National Consensus Project and Clinical Practice Guidelines

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

2. 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 

3. 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

4. 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

5. 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

6. 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

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

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

9. 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

10. 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

11. 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

12. 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

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

14. 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

15. 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

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

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

18. 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

19. 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

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

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