Integrating Palliative Care into Physiatric Care: Perspective of the Association of Academic Physiatrists Physiatry Palliative Care Task Force

Abstract

There are opportunities for physiatrists to apply a palliative care lens within clinical encounters across rehabilitation settings. The expanding population of patients with serious illness and injury cared for by physiatrists and the anticipated shortage of specialty palliative care clinicians make it important that physiatrists hone and apply basic palliative care skills as part of comprehensive physiatric care. In this article, four clinical vignettes highlight relevant palliative care communication skills and demonstrate the value of integrating these skills within physiatry encounters. Resources to support physiatrists in applying basic palliative skills are provided throughout.

The State of Palliative Care Education in United States Physical Medicine and Rehabilitation Residency Programs: Heterogeneity and Opportunity for Growth

“…A recent perspective by the Physiatry Palliative Care Task Force of the Association of Academic Physiatrists describes the holistic, quality of life-centered approach to care shared by PM&R and PC and provides several physiatry-relevant PC resources for learning, teaching, and clinical practice. 2 One potential barrier to developing PC education in physiatry residency programs could be lack of program director awareness about PC, the value it adds to comprehensive physiatric care, and relevant resources and trainings available to help PM&R residents develop a PC skillset. Advancement of the primary/specialty PC model within the healthcare system and PC resources designed for non-PC specialists have both evolved relatively recently.…”

“…Given an impending shortage of specialty-trained PC clinicians in the United States, 7 it is increasingly important that physiatrists, along with colleagues in all medical specialties, be able to provide primary PC and use specialty PC for the subset of patients with the most advanced PC needs. 1,2 Physiatrists can also become specialty PC providers themselves by pursuing formal HPM fellowship training, most commonly a 12-month postresidency program. On its Web site, the American Board of PM&R encourages diplomates to consider subspecialty certification in HPM.…”

“…Explicitly educating physiatry trainees using PC tools and frameworks is one approach to amplifying and expanding physiatrists' abilities to provide primary PC and navigate the full range of physiatric encounters. 2 Explicit clinical PC exposure during PM&R residency can additionally provide trainees the opportunity to explore the undersubscribed specialty of HPM. 10 There is currently no requirement or guideline for providing PC education in United States PM&R residency programs.…”

“…Comprehensive PM&R care for these patients, like all PM&R patients, includes attention to function, autonomy, and quality of life. Physical medicine and rehabilitation physicians can also apply a palliative care (PC) lens during encounters to enhance care for the most seriously ill and injured PM&R patients 1,2 . These patients include, but are not limited to, those with neurodegenerative disease, neurotrauma, stroke, vascular amputation, burns, congenital or developmental conditions associated with substantial disability across the lifespan, cancer, and multimorbidity.…”

“…Physiatrists can provide primary PC synergistically with PM&R care by providing a focused layer of skilled communication and symptom management to relieve suffering and recognizing indications for referral to specialty PC, including refractory symptoms, complicated team or family dynamics, and end of life care. Given an impending shortage of specialty-trained PC clinicians in the United States, 7 it is increasingly important that physiatrists, along with colleagues in all medical specialties, be able to provide primary PC and use specialty PC for the subset of patients with the most advanced PC needs 1,2 …”