Palliative Care Initiative

• Systematically assess non-movement symptoms, at least annually. 
• Use a scale, template, or checklist. 
• Comprehensive screening for non-movement symptoms should specifically include pain, constipation, appetite and weight loss, in addition to other commonly assessed symptoms.

Clinicians are encouraged to use a standardized scale or brief screening questions for systematic screening that goes beyond the psychiatric disorders of anxiety and depression to address normal but difficult emotions and spiritual challenges (such as feeling hopeless, grief, anger, frustration). 

For identified emotional and spiritual needs, chaplains can help address issues that are screened, but they are not the only way. Psychologists, counselors and social workers can also address emotional and spiritual needs.

The primary goal is to systematically screen care partners and to establish processes to handle positive screens. Teams can complete systematic assessment using a scale, template or checklist to screen for care partner distress. Providers or other team members can provide the screening. The team’s goal should be to assess the majority of care partners.

The goal is for healthcare teams to be systematic in screening for advance care planning and having these conversations in order to complete advance care planning documents.

Advance care planning documents should include healthcare proxy and state-specific forms. They should be visible and in the correct location in the Electronic Medical Record. If completed outside the medical setting, these documents should be reviewed by medical professionals to ensure they make medical sense and align with patient/family values.

Practitioners — a neurologist, dedicated Advanced Practice Providers and/or social worker — should discuss advanced care planning with patients and families in office. Alternatively, they can refer the patient and family to a group clinic, other hospital settings (such as a geriatric clinic) or another resource that can help them complete these documents.

• For specialist palliative care, be systematic in screening and have a process to address positive screens. Screening can include the use of a tool such as the Brief Needs Assessment Tool.
• Addressing needs could include having integrated neuropalliative care within the center or department, or referring to a palliative clinic in the institution or community.
• Hospice should be considered for patients who are in an advanced state. Teams should be comfortable discussing hospice and have a process for referring to hospice that includes staying involved in the care of patient, at least as a consultant.