MASSC Survey

1
MASSC Survey Program Leaders
Mellar P. Davis M.D. FCCP FAAHPM
2
Format

• Questions 4-25, 39, 44, 49, 51, 54-60, 62-65
  pertain to all programs.
• Questions 26-38 pertain to programs with
  dedicated (non-hospice) acute care beds.
• Questions 40-43 pertain to programs with a
  dedicated consultation service.
• Questions 45-48 pertain to programs that see
  patients in an outpatient setting

3
Format

• Question 50 pertains to programs that have a
  hospice program.
• Questions 52-53 pertain to programs with
  palliative medicine fellowship programs.
• Question 61 pertains to programs that have
  palliative care grand rounds.
• Questions 66-81 pertain to programs that have a
  research program. Note that questions 76-81
  appear to pertain to all programs however
  question 65 ends the survey if the program does
  not conduct research.

4
Results

• 62 program leaders completed the survey
• Program names were most often described using a
  single phrase (Question 2) Palliative care,
  22/61 (36)
• Comprehensive cancer care, 5/61 (8)
• Pain and symptom management, 3/61 (3)
• Supportive care 2/61 (3)
• An unlisted phrase,5/61 (8)
• 39 of programs were described using two or more
  phrases

5
Results

• The majority of programs were recorded as being
  more than five years old (43/61, 70) 3 (5)
  were recorded as being less than one year old 4
  (7) as being 1-2 years old, and 11 (18) as
  being 3-5 years old.
• Responses are reported for all leaders combined
  and broken down by whether the program is
  relatively new (lt5 years old) or mature (gt5 years
  old).

6
What are the specific kinds of palliative care
services that are available? What are the type
(s) of services that your palliative care team
offers?
7
Results

• Other than in-house hospice the majority of
  programs offer all of the services described in
  questions 4 and 5, with 49 of programs offering
  consultation/mobile team service, supportive care
  clinics, and dedicated PC acute care beds (Q4)
  59 of programs offered 7-8 of the specific
  services listed in Q5

8
Approximately, what proportion of patients seen
by palliative care belong to the pediatric age
group (lt18 year old)?
9
Results

• Approximately 1/3 (34) of programs see pediatric
  patients

10
What is the professional background of the
palliative care program leader?
11
Results

• The professional background of program leaders is
  quite varied. The most commonly recorded
  specialty was medical oncology (74). 69 of
  respondents recorded gt1 specialty

12
Within your program, please indicate the
approximate number of paid personnel assigned to
palliative care
13
Results

• 48 of programs reported having gt5 ward
  (inpatient) nurses assigned to PC 10 reported
  having gt5 clinic (outpatient) nurses assigned to
  PC
• The majority of programs have at least one
  chaplain, dietitian, mid-level provider,
  rehabilitation personnel, psychologist, and
  social worker assigned to PC, but no pharmacists
  or psychiatrists

14
Approximately, how many full-time equivalent
(FTE) physician positions are available in your
palliative care program?
Approximately, how many physicians on your
palliative care team have at least 20 academic
protected time?
Does your palliative care program require
physicians to be certified (finished a fellowship
and taken boards)?
Does your palliative care program require nurses
to be certified (taken boards in palliative
nursing)?
15
Results

• Programs reported a median (range) of 2 (0-15)
  FTE physicians available for PC over half (55)
  the programs reported that at least some
  physicians have gt20 academic protected time
• The majority of programs (58) required
  physicians to be certified (finished a fellowship
  and passed boards) and 53 required nurses to be
  certified

16
On average, how long does your palliative care
team follow patients in your institution (all
inpatient and outpatient encounters)?
17
Results

• 43 of programs followed patients throughout the
  course of their illness

18
Does your palliative care program have any
dedicated acute care beds in your institution
19
Results

• Almost 3/4 (74) of programs reported having
  dedicated (non-hospice) acute care beds median
  (range) number of beds - 10 (0-43)
• Almost 3/4 (74) of these programs had a
  designated PC unit
• Within these programs the median (range) number
  of inpatient discharges/month was 24 (2-250) and
  the median length of stay was 10 days (range
  3-98)

20
Results

• The median (range) inpatient PC mortality rate
  within these programs was 40 (2-99)
• Acute symptom management was the primary reason
  for admission. Program leaders reported a median
  of 60 (range 0-90) of admissions were for
  symptom management
• The primary referral sources were outpatient
  clinics (median 25 range 0-90)), and inpatient
  units other than intensive care (median 20
  range 0-100)

21
Results

• gt75 of patients received regular psychosocial
  assessments on each admission in 55 of programs
• gt75 of patients had family conferences in 50
  of the programs
• Oncologists attended gt75 of family conferences
  in 36 of programs
• gt75 of patients had standing DNR orders in 51
  of programs

22
Does your palliative care program have a
dedicated consultation service in your
institution?
23
Results

• The vast majority (92) of programs had dedicated
  consultations services
• The service was available 24/7 in 43 of programs
  
• A median (range) of 25 (3-400) referrals were
  made to the service monthly
• The most common referral sources were medical and
  radiation oncology, and surgery

24
Does your palliative care program see patients in
the outpatient setting?
25
Results

• 90 of programs saw patients in an outpatient
  setting (primarily dedicated PC units)
• Outpatient clinics were held a median (range) of
  5 (0.5-7) days a week and a median (range) of 30
  (3-250) referrals/month were made to it
• Similar to consultation services the most common
  referral sources were medical and radiation
  oncology, and surgery

26
Does your institution operate a hospice?
27
Results

• 23 of programs operated a hospice

28
Fellowship program for Palliative Medicine?
29
Results

• A little over 1/3 (37) of programs had a
  fellowship program for palliative medicine.
• Most of these programs (52) had 1-2 clinical
  fellows/year 56 had 1-2 research fellows/year

30
Mandatory palliative care rotations for
31
Results

• When applicable the majority of programs (56)
  required PC rotations for medical oncology and
  hematology fellows
• 33 required them for radiation oncology
  fellows
• 9 required them for pediatric oncology fellows
• 51 required them for other fellows/residents
• 35 required them for medical students

32
Training of mid-level providers in palliative
care
33
Results

• Most programs (61) trained mid-level providers

34
Dedicated palliative care grand rounds
35
Results

• A little over 1/2 the programs (53) held PC
  grand rounds 68 held 1/week and 32 held
  2-3/week

36
Length of training for fellows for certification
37
Results

• Slightly less than 1/2 the programs (48) had
  recognized accreditation requirements in order to
  be recognized as a PC specialist

38
Is there a research program in palliative care
39
Results

• 64 of leaders reported having a PC research
  program
• The research team most frequently consisted of
  physicians (100), data analysts (75), research
  nurses (72), and/or psychologists (56). 44 of
  the teams were fully staffed in the sense that
  they consisted of physicians, data analysts,
  research nurses and psychologists/social workers
  other personnel

40
Results

• 62 of the research programs received outside
  funding primarily from private foundations and
  philanthropy
• 86 of programs conducted prospective studies,
  57 conducted retrospective studies, 51 reported
  case series/reports, and 54 conducted
  qualitative studies

41
Results

• Research programs reported their results in PC
  and oncology journals, as well as more general
  medical journals (70 of programs had at least
  one publication in a PC journal last year 68
  had at least one in an oncology journal and 49
  had at least one in a general medical journal)

42
Young versus Mature Programs

• The number of newer programs is relatively small
  and therefore comparisons need to be viewed
  cautiously
• Several differences that are perhaps worth noting
  include

43
Young versus Mature Programs

• The professional backgrounds of the leaders from
  younger programs tended to be oncology based
  (medical/radiation oncology) more frequently than
  those of mature programs
• Among programs with dedicated acute care beds
  length of stay tended to be shorter in mature
  programs compared to younger programs (median
  (range) 9.5 (3-96) versus 14.5 (9-98) days,
  respectively, p007)

44
Young versus Mature Programs

• Among programs with dedicated consultation
  services mature programs tended to have more
  referrals/month than younger programs (median
  (range) 30 (3-400) vs 15 (4-40), respectively,
  p.04) however this may be an artifact of the
  size of the programs?
• Mature programs tended to require PC rotations
  for non-oncology fellows and residents more
  frequently than younger programs (60 vs 20,
  p.04) however this could be an artifact of the
  type of PC programs in each group?