A draft version of the 4th edition of the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care (NCP Guidelines) has set up expectations of excellence among all health care professions, including teams and organizations that treat patients with serious illnesses regardless of setting, diagnosis, prognosis, or age. All clinicians who treat such patients are expected to integrate high-quality palliative care in all patients, encompassing adults, children, and families.1
“[T]he goal of the NCP Guidelines is to improve the care that patients and their families receive by defining and supporting access to high-quality palliative care in all care settings,” the guidelines state.
Palliative care is expected to be offered in all care settings — from physician practices, health systems, cancer centers, hospices, long-term care settings, correctional facilities, and homeless shelters. It is required to take a holistic approach to managing patients with serious illness and their families — and is expected to account for the physical, functional, psychological, practical, and spiritual consequences of serious illness. The integrated approach requires the involvement of an interdisciplinary team (IDT), some of whom may include physicians, nurses, physician assistants, social workers, pharmacists, and chaplains, among others.
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First published in 2004, this draft edition of the guidelines discusses continuity, consistency, and quality of care across 8 domains, which are enhanced through use of the following: a comprehensive assessment, family caregiver assessment, care coordination (especially during care transitions), cultural aspects of care, and communication across palliative care teams with patients and their caregivers. Each domain has its own associated set of guidelines, criteria that need to be fulfilled for each, and clinical and operational implications. Domain 1 is associated with 10 guidelines; most other domains are structured to have 4 to 5 guidelines.
This edition of the NCP Guidelines focuses on 2 key concepts. Because palliative care is inclusive of patients with serious illness regardless of setting, diagnosis, prognosis, or age, care that is language-specific to the patient is emphasized. Secondly, timely consideration of palliative care is the responsibility of the IDP team, regardless of where the care is actually delivered. Emphasis is laid on community-based resources; anticipatory grief and bereavement; and continuity of care.
