Hospice and Palliative Care: Interdisciplinary Team Education

• Hospice and palliative care provide specialty healthcare to patients and families experiencing a life-limiting illness.  
• The need for ongoing continuing education is vital in hospice and palliative care as these services continue to grow.  
• Workplace-based educational programs allow collaboration with novice and experienced hospice and palliative care staff.  

Hospice and palliative care provide specialty healthcare to patients and families experiencing a life-limiting illness. Palliative care, which has evolved into a healthcare specialty in the past 25 years, improves quality of life by managing chronic symptoms, addressing patient and family stressors, and providing psychosocial team-based support (Ahluwalia et al., 2018). Hospice care became a Medicare health benefit in the early 1980s as an amendment to the Social Security Act.  

Once a life-limiting illness evolves into a life span of less than six months, and if other qualifications are present, patients may elect hospice as their primary health benefit through Medicare. Hospice and palliative care promote an interdisciplinary team focused on patient and family end-of-life needs and goals (Connor, 2007).  

Life-Limiting Illness

Life-limiting illnesses can occur at any age and hinder a person’s quality of life and their ability to do things they once could. A life-limiting illness is an active, progressive, or advanced disease that has little to no prospective cure and typically becomes worse with time, resulting in death.  

Some examples of life-limiting illnesses are: 

• Advanced cancer. 
• Motor neuron disease. 
• Dementia. 
• Neurological diseases. 
• Lung disease. 
• Advanced heart disease.

Ongoing Continuing Education

The need for ongoing continuing education is vital in hospice and palliative care as these services continue to grow (Connor, 2007). Continuing education allows for reviewing best practices, participating in research planning, and reviewing interdisciplinary team functions (Westcott et al., 2019). The interdisciplinary team often includes physicians, physician assistants, nurse practitioners, social workers, registered nurses, licensed practical nurses, chaplains, volunteers, physical therapists, and nursing assistants. The interdisciplinary team must understand each other’s roles and how to provide high-quality hospice and palliative care effectively (Levine et al., 2017). The evidence discussed next will determine if interdisciplinary palliative and hospice education is efficacious in improving an increase in clinical knowledge and practice application.   

Though palliative and hospice care provide team-based care for patients and families experiencing life-limiting illness, their practices have different structures.   

Healthcare organizations often contain both care practices. The interdisciplinary team may practice, educate, and consult in both healthcare arenas. Most private and governmental insurance systems view palliative care as a specialty. Hospice is a Medicare benefit, elected once patients meet criteria of less than six months of life expectancy. Medicare requires hospice agencies to follow a set of rules known as Conditions of Participation (COP). One COP requires an interdisciplinary team to meet at least bimonthly to review a patient and family’s goal of care (Connor, 2007). 

An interdisciplinary hospice team navigates complex medical conditions and associated symptom management, family dynamics, and end-of-life spiritual and psychosocial issues. A physician trained in hospice and palliative care leads the interdisciplinary team. However, the remainder of the team often does not have pre-employment education to support this approach to care. Training and learning occur in the clinical environment for interdisciplinary members new to hospice and palliative care (Sivell et al., 2015). Research evidence data collection took place to assess the effectiveness of these training programs, and four scholarly articles were reviewed.  

The articles were original research and contained measurable data related to hospice and palliative care education training programs or the development of programs. The education training programs varied in format and delivery. All training programs involved most of the interdisciplinary team from established palliative and hospice care teams. The interdisciplinary team participants not represented in the articles were volunteers and nursing assistants. Three palliative and hospice care teams in the research articles practiced in the United States (Levine et al., 2017; Sivell et al., 2015; Westcott et al., 2019). One palliative care team practiced in Ukraine (Paal et al., 2020). Sample sizes were adequate for all data collected except for the study by Wescott et al., which contained six participants (2019). Study designs included qualitative and mixed methods.   

Surveys of palliative and hospice clinical members indicated they often serve as educators for each other. Clinical team members also reported they had no formal educational or teaching training. The type of teaching focused on the team member’s perception of what inexperienced team members needed for their job. Types of learning identified included experiential learning, debriefing, and role modeling (Wescott et al., 2019).   

One qualitative survey demonstrated that participants felt an interdisciplinary team best taught palliative care topics (Sivell et al., 2015). A one-week-long training program for interdisciplinary palliative care providers in Ukraine revealed that post-survey results were positive for a gain in theoretical palliative knowledge (Paal et al., 2020). A two-year, intermittent, palliative care training program for physicians, advanced practice registered nurses, and registered nurses revealed a statistically significant and positive gain in knowledge with pre- and post-testing. Qualitative comments also revealed themes of positive learning environments, knowledge gained, collaborative relationships developed, and clinical practice application (Levine et al., 2017). This data has implications for the future of post-graduate hospice and palliative education.   

Workplace-Based Educational Programs

Implications from the four-article evidence critique include ongoing hospice and palliative-specific educational programs in the workplace. Workplace-based educational programs provide an opportunity for collaboration with novice and experienced staff. Experiential learning, role modeling, working alongside others, and project improvement projects projected higher scores for assessment of learning (Levine et al., 2017).   

Before developing an educational program, one article suggested the importance of identifying the topics or themes most needed by the hospice or palliative care team (Sivell et al., 2015). Also, consider topics or themes specific to your medical institution or culture (Paal et al., 2020). Article results suggested that an interdisciplinary team would be the primary teachers, but they would need formal training to educate adult learners (Wescott et al., 2019).   

These articles did not consider the duration and frequency of training, though they all suggested ongoing training. The small number of social workers and chaplains participating and teaching within the educational programs was a limitation in two out of four research studies (Levine et al., 2017 & Westcott et al., 2019). No volunteers or nurse assistants participated in the research in all articles reviewed.   

Hospice and palliative health care services provide holistic support to patients and families facing the end of life. Hospice and palliative care clinicians are interdisciplinary (Connor, 2007). The evidence suggests that ongoing, postgraduate, and interdisciplinary education will support clinical teams and provide mentoring and networking opportunities. Evidence also suggests that hospice and palliative care education be taught by the team that cares for patients and families, an interdisciplinary team. Designated team educators need additional education on teaching and assessing learning (Sivell et al., 2015).  

The Bottom Line

In all four research articles, not all hospice and palliative care team members actively assessed, planned or participated in team-focused education. Options for future research can involve all team members, including nursing assistants, volunteers, and more chaplains and social workers. All team members can work together to assess, plan, implement, and evaluate interdisciplinary team hospice and palliative education. Evidence indicates that more team-based, interdisciplinary palliative and hospice education opportunities will promote high-quality care.  

Read More