Seriously ill patients often navigate a complex referral system for pain and symptom management in the United States. A pair of physicians recently published a strategic framework to improve access and support for these individuals.
Some patients with chronic conditions often see several healthcare specialists to manage their diverse range of symptoms, according to Dr. Suresh Srinivasan, director of pain medicine at Trinity Health System. A lack of coordination among these care providers can result in difficulty identifying and managing patients’ pain and physical or emotional needs, he stated.
Strengthening referral relationships across the healthcare continuum could go a long way toward improved quality, Srinivasan said. Providers lack sufficient avenues of communication and connection in today’s healthcare system, an issue Srinivasan is working to better address.
“The biggest question is timing and who to refer,” Srinivasan told Palliative Care News. “Communication is the key. Palliative care teams may not always know who is an eligible patient. We know we can help patients with focused pain management and still have a meaningful quality of life. The important thing is to have all different types of specialists involved.”
Srinivasan and Dr. Kiran Khurshid, internal medicine physician at ProMedica, coauthored a recently published article in Clinics in Medicine and Medical Research — Building the Bridge: A Framework for Collaborative Referral Pathways between Palliative Medicine and Interventional Pain Specialists. The publication includes a strategy designed to improve care collaboration, patient identification and goal-concordant care delivery.
The framework features five steps for clinical teams to improve referrals:
1. Recognize a potential referral trigger through ongoing pain and medication management and discussions around patients’ goals of care
2. Perform a focused bedside assessment in which the patient describes their pain levels, attempted treatments, physical functions, clinical factors and priorities
3. Discuss patients’ goals and expectations of care, including their physical, emotional, spiritual and psychosocial needs
4. Communicate a specific clinical question that addresses the patient’s most persistent symptoms
5. Close the loop after a consultation between a referring and receiving healthcare provider, particularly during transitions of care between hospice, hospitals and outpatient care settings
A main goal of the framework is to make palliative care and pain management easier to access for patients with serious illness, according to Srinivasan. Greater care collaboration is needed to help patients avoid symptoms such as uncontrolled pain, medication toxicity or functional decline that “substantially narrows” their treatment options, he stated.
Patients need coordinated care plans developed with clear communication from providers, Srinivasan indicated. Gaps in communication often exist in palliative care and pain management referrals, which can result in symptom burden and potentially other adverse effects for patients.
Stronger care collaboration could help to ease referral challenges, according to Srinivasan.
“We developed this framework to make collaboration between palliative care and interventional pain more practical,” he said. “We’re hoping that through this publication, it can help us to reach the patient side. I see the future as more coordinated, more individualized and more closely connected to where patients receive care. Palliative medicine, oncology, primary care, interventional pain and hospice need practical ways to share information and make decisions together throughout the illness trajectory.”
