MASSC Survey – Program
Leaders
Mellar P. Davis M.D. FCCP FAAHPM
Format
• Questions 4-25, 39, 44, 49, 51, 54-60, 62-65 pertain to all
programs.
• Questions 26-38 pertain to programs with dedicated (nonhospice) 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
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.
Results
• 62 program leaders completed the survey
• Program names were most often described using a single
phrase (Question 2) – “Palliative care”, 22/61 (36%)
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“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
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
(<5 years old) or mature (>5 years old).
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?
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
Approximately, what proportion of patients
seen by palliative care belong to the pediatric
age group (<18 year old)?
Results
• Approximately 1/3 (34%) of programs see pediatric
patients
What is the professional background of the
palliative care program leader?
Results
• The professional background of program leaders is
quite varied. The most commonly recorded specialty
was medical oncology (74%). 69% of respondents
recorded >1 specialty
Within your program, please indicate the
approximate number of paid personnel assigned to
palliative care
Results
• 48% of programs reported having >5 ward (inpatient)
nurses assigned to PC; 10% reported having >5 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
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)?
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
>20% 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
On average, how long does your palliative
care team follow patients in your institution (all
inpatient and outpatient encounters)?
Results
• 43% of programs followed patients throughout the
course of their illness
Does your palliative care program have any
dedicated acute care beds in your institution
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)
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%)
Results
• >75% of patients received regular psychosocial
assessments on each admission in 55% of programs;
• >75% of patients had family conferences in 50% of
the programs;
• Oncologists attended >75% of family conferences in
36% of programs;
• >75% of patients had standing DNR orders in 51% of
programs
Does your palliative care program have a
dedicated consultation service in your
institution?
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
Does your palliative care program see patients
in the outpatient setting?
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 (3250) referrals/month were made to it
• Similar to consultation services the most common
referral sources were medical and radiation oncology,
and surgery
Does your institution operate a hospice?
Results
• 23% of programs operated a hospice
Fellowship program for Palliative Medicine?
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
Mandatory palliative care rotations for…
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
Training of mid-level providers in palliative care
Results
• Most programs (61%) trained mid-level providers
Dedicated palliative care grand rounds
Results
• A little over 1/2 the programs (53%) held PC grand
rounds – 68% held 1/week and 32% held 2-3/week
Length of training for fellows for certification
Results
• Slightly less than 1/2 the programs (48%) had
recognized accreditation requirements in order to be
recognized as a PC specialist
Is there a research program in palliative care
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
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
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)
“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:
“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, p=007)
“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?