Primary Palliative Care

Why We Need Primary Palliative Care

Serious illness is a thread that is woven throughout South Dakota. It touches nearly everyone in the state. If you aren’t directly impacted by a serious illness, chances are you know someone who is. Access to palliative care in South Dakota is limited with only 16 board certified hospice and palliative care physicians in the state to care for over 930,000 residents. Nine of these physicians are in one urban area, leaving most of the state without access. Those living with serious illness are at risk of missing out on care that could significantly improve their quality of life and address the issues that matter most to them. Acknowledging the challenges posed by the state’s rural nature and limited access to palliative care is only the beginning. A strong palliative care network is needed to pool resources, expertise, and experiences to meet the palliative care needs of our residents.

There is an urgency across the state to equip healthcare professionals in every hospital or clinic with at least basic palliative care knowledge, skills, and resources to care for patients. With a proven track record of collaboration, South Dakota is poised to bring together dedicated healthcare professionals and organizations to create a network of support for rural professionals throughout the state. LifeCircle-South Dakota’s Hospice and Palliative Care Network can be the network to satisfy that urgency. Through our combined efforts we are determined to improve health care resources for the seriously ill in our state.

WHAT IS PRIMARY PALLIATIVE CARE:

Care provided by practitioners who are not specialty trained in palliative care like internists, family practice doctors, specialists like oncologist, cardiologist or any other practitioner who cares for someone with a serious illness. They have basic skills that allow them to provide basic symptom management, review code status and goals of care conversations, and smooth transitions to hospice1.  Primary palliative care providers may or may not have an interdisciplinary team to help support the patient and support person(s).

When to Refer to Specialty Palliative Care

The following criteria from the Center to Advance Palliative Care (CAPC) can be used to help you decide when referring to specialty palliative care may be warranted:

Presence of a serious illness and one or more of the following:

  • New diagnosis of life-limiting illness for symptom control, patient/family support
  • Declining ability to complete activities of daily living
  • Weight loss
  • Progressive metastatic cancer
  • Admission from long-term care facility (nursing home or assisted living)
  • Two or more hospitalizations for illness within three months
  • Difficult-to-control physical or emotional symptoms
  • Patient, family or physician uncertainty regarding prognosis
  • Patient, family or physician uncertainty regarding appropriateness of treatment options
  • Patient or family requests for futile care
  • DNR order conflicts
  • Conflicts or uncertainty regarding the use of non-oral feeding/hydration in cognitively impaired, seriously ill, or dying patients
  • Limited social support in setting of a serious illness (e.g., homeless, no family or friends, chronic mental illness, overwhelmed family caregivers)
  • Patient, family or physician request for information regarding hospice appropriateness
  • Patient or family psychological or spiritual/existential distress

Presence of any of the above, and/or:

  • Metastatic or locally advanced cancer progressing despite systemic treatments
  • Karnofsky < 50 or ECOG > 3
  • Brain metastases, spinal cord compression, or neoplastic meningitis
  • Malignant hypercalcemia
  • Progressive pleural/peritoneal or pericardial effusions

Presence of any of the above, and/or:

  • Folstein Mini Mental score < 20
  • Feeding tube is being considered for any neurological condition
  • Status Epilepticus > 24 hrs
  • ALS or other neuromuscular disease considering mechanical ventilation
  • Any recurrent brain neoplasm
  • Parkinson’s disease with poor functional status or dementia
  • Advanced dementia with dependence in all activities of daily living

How to Refer to Specialty Palliative Care

Use this link to find Specialty Palliative Care Practices/Providers in South Dakota.  You will find a map of locations along with a directory of programs, staff and contact information.

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