National Consensus Project and Clinical Practice Guidelines Kelli Gershon, MSN, APRN, BC-PCM Palliative Care The University of Texas M.D.Anderson Cancer Center

What is the National Consensus Project?

Consortium of three key national palliative care organizations:  American Academy of Hospice and Palliative Medicine  Hospice and Palliative Nurses Association  National Hospice and Palliative Care Organization

National Consensus Project Mission To create a set of voluntary clinical practice guidelines to guide the growth and expansion of palliative care in the United States

National Consensus Project Structure  Steering Committee – 20 members develop draft document  Advisory Committee – 100 nationally recognized leaders across a variety of health care settings, review and revise  Liaison Organizations – 50 organizations with major responsibility for health care of patients with life-threatening illnesses, endorse and disseminate the standards

Core Elements of Palliative Care  Patient Population  Patient and Family Centered Care  Timing of Palliative Care  Comprehensive Care  Interdisciplinary Team  Attention to Relief and Suffering

Core Elements of Palliative Care  Communication Skills  Skill in Care of the Dying and Bereaved  Continuity of Care Across the Settings  Equitable Access  Addressing Regulatory Barriers  Quality Improvement

Clinical Practice Guidelines Consensus of the leading palliative care organizations in the U.S., based on 1. Scientific evidence 2. Clinical experience 3. Expert opinion

Baseline Assumptions  Goal Guidelines  Healthcare quality standards  Codes of ethics  Ongoing revision  Peer-defined guidelines  Specialty care  Continuing professional education  Applicability of guidelines

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Clinical Practice Guidelines: 8 Domains Structure and Process of Care Physical Psychological and Psychiatric Social Spiritual, Religious and Existential Cultural The Imminently Dying Patient Ethics and Law

Domain 1: Structure and Processes of Care  Comprehensive interdisciplinary (ID) assessment of patient and family  Care plan based on values, goals and needs of patient and family  Interdisciplinary team (IDT) provides services based on care plan  IDT may include trained and supervised volunteers

Domain 1: Structure and Processes of Care  Support for education and training is available to the IDT  Palliative care program (PCP) committed to quality improvement in clinical and management practices  PCP recognizes emotional impact on the palliative care team of providing care to patients with life threatening illness and their families

Domain 1: Structure and Processes of Care  PCP should have relationship with one or more hospices and other community resources in order to provide continuity of the highest quality palliative care across the illness trajectory  Physical environment should meet preferences, needs and circumstances of the patient and families

Domain 2: Physical Aspect of Care  Pain and other symptoms and side effects are managed based upon the best available evidence

Domain 3: Psychological and Psychiatric Aspects of Care  Psychological and psychiatric issues are assessed and managed based on best available evidence  A grief and bereavement program is available to patients and families

Domain 4: Social Aspects of Care  Comprehensive ID assessment identifies social needs of patients and their families, and care plan developed in order to respond to these needs

Domain 5: Spiritual, Religious, and Existential Aspects of Care  Spiritual and existential dimensions are assessed and responded to based upon the best available evidence

Domain 6: Cultural Aspects of Care  PCP assess and attempts to meet the culture-specific needs of patients and families

Domain 7: Care of the Imminently Dying Patient  Signs and symptoms of impending death are recognized and communicated, and care appropriate for this phase of illness is provided to patient and family

Domain 8: Ethical and Legal Aspects of Care  The patient’s goal, preferences and choices are respected within the limits of applicable state and federal law and form the basis for the plan of care  PCP is aware of and addresses complex ethical issues arising in the care of persons with life-threatening debilitating illness

Domain 8: Ethical and Legal Aspects of Care  The PCP is knowledgeable about legal and regulatory aspects of palliative care

National Consensus Project and Clinical Practice Guidelines For more information: www.nationalconsensusproject.org