Tuesday, April 23, 2019
Home Health Martha L. Twaddle, MD: Updated National Clinical Guidelines for Palliative Care

Martha L. Twaddle, MD: Updated National Clinical Guidelines for Palliative Care

As critically ill patients and their families are the largest growth sector in the US healthcare system, access to palliative care is of paramount importance. However, with the publication of the 4th edition of national guidelines for palliative care in clinical practice, this care becomes even more accessible.

"Palliative care is by definition an interdisciplinary care," said Martha L. Twaddle, clinical professor at Northwestern University, the Feinberg School of Medicine MD Magazine®, "It's about working as a team, and the interdisciplinary model is one in which each of us has the opportunity to seek out-of-the-box needs outside of our field of expertise. We call on health care to return to what was originally intended: to care for people in the context of their family and community, and to personalize their care. "

"The guidelines are really important because," These are the essential elements that are necessary to say that you are doing palliative care. "It helps turn care into the model that we think is so important in the care of seriously ill people," she added.

Originally founded in 2001 and published in 2004, that is Clinical Practice Guidelines for High Quality Palliative Care highlight critical aspects of the field. In the updated edition, the authors demand a critical assessment by the various members of a patient's interdisciplinary team and emphasize the importance of the family, which includes not only the biological family, but also the patient community and the patient support group.

The assessment of caregivers' capacity and stress, as well as transitions in the care of critically ill patients, are further priorities in the updated guidelines – regardless of prognosis, environment and age. That's why pediatrics is also emphasized because, according to Twaddle, the guidelines apply to 5-year-olds as well as 90-year-olds.

Due to a lack of literature, the original guidelines were determined by national consensus in the United States. However, the updated guidelines contain even more critical stakeholders. 16 different organizations participated in the creation of this edition. A systematic review of the evidence available to date has also included the benefits of palliative care and well-researched areas of research that are still needed.

"The guidelines reflect the progress of the field," added Twaddle. "The AIDS epidemic has quite frankly led healthcare to better serve the seriously ill. In this context, the field of palliative care was really born. "

Twaddle added that a lack of organization has significantly influenced the standardization of the palliative care guidelines available today, which now form the basis of all the accreditations that occur in palliative care. For example, the Joint Commission uses the guidelines to review programs to ensure that they perform palliative care.

"The guidelines form the foundation upon which we build our quality metrics and standards," said Twaddle. "To measure good care, it needs to be linked and refer to what the guidelines consider important."

She added that pay is also largely governed by the directives because insurance contracts often, sometimes literally, contain the guidelines for which palliative care is defined.

Another exciting addition to the guidelines, according to Twaddle, is a focus on collaboration. Although specialists are required, in certain situations the entire patient team is important. Through the creation of 45 different practice examples, which consist of innovations of individuals who have endeavored to meet the needs of critically ill patients, the guidelines highlight the importance of collaboration.

"We need to create synchronized swimming models," Twaddle said. "We need to use resources mutually and work as a team. The team may not be spatially limited or defined. The team could be bigger. [We have to] Remember what is the ability to meet the needs of patients, such as a practice that works with a community hospice or an emergency room that works with a children's hospital.

Looking to the future, Twaddle sees the new guidelines as a catalyst for further research as the systemic review reveals data gaps needed in this area. She claims that these gaps are a framework for her to work.

"One important thing that needs to be highlighted is the difference between palliative medicine and hospice care," concluded Twaddle. "Palliative care is for anyone who suffers from a serious illness. Hospice is a form of palliative care for persons at the end of life whose prognosis is several months. All that is palliative care is hospice, but not all that is hospice is palliative medicine. The guidelines cover the entire roof of palliative care – including, but not limited to, end-of-life care. "



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