Domain 1: Structure and Processes of Care
This domain discusses the structure and process that is required to deliver palliative care — the IDT composition; its education and emotional support, as well as what is expected of the IDT team to ensure appropriate and culturally sensitive care — care that is expected to be delivered 24/7 by phone or through telehealth applications.
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The process begins with a comprehensive palliative care assessment, which leads to the development of a palliative care plan that is tailored to a patient’s preferences, needs, values, expectations, goals, and family concerns. All palliative care clinicians must be trained in opioid use, abuse, and safe disposal.
The plan is implemented and updated as required. Updates may involve hospice referral, considering treatment and care setting alternatives, and interfacing with a surrogate decision-maker for patients with cognitive impairment. Continuity of care is discussed with patients and grief support, and access to long-term bereavement is provided upon a patient’s demise.
In every care setting that care is provided, each member of the IDT is expected to get education, training, and professional development (eg, licenses and graduate training) so that with each skill set, acquired care is coordinated, and care transitions (between team members or between care settings) are anticipated and planned.
Finally, the IDT is expected to develop, implement, and maintain palliative care that is data-driven and that is committed to continuous quality improvement.
Domain 2: Physical Aspects of Care
The physical aspects of care address the management of acute and chronic symptoms, which include pharmacologic, interventional, and nonpharmacologic aspects of treatment. Safe and timely symptom relief and improvement of quality of life must be the goals of this aspect of care.
Screening and assessment, treatment, and ongoing care should be the guiding principles for the IDT. In assessing patient needs, symptom assessment should include anticipation of challenges associated with delirium, cognitive impairment, developmental capacity, or mechanical interference of voice. When prescribing controlled substances for pain management, risk of diversion and substance abuse disorder must also be assessed.
Treatment plans must be revisited, and collaboration with specialists, especially when dealing with neonatal and pediatric patients, is expected. When symptoms are refractory to standard treatments, alternate approaches must be evaluated and implemented, when appropriate.
Ongoing care is ensured through periodic monitoring, referral, and care coordination — all of which should be documented and communicated to the primary care provider who is involved in the ongoing care of a patient.
