How to Incorporate Palliative Care into Community Health Needs Assessments

Posted Friday, January 20, 2012 by .

Posted by Scott Good

Palliative care issues are rarely identified by community leaders when developing their Community Health Needs Assessment (CHNA).  I, personally, or Crescendo colleagues have conducted a boatload of community assessments over the past 20 years.  Honestly, working with hospital administrators, community groups, healthcare leaders, and (yes, I admit it) reams of data is probably one of the more enjoyable parts of my job.  For example, community leaders are, de facto, highly engaged with issues in their neighborhoods or towns, and gathering a dozen of them for a focus group (as I am doing in a few hours) creates an energetic dynamic.  However, quality of life services for seriously ill patients (palliative care) is rarely addressed in a direct way.

Let's look at a few of the numbers ... An estimated 150 million Americans (or a family members) have either been diagnosed with a serious or life threatening illness - a number expected to increase dramatically as baby boomers age.  Currently, nearly six million people in the US could potentially benefit from receiving palliative care.  Over the next 25 years, that number is expected to exceed 10 million.  Over 1.5 million people are diagnosed with cancer and over 500,000 die annually.[1]  In addition, nearly another one million people die from heart disease, cerebrovascular diseases, lower respiratory diseases, and Alzheimers disease.[2]  Compounding the landscape is America's aging population:  the median age is 37.2 years (up from 32.9 in 1990), and over 40 million Americans are 65 or older.[3] 

Given the magnitude of the disease incidence and the aging population, there is a growing healthcare challenge that includes helping people improve their quality of life - regardless of disease and diagnosis.  Palliative care offers an integrated set of services that coordinate with curative services in order to improve the quality of life, better manage pain and discomfort, reduce stress and anxiety, and support the patients and their families with spiritual and/or social challenges.

So how do we take this stark data to DO SOMETHING POSITIVE with it?  Well, if you work at a not-for-profit hospital or live in a community served by one, you can incorporate palliative care into your CHNA.  Here's how ...

  • Learn. Understand that palliative care means: Providing integrated services that improve the quality of life for seriously ill patients. This could include coordinated counseling to address psycho-social concerns (e.g., less depression and anxiety), pain management, family support and transition issues, faith-based needs, and curative care.
  • Collect. Make a list of three to seven organizations in the community that may be able to come together to provide an integrated set of palliative care services at the local hospital. Of course, contact the hospital in order to identify ways in which the facility currently offers palliative care services (if at all) and the contact information of the on-site lead. Your CHNA will probably generate this list as a normal course.
  • Recognize basic challenges. The biggest challenges to enhancing palliative care efforts include (1) educating people of the need for palliative care, (2) framing palliative care in terms of "improving the quality of life" as opposed to "end-of-life" services, and, (3) communicating that their efforts can make a tremendous, positive impact on the lives of the seriously ill and their families.
  • Reach out. Contact the three to seven people on your list, meet and discuss the possibility of cooperatively addressing this need. When meeting, though, make sure that you have your ducks in a row - know the goal and structure of palliative care, current efforts at the hospital, and a "starting point" list of ways that the community groups may be able to enhance hospital efforts. It is also a good idea to involve the hospital palliative care leadership early in the process; have them attend meetings or conference calls to get things rolling.
  • Plan. Draft up a simple, short, achievable list of goals and activities for your palliative care community group (including the hospital leader). A CHNA is required to be followed by with an Implementation Plan that indicated how a hospital will address community needs. This is a good place to include a section on palliative care and, therefore, formalize efforts.
  • Engage. Get involved. Execute your plan. Make a difference in people's lives. This is an easy message to sell to those of us involved in community service (directly or indirectly) - AS LONG AS it is not too big of a time sink or is run inefficiently.

    • Developing the CHNA will help the hospital identify a breadth of needs.  Be careful not to overlook one of the services that community members are most likely to need at some point in their lives - palliative care.  Use the CHNA to help identify existing palliative care services and prospective collaborators to enhance them.  It can also guide the development of plans to meet unmet needs in the area (via the Implementation Plan).  If you would like a few pointers about accomplishing some of these specific tasks, please give me a call - but not after 4:00 today, as I'll be working with a group of community leaders to do just this!  

     

    [1] American Cancer Society, Cancer Facts and Figures, 2011.

    [2] Centers for Disease Control and Prevention, Fast Stats, Five leading causes of disease-based deaths, 2009.

    [3] US Census Bureau, 2011.

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