Who should get Palliative Care? Kate Courtright
In the US, geriatrics \u201cgrew up\u201d as an academic profession with a heavy research base.\xa0 This was in part due to the tremendous support of the National Institute on Aging.\xa0 Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population.\xa0
Palliative care, in contrast, saw explosive growth in US hospitals.\xa0 In contrast to geriatrics, the evidence base for palliative care lagged clinical growth, in part because palliative care has no centralized \u201chome\u201d at the National Institutes of Health.\xa0 The National Palliative Care Research Center (NPCRC)and Palliative Care Research Cooperative (PCRC)were founded in part to meet this need.
Today we interview Kate Courtright, a critical care and palliative care physician-researcher who conducts trials of palliative care.\xa0 Kate\u2019s journey is in a way emblematic of the lack of centralized funding for palliative care: she\u2019s received funding from three separate NIH institutes, the NPCRC, and been involved in the PCRC.
We talk with Kate about how despite how far we\u2019ve come in palliative care research, we still don\u2019t have answers to some fundamental questions, such as:
- Who should get specialized palliative care?\xa0 Should eligibility and access be determined by clinician referral? By diagnosis?\xa0 By prognosis?\xa0 By need?
- If we move away from clinician referrals as the means by which people get access, how do we keep the clinicians engaged, and not enraged?\xa0 Can nudges help?\xa0 (see our prior podcast on Nudges with Jenny Blumenthal-Barby and Scott Halpern)
- When should people get palliative care?\xa0 What does \u201cearly\u201d really mean?\xa0 We can\u2019t possibly meet the needs of all people with newly diagnosed serious illness
- How do we move from efficacy (works in highly controlled settings) from effectiveness (works in real world settings?\xa0 What\u2019s the role of implementation science? What is a pragmatic trial?
- What outcomes should we measure?
We cover a lot of ground!\xa0 Working on a mystery.\xa0 Going wherever it leads.\xa0 Runnin down a dream\u2026
-@AlexSmithMD