Clinicians seek program to program uniformity

While the rapid growth of hospital-based palliative care programs is the good news, the bad news is the wide range of quality and standards that exist, notes Betty Ferrell, PhD, RN, research scientist at City of Hope National Medical Center in Los Angeles and chair of the National Consensus Project for Quality Palliative Care (NCP) Task Force.

"It is wonderful if Mercy Hospital in Des Moines and M.D. Anderson in Texas start programs, but what is more important from the patient's perspective is that there is some uniformity in programs," she asserts.

The fact that of the 2,000 plus hospital-based programs no two are alike is "a huge challenge," Ferrell continues. "What if you had a wonderful experience with your mom in your town but grandma is 100 miles away and gets sick, and you tell your brother he should definitely get her into a program? You might then find out the staff is an art therapist and a social care provider."

The idea behind the task force, she says, "Is that we need a common definition and an assured framework, so consumers and payers and accrediting bodies can begin to have some shared understanding of what this is all about."

The NCP has taken significant steps in this direction, says Ferrell. "If you go to our web site [], there are eight domains — a sort of simple template," she points out. The domains are: structure and process of care; physical; psychological and psychiatric; social; spiritual, religious, and existential; cultural; the imminently dying patient; and ethics and law. The NCP site also includes clinical practice guidelines and other detailed information on what a palliative care program should include.

"If you have a program now, or are starting one, refer to these. This is what will direct the future of reimbursement and accreditation, and you can look at them and assess how you are doing," Ferrell suggests.

Within the next couple weeks, for example, the National Quality Forum will have available on its web site written preferred practices for the field, after having reviewed the NCP's clinical practice guidelines, according to Ferrell. "We served on the NQF group, and they have developed preferred practices for each of our eight domains," she adds. "These measures indicate where the field is going."

For more information, contact: Betty Ferrell, PhD, RN, Research Scientist, City of Hope National Medical Center, Los Angeles, CA. Phone: (626) 256-4673, Ext. 62825. E-mail: