Staff-Identified Palliative Care Needs Among Programs of All-Inclusive Care for the Elderly (PACE): A Survey Study.

OBJECTIVES

The Program of All-Inclusive Care for the Elderly (PACE) program provides nursing home-level care to older adults living in the community. We sought to characterize provider perceptions of PACE patients' unmet palliative care needs and quantify the palliative care educational needs of multidisciplinary PACE staff members by conducting a palliative care needs assessment survey of clinical staff at 3 PACE sites.

DESIGN

A cross-sectional survey.

SETTING AND

PARTICIPANTS

Participants were clinical staff at 3 PACE sites, including physicians or other advanced practice providers, registered nurses, social workers, physical therapists, occupational therapists, speech language pathologists, certified nursing assistants, and licensed practical nurses.

METHODS

Descriptive statistics were calculated for each survey measure.

RESULTS

Eighty-one PACE clinicians responded. More than half of respondents agreed that they would like to increase palliative care access (53%) and believed that palliative care would improve the quality of life for their patients (70%). Pain management (80%), caregiver and family support (57%), and psychiatric symptom management (46%) were the most frequently endorsed ways a palliative care specialist could help PACE patients. Similarly, caregiver and family support (69%), advance care planning and goals of care conversations (67%), and psychiatric symptom management (63%) were the 3 top domains that respondents identified where PACE patients could benefit from additional services.

CONCLUSIONS AND IMPLICATIONS: Although most PACE clinicians believed their patients could benefit from palliative care and wanted to improve access to the service, their patients have high unmet needs in the domains of advance care planning, caregiver support, and psychiatric symptom management. This likely reflects the complex psychosocial and behavioral health needs of PACE participants and their care partners. Because of the high level of need and population-specific challenges in psychosocial domains of palliative care, integrated behavioral health-palliative care models may be preferable to consulting arrangements in PACE programs.