Palliative care education programs are gaining speed regionally, leading some to hope for a “domino effect” that would spur further growth.
Without widespread change, demand for palliative care in the United States is projected to outstrip the supply of the clinicians trained to provide it during the next decade. A key barrier to building that workforce is that most clinicians receive little to no exposure to those types of care during their training.
A 2018 study showed that most students in clinical disciplines do not feel prepared to provide family care at the end of life.
In response to growing need, more educational and academic institutions have been creating new pathways for hospice and palliative care clinical training.
Regional programs cropping up
One such example is the recent launch of CARE-7, a four-year palliative care curriculum launched at the Perelman School of Medicine at the University of Pennsylvania.
“As these programs grow, I think it will become more apparent just how essential these skills are,” Dr. Alana Sagin, associate professor of hospice and palliative care at Perelman and CARE-7 curriculum director, told Hospice News in an email. “Those who pave the way really do make it easier for others to follow. I hope it will change culture enough that a curriculum like this will be an expected part of medical education.”
Educators and health care providers are increasingly collaborating to move the needle.
Giving medical students early exposure to palliative care experts, coaches and interdisciplinary team members will hopefully further emphasize the importance of these services and ultimately expand the workforce, according to Dr. Nadia Bennett, Perelman’s associate dean of clinical and health systems sciences curriculum and a CARE-7 program advisor.
“Palliative care providers can continue to leverage the fact that learning how to care for patients with serious illness is an essential skill set for all health care providers, regardless of what field they are going into,” Bennett told Hospice News. “Luckily, more institutions are recognizing this.”
A number of universities have independently developed new programs focused on hospice, palliative care, goals-of-care conversations, and other home-based health services, including the University of New Mexico, the University of Nebraska, the University of Arizona, and the University of Maryland.
The University of New Mexico Health Sciences recently rolled out a new palliative care program aimed at improving care for patients who are facing life-threatening illnesses or nearing the end of life. The New Mexico Palliative Care ECHO Program is part of the university’s Project ECHO model, which offers roughly 70 different educational programs to more than 750 organizations across the globe through virtual learning courses.
The interdisciplinary program is open to all New Mexico primary care and specialty care providers, chaplains, social workers, and virtually “anyone involved in palliative and end-of-life care,” said university representatives.
Flexibility is a common thread woven throughout palliative care education programs, according to Christopher Piromalli, associate professor at The University of New Mexico. Piromalli is also co-medical director of Project ECHO.
“Every community has different patient populations, different cultural perspectives and lenses, different workforce levels, challenges and learning needs,” Piromalli told Hospice News. “It’s critical [to] truly think of a community of learners. It’s important to have flexible and bidirectional learning didactics going on and be flexible to incorporate the ‘here and now’ needs that communities and learners might have.”
Pillars of designing palliative care curricula
Remaining nimble with curriculum development, delivery and supportive partnerships are keys to building and sustaining palliative care training, according to educators who spoke with Hospice News.
Considering the context of students’ learning environments is key when designing and implementing these curricula, according to Sagin. This in part involves an understanding that learners can be pressed for time in both their personal and professional environments.
Flexible course scheduling and offering a mix of in-person and remote learning opportunities are vital components, Piromalli said. Offering virtual learning opportunities in small chunks of time can be beneficial to attract and retain interest in palliative care programs, he added.
“It’s leveraging technology so that no matter where they are, they can be part of a community of learners that grow and gain these special skills,” Piromalli said. “Technology has really expanded the ways for people to get the education they need. It’s a powerful tool to get people to share their specialty knowledge and interact and engage on different platforms.”
Offering virtual mentorship as students progress through palliative care programs can also drive participation, said Kyky Knowles, director of replication operations at Project ECHO.
Developing these relationships can encourage participants to remain connected after graduation and build stronger collaborative ties across medical communities, she explained.
Incorporating technology into palliative care learning can also make it more convenient for educators to participate and collaborate on content development, according to Piromalli. With a limited number of instructors available to provide training, offering virtual teaching opportunities allows educators a flexible schedule and opens the door for a wider range of perspectives on care delivery, he said.
“It’s communicating with learners on a regular basis and creating a multidisciplinary team really aligned with equity and diversity,” Knowles said. “We want to make sure that learners want to keep coming back. That their curriculum is innovative, flexible and engaging.”
Laying the foundation includes developing basic skill sets in communication with patients and families and increasing knowledge about serious illness and end-of-life care options, according to Sagin.
“Communication skills are a major component of a palliative care curriculum. [They] are so universally applicable,” Sagin told Hospice News. “[It’s] improving the primary palliative care skills of all our graduates, because these skills will make them better doctors, and at the same time, ease the burden on the palliative care workforce. The goal of CARE-7 is to turn out physicians who are comfortable with the predictable situations that come up around serious illness conversations, symptom management and support.”
Regardless of whether graduates enter the palliative care field, learning the building blocks of this care can lead to more awareness across the health care spectrum — and perhaps more referrals.
Many physicians hesitate to refer patients to hospice or palliative care because they do not fully understand the nature of those services or their benefits. Many also lack the skills necessary to conduct goals-of-care conversations with patients and families.
Caring for seriously and terminally ill patients is wearing on employees, often leading to burnout.
The ability to gauge and manage their own mental health needs is an important element of palliative care education, according to Sagin.
‘If you build it, they will come’
Developing a solid program curriculum with these pillars in mind is key to buy-in from stakeholders, as well as ensuring sustainability, according to Knowles.
“If you build a really amazing program, the money will follow,” Knowles told Hospice News. “We’ve seen this happen time and time again with our partners who create these innovative programs and find money and funding support to keep them growing. It’s helping leaders of different institutions and organizations to see the benefits of how this education is going to impact the quality of care for patients and families.”
Funding resources take time and effort to develop, Knowles added. Casting a wide net of stakeholders can be critical, including state and local agencies, health care providers, advocacy organizations, and community leaders. Reaching leaders in different faith groups and in rural and underserved populations can also be key to long-term health equity and access, she stated.
Engaging in continuous conversations with financial backers helps grow partnerships that help palliative care learning programs to thrive, according to Bennett.
“Once the value is recognized, hopefully resources will follow,” Sagin added.