The “101” Palliative Care Encounter:  What is It?

Copious well-designed studies have confirmed the value of palliative care consultations for seriously ill inpatients and outpatients with a wide variety of cancer and non-cancer diseases. This has led to Palliative Care trigger projects and other integrated, system-based practice approaches to foster broader and more reliable access to palliative care consult teams earlier in an illness trajectory. But what does a palliative care consultation entail? Is it uniformly performed across all palliative care clinicians? Institutions? If you randomly plucked a palliative care clinician from a random institution in the US, would he or she be able to reproduce the palliative care interventions that were proven to be effective for metastatic non-small cell lung cancer patients in the often-referred to Temel study? For many referring clinicians, a palliative care consultation is imagined as a “black box” from which patients often emerge with new direction in care and a new symptom management plan. I worry that this creates a mystified sense of the work we do. After introducing yourself as a palliative care clinician, have you ever had a clinician say to you: “you must be such a special person to do what you do. I don’t know how you do it.”

I’ve heard such a phrase multiple times in the 10 years or so I’ve been practicing palliative care. Initially, I guess it made me feel a little warm and fuzzy inside. But after the honeymoon wore off, I now find myself bristling a bit if I hear comments such as this regarding palliative care work. Although I’m 100% convinced the work we do is needed, I am not 100% convinced our work is truly “special”. In fact, often I feel amazed that I get paid to offer what are often common-sense, big-picture assessments and recommendations to experienced clinicians, even specialists of patients with, yes serious, but also common-place medical problems. But more so, it is the last sentence of a comment such as this, that I find myself ruminating over in a very literal fashion. I think I’ve been misinterpreting the most plainly stated portion of a comment such as this: many clinicians aren’t marveling at our emotional stamina to the work in palliative care or marveling at our empathetic reserves, they really want to know, what do we do in a palliative care encounter.

I think there could be great benefit to our patients, clinicians, and the larger health care system if we can demystify our work. One step toward making our work more reproducible and understandable, would be to articulate what a “101” or basic Palliative Care Consultation should entail. Perhaps by doing so:

  • Referring clinicians and patients would have a better anticipation of the systematic process involved when palliative care teams make independent assessments and recommendations to address unmet palliative care needs.
  • Less experienced clinicians and clinicians-in-training may have better confidence and direction in performing palliative care interventions when rotating or onboarding on palliative care consultative teams.Documentation of palliative care consultations could be better standardized.

What do you think? Do you feel there is a need for our field to develop a more broadly referenced, agreed upon, and reliable guideline on how to do a Basic “101” Palliative Care Encounter or Palliative Care Consultation? Is such a goal achievable? If so, what do you feel should be essential components in a basic “101” Palliative Care Consultation?