National Consensus Project

Palliative care assists increasing numbers of people with chronic, debilitating, and life- limiting illnesses. A growing number of programs provide this care in a variety of settings: hospitals, outpatient settings, community programs within home health organizations, and hospices. Within these settings are dedicated teams of physicians, nurses, social workers, chaplains, counselors, nursing assistants, rehabilitation specialists, speech and language pathologists, and other healthcare professionals. These providers, who are devoted to special populations with palliative-care needs, assess and treat pain along with other symptoms; facilitate patient-centered communication and decision making; and coordinate continuity of care across settings throughout the disease continuum.

The first edition of the Clinical Practice Guidelines for Quality Palliative Care was developed by the National Consensus Project (NCP) to describe the core precepts and structures of clinical palliative care programs. Two years later, the National Quality Forum (NQF) adopted the Clinical Practice Guidelines for Quality Palliative Care within the document A National Framework for Palliative and Hospice Care Quality Measurement and Reporting. This revision continues the consensus process among the four consortium organizations that comprise the NCP.

The Clinical Practice Guidelines for Quality Palliative Care have been updated for several reasons. First, as part of its mission, the National Consensus Project for Quality Palliative Care aims to promote consistent and high quality care. Within health care, this is an evolving process, requiring periodic revisions to reflect the growing practice and evidence of palliative care as it continues to move into mainstream health care. This includes an update of the references and definitions used in the Guidelines.

Second, when the National Quality Forum released the 38 preferred practices for hospice and palliative care, it was necessary for the Clinical Practice Guidelines for Quality Palliative Care to have concordance with those practices. In order to ensure this, it was necessary to review the guidelines to be certain that all the preferred practices were reflected within the domains.

Finally, over the last five years, many organizations have asked how the theory of the Clinical Guidelines can be implemented into practice. Consequently, we identified real examples of how various organizations have used the Guidelines to operationalize optimal end-of-life care. Some are programs that demonstrate their use in practice. Also included are NCP Leadership Award winners that demonstrated excellence through the use of the Clinical Practice Guidelines. Seeing the widespread use of the Clinical Practice Guidelines for Quality Palliative Care as the basis of many palliative care programs has, in and of itself, demonstrated another aspect of the mission of the NCP the widespread dissemination and distribution of the Guidelines and the related Preferred Practices from the NQF.

Because the foundation work of the NCP had established the eight domains through a consensus process, they themselves remain the same. In revising the document, clarifications were made to make the document both more inclusive and expansive to all settings that provide palliative care. Additionally, some sections further develop a particular domain. Our goal is for the Clinical Practice Guidelines for Quality Palliative Care to continue to serve as the blueprint upon which to build optimal palliative care. We recognize that palliative care will continue to evolve. We welcome your feedback on the Clinical Practice Guidelines for Quality Palliative Care and their place in program development.

Constance Dahlin, MSN, ANP, BC, ACHPN
Chair, Revision Task Force
National Consensus Project
For Quality Palliative Care
One Penn Center West, Suite 229
Pittsburgh, PA.15276-0100
Phone: (412) 787-1002
Fax: (412) 787-9305
www.nationalconsensusproject.org

Acknowledgments

In the five years since the National Consensus Project for Quality Palliative Care released the first edition of the Clinical Practice Guidelines for Quality Palliative Care, the discipline of palliative care has continued to advance, particularly now that it is recognized as a medical specialty. This revision reflects the continued teamwork in the process. The Steering Committee of the National Consensus Project for Quality Palliative Care extends its thanks to all the healthcare professionals who gave us the benefit of their support, experience, and thoughtful comments as we revised the Clinical Practice Guidelines for Quality Palliative Care.

We also thank Dr. Betty Rolling Ferrell for her leadership of the National Consensus Project for Quality Palliative Care and the task force members for their commitment to the project.

Stephen Connor, PhD
Constance Dahlin, MSN, ANP, BC, APRN
Betty Ferrell, PhD, RN
Nancy Hutton, MD
Judy Lentz, RN, MSN, MHA
Dale Lupu, MD
John Mastrojohn, RN, MSN, MBA
Diane Meier, MD, FACP
Judi Lund Person, MPH

Funding

The National Consensus Project for Quality Palliative Care is deeply grateful to the following organizations and foundations for the financial support that made this project possible.

Grantors

Arthur Vining Davis Foundation
California Health Care Foundation
Kornfeld Foundation
Mayday Fund
Milbank Fund

National Consensus Project for Quality Palliative Care Consortium Organizations

American Academy of Hospice and Palliative Medicine
Center to Advance Palliative Care
Hospice and Palliative Nurses Association
National Hospice and Palliative Care Organization