Gaps in clinical training in palliative care and palliative care hamper recruitment of providers

Lack of hospice and palliative care nursing and medical education creates an additional hurdle for providers trying to address industry-wide labor shortages. Not only are hospices competing with other healthcare sectors for new hires, but the vast majority of clinicians entering the workforce are unprepared to provide these services.

Most medical, nursing, pharmacy, and social work students have little exposure to palliative or palliative care during their training. A 2018 study showed that most students in clinical disciplines do not feel prepared to provide end-of-life family care.

Without widespread change, the demand for palliative care exceed the offer trained clinicians to deliver it over the next decade.

“A lot of people in vocational schools don’t learn much about palliative care, and it’s been published in the literature,” Kashelle Lockman, assistant clinical professor at the University of Iowa, told Hospice News. College of Pharmacy. “If they don’t know, they can’t care. This is why I am so passionate about teaching palliative care.

This reality has had a direct impact on the recruitment and retention of certain suppliers.

Example: Silverstone Hospice, based in Texas, contacted nursing schools close to its markets to integrate new graduates into its teams. This initiative did not go well.

“An idea that I thought was an amazing idea ended up being a disaster. It was about going to nursing schools, finding graduate nurses and getting them into hospice,” said the Silverstone CEO , Alfonso Montiel, to Hospice News “To my very unpleasant surprise, the nursing schools don’t go into the details of hospice, so the nurses didn’t know what to do.”

In some cases, nurses fresh out of school not only lacked the technical skills, but also the emotional resilience needed to care for the dying on a daily basis, Montiel said.

The problem is multiple. Not only do providers need clinicians to do the job, but there are also barriers on the referral side. Many physicians are hesitant to refer patients to palliative or hospice care because they do not fully understand the nature of these services or their benefits. Many also lack the skills to lead conversations about goals of care with patients and families.

Educating physicians in other settings about these benefits remains a critical area for improvement, a recent Trella Health Report indicated.

Other research supports these findings, including a 2014 study in the journal Palliative & Supportive Care.

“Exploration of unfounded and preconceived fears associated with referral to palliative care must be incorporated into the curriculum, in order to prepare future generations of physicians,” the study authors wrote. “Medical education should focus on providing the right amount of end-of-life care training, at the right time, within the curriculum of medical school and residency.

Driving Change

Although the problem is widespread, some stakeholders are struggling to drive change.

For example, the UI College of Pharmacy is one of the few that offers a certificate program in palliative care for students. The university’s schools of social work and nursing also offer courses in palliative care. A long-term goal for Lockman and his colleagues is to pursue a coordinated effort across these programs that reflects the interdisciplinary nature of the palliative care model.

Lockman received a $180,000 grant from the Cambia Health Foundation’s Sojourns Scholar Leadership Program to facilitate the development of consensus-based entrustable professional activities (EPAs) for palliative care specialists and general pharmacists.

This project will also design an EPA-aligned pilot educational program and create a pilot toolkit for integrating palliative care into PharmD curricula.

Other universities – and some providers themselves – are also taking steps to fill the gaps.

Last year, faculty at the University of Arizona’s Center on Aging collaborated with other colleges and health care centers to develop its interprofessional education program in end-of-life care focused on approaches multicultural and interdisciplinary end-of-life conversations.

The Medical University of South Carolina (MUSC) has also designed an “internship” program to accelerate the professional development of advanced practice providers, including skills related to palliative and hospice care.

Medical schools at the University of Maryland, Tufts University, University of Vermont, and University of California, San Francisco have also introduced more palliative care into their curricula.

The availability of such training could make a significant difference to provider recruitment.

For example, Delayne Glassgow, a student at UI College of Pharmacy, told Hospice News that her palliative care classes were “eye-opening” for herself and her peers. It even led her to consider a career in the field.

“I think everyone in my class kind of stopped and said, ‘Oh my God, we had no idea,'” Glassgow said. “These are things we need to learn now to be able to provide better care later. You don’t realize that until you get to know them, so I think it’s great that we’re actually incorporating them into our therapy classes.

Some providers take matters into their own hands.

Hospice and home care provider LHC Group (NASDAQ: LHCG) announced in 2021 a 10-year, $20 million investment in the University of Louisiana at Lafayette’s College of Nursing and Allied Health Professions to boost training in home care.

Staffing shortages contributed to the impetus for this decision.

“This is a strategic investment in our future, especially that of our LHC Group family of healthcare providers – our greatest asset and our most important resource,” said Keith Myers, Chief Executive Officer. general of the LHC group, in a press release. “Improving employee training is one of the strongest and most strategic differentiators for employee recruitment and retention.”

At Care Dimensions, a Massachusetts-based palliative care provider, Susan Lysaght Hurley, director of research, is working to transform her organization’s nursing residency program into a national model. Hurley also received a $180,000 Sojourns Scholar from Cambia to further this project.

The Care Dimensions nursing residency program provides training for nurses new to palliative care and palliative care, although they may have experience in other clinical settings.

“Nursing residency has been around for some time in other specialty areas of nursing. However, the vast majority of them are in acute care settings,” Hurley told Hospice News at the project launch. “Bringing specialization to the community level is paramount in order to really think about quality of care in the future.”

These efforts by providers and educators can make a difference, but more needs to be done to boost training nationwide. Patients who need hospice and hospice care reside in every nook and corner of the United States, and the handful of responders taking action likely won’t be able to meet this nationwide demand.

Meanwhile, federal legislation designed to strengthen the hospice and hospice workforce has repeatedly stalled despite the best efforts of policymakers and industry advocacy groups.

These include the Palliative Care Provider Training Act, which would clear the way for members of the National Health Service Corps to defer service for a year to pursue additional training in hospice care.

Another key bill is the Hospice and Palliative Care Education and Training Act (PCHETA), which would fund training for doctors and nurses, among other interdisciplinary professions such as pharmacy, social work and chaplaincy.

Sen. Tammy Baldwin (D-Wis.) and Rep. Yvette Clarke (DN.Y.) wrote to congressional leaders last September demanding action against PCHETA.

“To ensure access to hospice and hospice care for those who need it, we must support an interprofessional team-based approach to care and make the necessary investments in the hospice and hospice workforce,” wrote the two members of Congress. “These investments must include efforts to address workforce development; training of health care providers, including doctors, nurses and other health professionals; improved search; academic and professional awards; and increased education and awareness.

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