"We're Onto Something Here!": Clinician Perspectives of a Pilot Program to Increase Palliative Care Access in an Urban Skilled Nursing Facility

Brook Calton; Pamela Williams; Carolina Jaramillo; Kathryn Corelli; Katie Carr; Louis Waldman

doi:10.1016/j.jamda.2023.11.022

"We're Onto Something Here!": Clinician Perspectives of a Pilot Program to Increase Palliative Care Access in an Urban Skilled Nursing Facility

J Am Med Dir Assoc. 2024 Jan 4:104907. doi: 10.1016/j.jamda.2023.11.022. Online ahead of print.

Authors

Brook Calton¹, Pamela Williams², Carolina Jaramillo³, Kathryn Corelli⁴, Katie Carr⁵, Louis Waldman⁶

Affiliations

¹ Division of Palliative Care and Geriatric Medicine, The Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Brigham Office of Population Health, Boston, MA, USA. Electronic address: bcalton@mgh.harvard.edu.
² Division of Palliative Care and Geriatric Medicine, The Massachusetts General Hospital, Boston, MA, USA.
³ Cambridge Health Alliance, Cambridge, MA, USA.
⁴ Massachusetts General Brigham Office of Population Health, Boston, MA, USA; Division of General Internal Medicine, The Massachusetts General Hospital, Boston, MA, USA.
⁵ Massachusetts General Brigham Office of Population Health, Boston, MA, USA.
⁶ Spaulding Rehabilitation, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA.

PMID: 38185467
DOI: 10.1016/j.jamda.2023.11.022

Abstract

Many adults cycle between the hospital and skilled nursing facilities (SNFs) near the end of life. However, palliative care services, which can provide specialized support for patients with serious illness, are often limited at SNFs. The "3C's Palliative Care Program," a 5-month pilot, aimed to improve palliative care access for patients admitted to subacute rehabilitation at an SNF affiliated with an urban academic medical center. This manuscript focuses on the pilot's feasibility, acceptability based on SNF clinician feedback from interviews, and lessons learned. The 3C's Program featured primary palliative care skill coaching, virtual palliative care consultations, and continuity via referrals to home-based palliative care at discharge. Ninety percent of SNF clinicians surveyed recommended the continuation of the pilot. SNF clinicians felt the program improved their ability to identify patients for PC consultation, to understand the role and value of palliative care, and to appreciate their patients' illness trajectories. Lessons learned from this pilot suggest SNF-Palliative Care clinician relationship building and simple patient identification mechanisms for palliative care are key to the success of palliative care at SNF integration.

Keywords: Palliative care; primary palliative care; skilled nursing facility; subacute rehabilitation; telemedicine.