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 1.Scientific evidence 2.Clinical experience 3.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 1. Structure and Process of Care 2. Physical 3. Psychological and Psychiatric 4. Social 5. Spiritual, Religious and Existential 6. Cultural 7. The Imminently Dying Patient 8. 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