MUSC offers rare post-master's doctoral degree in palliative care

by Barry Waldman

For a century, western healthcare systems operated on a curative, disease-based model where patients were often reduced to a series of symptoms that required repair. There were still a few efforts underway, however, that promoted looking at the whole person beyond their pathology.

In the late 1960s, Cicely Saunders founded St. Christopher’s Hospice for the terminally ill in London, and Elisabeth Kubler-Ross published the iconic On Death and Dying, which outlined five stages of grief. They and others helped launch the hospice movement and re-focus health care on patients’ multifaceted physical, emotional, psychological, and spiritual needs, with particular emphasis on ameliorating pain and suffering.

Thus, palliative care was born. Described by the World Health Organization as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual," it is a large part of MUSC’s core values and curriculum.

Palliative care and hospice care

Palliative care as a whole is designed to help people living with serious illness and is often considered an extra layer of support throughout the trajectory of that illness. It focuses on the quality of life of both the patient and the caregiver and can be offered alongside curative care at any point in the duration of the illness. It is also a recognized medical specialty in both the U.S. and around the world.

Palliative care is associated with decreased hospital stays, lower cost, better quality of life and even higher life expectancy. The benefits ripple out beyond those with serious health conditions to their families, offering comfort and emotional support.

Hospice care, on the other hand, focuses specifically on providing end-of-life support to patients with a prognosis of six months or less. But in most cases patients don't receive hospice care until the final weeks or even days of their lives, which could possibly mean missing out on helpful care and quality time.

Palliative care and MUSC

Health care teams in the MUSC Health Palliative Care Program weave palliative care into the fabric of their daily operations with the help of specially trained doctors, advanced practice nurses, nurses, social workers, chaplains and volunteers who care for patients across the MUSC Health System, from before life in perinatal palliative care to after death with specialty bereavement programs.

The palliative care program and the MUSC College of Nursing Palliative Care program also work closely together to advance the care of patients with serious illness, as well as their families. Kathleen Lindell, Ph.D., RN, ATSF, FAAN, is the Mary Swain Endowed Chair in Palliative Care Health at the MUSC College of Nursing, and she works to promote awareness of palliative care and to ultimately improve quality of life for patients and families affected with serious illness. Her research focuses on patients with advanced lung disease and their families.

“Leadership at MUSC recognizes the value of palliative care throughout our patients’ lives from pediatrics to geriatric care,” said Carrie Cormack, DNP, APRN, CPNP-BC, the Marr Distinguished Professor and lead Palliative Care faculty in the Doctor of Nursing Practice program.

Palliative care and education

The post-master’s Doctor of Nursing Practice in Lifespan Palliative Care helps advance-practice RNs develop expertise in the science supporting palliative care. They integrate professional, legal, moral, and ethical standards into the practice of palliative care and become leaders in the care of those with serious and chronic illness among advanced care nurses.

The asynchronous online curriculum includes didactic courses in the underlying science as well as pain management, interprofessional collaboration and health policy and advocacy in addition to two clinical residencies over its five semesters. Upon completion, students have met the instruction and practice requirements to sit for the Advanced Certified Hospice and Palliative Nurse (ACHPN) certification exam. Graduates go on to serve as advocates for palliative care as its benefits gain traction among health care practitioners.

On Cormack’s initiative, MUSC started folding curriculum from the national End-of-Life Nursing Education Consortium (ELNEC) into its nursing education in 2017. According to ELNEC, it focuses on training the trainers, so that best practices in palliative care can ripple out into the field logarithmically. More than 1,800 MUSC undergraduates, graduates and faculty members have completed the training and earned certificates.

Today, every student in the College of Nursing receives this training, which often results in graduating nurses who enter their work communities advocating for and providing better care for patients with serious illness and their families.

For the past two years, nursing students completing the ELNEC curriculum have earned a digital badge – a type of online credential that is gaining popularity. In addition, nearly 1,000 bachelor’s degree nursing students at MUSC have benefited from real-life simulations with apocryphal patients living with serious illnesses, which helps them confront the communication and care challenges for patients and families in these situations in the future.

Palliative care and nursing go hand in hand, according to Cormack, and other schools around the nation are catching on. “It’s not just the right thing to do, but necessary if you want to call yourself a nursing school. We’re ahead of the game, and now we’ve become a model for this,” Cormack said. Nursing schools across the country have even reached out to the MUSC program asking how to integrate palliative care training into their curricula.

Palliative care and the future

Recently, ELNEC held its national palliative care conference in Charleston. The late-September gathering at the Charleston Marriott offered courses across the lifespan and provided CEUs for attendees. One of the presenters was Patrick Coyne, MSN, ACHPN, ACNS-BC, FPCN, FAAN, assistant professor of nursing and recently retired director of palliative care at MUSC.

Many of the national leaders in palliative care who spoke at and attended the ELNEC conference stayed on for MUSC College of Nursing’s Palliative Care Showcase Day to share their work in palliative care and build more collaborations nationwide among the more than 100 attendees.

Palliative care advocates at MUSC and the College of Nursing are working to establish a center for palliative care that brings clinical, educational, and community programs together. With generous and recent funding and support, the group plans to hire an education coordinator to expand educational offerings to other professions and throughout the community.

It has been a long, slow effort over the decades to incorporate palliative care into the nation’s health system, but many of the barriers are coming down, according to both Lindell and Cormack.

“It was not part of care [at MUSC] in the 90s, but now graduates of our nursing program have baseline education in palliative care,” said Cormack. And that’s something she’s excited about.

“There is a lot of work to do, but we are determined to make a difference for our patients and families.”