1º, 2º, 3º Model of Palliative Care Delivery
Patients and families expect health care providers to to provide competence in the
wide range of issues they face during the course of an illness.
In fact, all healthcare practitioners provide the basics of palliative
caring. While they may not have been well trained to manage these issues,
most clinical practitioners experience the need to relieve suffering on a
weekly, if not daily, basis.
To respond to the ever increasing need for therapies to relieve suffering
and improve the quality of patients' and families' lives, palliative care
providers might best evolve a primary, secondary, and tertiary delivery
model similar to that practiced by most other medical specialties:
Primary Palliative Care
All practitioners are competent in the core skills of palliative caring.
Secondary Palliative Care
Each organization or region has a specialized interdisciplinary team that
is available for consultation on difficult palliative care issues See Elements: Types of
Services.
Tertiary Palliative Care
Each major academic center has an interdisciplinary team of experts in
all aspects of palliative caring. They serve as consultants to primary
providers and secondary level experts for tough clinical situations. They
are also involved in educational and research activities related to
hospice and palliative care.
Expanding access to expertise in palliative care is needed in many
different settings.
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Rationale
Select section:
Changing Illness Experience
Changing Expectations and Needs
Progressive Healthcare Response
Responding to the Opportunity
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Changing Illness Experience
Illness in the Past
Progress Fighting Disaese
Illness Today
Prolonged Illness Experience
Chronic Disease Process
Determining Prognosis
Cancer
Manifestations
Predicament
Prolonged End-of-life Experience
Sudden Unexpected Death
Predictable Decline
Slow Decline, Multiple Acute Crises
Death in the US
Leading Causes of Death
Setting of Death
Desired
Reality
Multiple Issues Cause Suffering
The Square of Care
Morbidity
Pain
Need for Assistance
Social, Financial Impact
Implications for Care
Variable Need for Care
Opportunities
For Patients
For Families
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Changing Expectations and Needs
Increased Consumer Autonomy
Picker Institute 8 Dimensions of Care
Goals, Not Problems, Drive Care
Shift to Goal-oriented Care
Expect Competence, Expertise
Expect Comprehensive Assessment
Expect Effective Communication
Expect Participation in Decision-making
Expect Timely, Continous, Coordinated Care Delivery
Expect Assistance with Caregiving
Caregiver Training, Support
Caregiver Financial Support
Alternate Settings of Care
Respite Relief
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Progressive Healthcare Response
Focus on Disease-modifying Therapy
Focus on Care of the Dying
Early Hospice
Modern Hospice Movement
Dame Cicely Saunders
Origins of "Palliative Care”
Evolution of Hospice, Palliative Care
In United Kingdom
In Canada
In United States
Convergent Evolution
Hospice, Palliative Care in US Today
Hospice Growth
Continued Unmet Opportunity
A Public Health Issue
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Responding to the Opportunity
Paradigm Shift in Thinking
Provide Concurrent Care
Consider Application to Those at Risk
Expand Services, Settings of Care
1º, 2º, 3º Model of Delivery
Expand Access to Expertise
Create Specialized Environments
Many Names, Same Focus of Care
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