
Delivering interdisciplinary outpatient care shows students that nursing cannot be practiced in a silo, and that many patients face financial, social and logistical challenges, according to Acker.
“When they are interacting with patients, they need to be very conscious of the complexities. When we recommend things for patients or their caregivers, they need to keep in mind the availability of resources, the financial implications of what we recommend, and what type of support systems are in place,” Acker said. “Some of these patients show up without the social support needed. They even have difficulty with transportation, getting back and forth to their treatments.”
The supportive care program is currently available to patients at the Manderson Cancer Center, but the DCH health system said it plans to expand access to more patient populations in the near future.
Acker said she is hopeful the model could be replicated elsewhere, such as in a primary care setting or for mental health services.
“One of the challenges we would have is to make sure that we have the workforce for providers to replicate the model in that type of setting,” she added.
