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Specialty-Aligned Palliative Care: Responding to the Needs of a Tertiary Care Health System

  • Samantha L. Gelfand
    Correspondence
    Address correspondence to: Samantha Gelfand, MD, 450 Brookline Ave, Boston, MA 02215, USA
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Division of Renal Medicine (S.L.G, E.I.M.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • Joshua R. Lakin
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • Kate R. Sciacca
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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  • Emily R. Rivkin
    Affiliations
    Dana-Farber Cancer Institute (E.R.R., J.C.E.), Boston, Massachusetts, USA
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  • Jessica C. Eves
    Affiliations
    Dana-Farber Cancer Institute (E.R.R., J.C.E.), Boston, Massachusetts, USA
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  • Shelly Anderson
    Affiliations
    Brigham and Women's Hospital (S.A.), Boston, Massachusetts, USA
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  • Ernest I. Mandel
    Affiliations
    Division of Renal Medicine (S.L.G, E.I.M.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • Akshay S. Desai
    Affiliations
    Division of Cardiovascular Medicine (A.S.D., M.J.L.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • Nelia Jain
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • Michael J. Landzberg
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Division of Cardiovascular Medicine (A.S.D., M.J.L.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • Natasha M. Lever
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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  • Kristen G. Schaefer
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • Richard E. Leiter
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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  • James A. Tulsky
    Affiliations
    Division of Palliative Medicine (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., K.G.S., R.E.L., J.A.T.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (S.L.G, J.R.L, K.R.S., N.J., M.J.L., N.M.L., R.E.L., J.A.T.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Harvard Medical School (S.L.G, J.R.L, E.I.M., A.S.D., N.J., M.J.L., K.G.S., R.E.L., J.A.T.), Boston, Massachusetts, USA
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      Abstract

      Background

      Expanding specialty palliative care within complex health systems involves consideration of patients’ unmet needs, clinicians’ perceptions of palliative care, and the availability of palliative care resources. Prior to this quality improvement (QI) project, palliative care services in our health system primarily served oncology patients.

      Intervention

      We undertook a prospective strategic planning process that included executive sponsorship and engagement of institutional leaders and clinicians to help define which palliative care services were most needed by the health system.

      Measures

      We interviewed and surveyed a broad range of clinicians including physicians, nurse practitioners, and social workers.

      Outcomes

      The two most prominent themes that emerged from the stakeholder engagement process were clinicians’ wish for specialty-aligned interprofessional palliative care teams and for expansion of nononcology palliative care access.

      Conclusion

      Careful needs assessment and stakeholder engagement can result in goal-directed and data-driven expansion of palliative care services within tertiary health care systems.

      Key Words

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