Palliative Care in Rheumatology: Perspectives of Rheumatologists and Palliative Care Clinicians Across the United States.

Abstract

OBJECTIVE Explore perspectives of rheumatologists and palliative care clinicians on the role of palliative care in rheumatic disease. METHODS We developed two questionnaires, one for rheumatologists and a second for palliative care clinicians, exploring education about the opposite specialty, frequency of Advance Care Planning (ACP) discussions and referrals, and clinician comfort with palliative care skills in rheumatic disease. Questionnaires were distributed to clinicians across the United States in a variety of clinical practice settings. RESULTS 201 rheumatologists and 217 palliative care clinicians completed the questionnaires. Few clinicians had received more than a lecture about the opposite specialty. Most rheumatologists reported never or rarely discussing ACP (71.6%), many had not referred a patient to palliative care in the last year in the outpatient (67.2%) or inpatient (47.5%) setting, and they reported low comfort with many palliative care skills. However, the majority agreed that more of their patients could benefit from palliative care (66.2%). Most palliative care clinicians felt less comfortable providing care for rheumatology patients compared to other patients in their practice (75.6%), but the majority felt they could be helpful across many common referral indications for people with rheumatic disease. Clinicians with more advanced education in the opposite specialty reported higher comfort across palliative care skills. CONCLUSION There is a clear gap in cross-disciplinary education and collaboration between rheumatologists and palliative care clinicians with low rates of referral and low rates of clinician-comfort. Nonetheless, clinicians feel collaboration would be beneficial. Further partnership is needed to improve this gap.