Wednesday, October 31, 2018

NEW Clinical Practice Guidelines for Quality Palliative Care Released!!

by Christian Sinclair (@ctsinclair)

Happy Halloween!

Today is the beginning of a new era in palliative care as the 4th edition of the Clinical Practice Guidelines for Quality Palliative Care (aka NCP Guidelines) are being released into the wild to begin changing practices all over!

Well, that is the plan and the hope, of course. With any sort of guidelines or statement document, the real work comes AFTER they are published.


To be effective, policymakers, front-line clinicians, and healthcare leaders need to make time in their hectic schedules to review these new guidelines, compare what they are doing to what the standards are, and devise a plan to close those gaps. Over the next month in celebration of National Hospice and Palliative Care Month and the release of these guidelines, you will see posts on Pallimed and our social media accounts highlighting different aspects of the guidelines with straightforward action steps that you can implement.

You may be thinking, "4th edition? I never even heard of a third edition. What are these guidelines and who is telling me how to do my job?" If so, you should know that these guidelines date back to 2002 when The National Consensus Project began. That was a time when palliative care was beginning a rapid period of acceleration but still not widely available nor part of the mainstream of healthcare. The NCP released previous editions in 2004, 2009 and 2013. There is a good chance that some of the things you take for granted today in palliative care indirectly result from the standards set out in these previous editions. From my point of view, the NCP guidelines are designed to stretch us and enable our programs to become more efficient, effective and equitable.

The guidelines are structured to cover eight domains and my quick way of remembering what they are:
  • Structure and Processes of Care - who is on the team and what do they need to know
  • Physical Aspects of Care - how to assess and treat symptoms
  • Psychological and Psychiatric Aspects - how to assess and treat psych-related issues
  • Social Aspects of Care - how to assess and address social support
  • Spiritual, Religious, and Existential Aspects of Care - how to screen and support spiritual issues
  • Cultural Aspects of Care - how culture impacts care delivery
  • Care of the Patient Nearing the End of Life - how to excel in the special time of final days and weeks
  • Ethical and Legal Aspects of Care - regulatory, ACP, and ethics
Some big changes in this edition include a bigger emphasis on the caregiver as a locus of care, the burden of transitions, culture and diversity, and lifting up the science of communication. There is also more content that demonstrates the importance and growth of community-based palliative care and a more extensive reference section to ease access to the primary literature supporting the guidelines. I think many will appreciate the inclusion of examples which will enable teams and organizations to see themselves narratively and not get stuck on using imagination to make potentially dry guidelines come to life.

If you like what you see in these guidelines, please give a big thanks to the team behind it, co-chairs Betty Ferrell and Martha Twaddle, writer and editor Kathy Brandt, the National Coalition for Hospice and Palliative Care led by Amy Melnick and the NCP team of Gwynn Sullivan, Cozzie King, and Vivian Miller.


Lastly, to help all of us be more accountable, I want to encourage you to leave a comment telling the world what you plan to do with these guidelines. It could even be as simple as reading this post or sharing it with key people in your organization.

I'll tell you what I already did this morning, I went to my division chief, Karin Porter-Williamson and volunteered to be part of a small workgroup which will compare our current inpatient and outpatient programs at the University of Kansas Health System with the NCP Guidelines. To my delight, she said, 'Guess what just showed up in my email this morning? The new NCP Guidelines!"

So tell the world, what will you do with these blueprints?

Christian Sinclair, MD, FAAHPM, is the Editor-in-Chief of Pallimed and member of the palliative care dork club. When not reading guidelines over chai tea, he can be found reading rules to boardgames. See more posts from Christian Sinclair here. You can also find him on Twitter at @ctsinclair.

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