Organizations that set up palliative care consults expand the opportunity to educate many health care providers about the goals and practices of palliative care. Charles von Gunten, MD, former director of the palliative care consult service at Chicago's Northwestern Memorial Hospital (and now medical director of the Hospice of San Diego) describes it this way: "Besides yielding direct benefits to the health of patients and their families, consultation serves a second important purpose. Physicians learn about developments and approaches to patient care through consultation. The consultation represents an example of learner-centered learning. The referring physician (the learner) has identified the problem(s) that need solving, and the new material is clearly relevant to the problem at hand" (von Gunten et al., 1998). Its educational focus is on improving provider ability to assess and manage pain and other symptoms; improving clinicians' ability to communicate with patients and their loved ones; and improving knowledge and awareness of palliative medicine as a resource that can help physicians.
In a survey of providers who had referred patients to the palliative care consult team, Northwestern found that attending physicians, physician house staff, medical students, and ward nurses all learned from the experience. During the four years in which the service has been operated, requests for direct training through it have gone from none to more than 200 medical students, as well as 30 residents for direct clinical experience (von Gunten et al., 1998). Trainees have indicated many other goals for their experience, such as improving their own level of comfort in dealing with death and dying, and developing ways to apply palliative care approaches to other fields of adult medicine.
Many programs, like the one at Northwestern, involve provider training and outreach. The task may include educating colleagues about palliative care, facilitating communication among the many providers who work with a patient, and teaching students, interns, and residents about pain management.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].