National Consensus Project and Clinical Practice

GuidelinesKelli 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

Clinical Practice Guidelines: 8 Domains

1. Structure and Process of Care2. Physical3. Psychological and Psychiatric4. Social5. Spiritual, Religious and Existential6. Cultural7. The Imminently Dying Patient8. 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

GuidelinesFor more information:

www.nationalconsensusproject.org