The objective of this study was to identify, through a consensus process, the essential practices in primary palliative care.
Members of the working group included Michael Bennett, Eduardo Bruera, Liliana De Lima, Derek Doyle, Julia Downing, Clara Granda-Cameron, Peter Hudson, Scott Murray, Florian Strasser and Roberto Wenk.
Methodology: A three-phase study was designed. Phase 1 included development of a working group; a literature review; development of a baseline list of practices; and identification of levels of intervention. In Phase 2, physicians, nurses, and nurse aides (n = 425) from 63 countries were asked in three Delphi rounds to rate the baseline practices as essential or nonessential and select the appropriate levels of intervention for each. In Phase 3, representatives of 45 palliative care organizations were asked to select and rank the 10 most important practices resulting from Phase 2. Scores (1-10) were assigned to each, based on the selected level of importance.
Results: Phase 1 a baseline list of 140 practices was developed. Three levels of intervention were identified: Identification/Evaluation; Diagnosis; and Treatment/Solution measures. In Phase 2, the response rates (RR) for the Delphi rounds were 96.5%, 73.6%, and 71.8%, respectively. A consensus point (≥80% agreement) was applied, resulting in 62 practices. In Phase 3, RR was 100%. Forty-nine practices were selected and ranked. Evaluation, Diagnosis and Treatment of Pain scored the highest (352 points). The resulting list includes 23 practices with different levels of intervention under the following domains of care: Physical Care; Psychological/Emotional/Spiritual Care; Care Planning and Coordination; and Communication Issues.
Conclusion: The IAHPC List of Essential Practices in Palliative care may help define appropriate primary palliative care and improve the quality of care delivered globally. Further studies are needed to evaluate their uptake and impact.
To read the project description, including detailed methodology, participants and resulting practices, click here (in English only).
De Lima L, Bennett MI, Murray SA, Hudson P, Doyle D, Bruera E, Granda-Cameron C, Strasser F, Downing J, Wenk R. International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices in Palliative Care. J Pain Palliat Care Pharmacother. 2012 Jun;26(2):118-22.
The IAHPC List of Essential Practices is available in several languages. Click on the links below to open each version.