Institute Leads Palliative Care Response to COVID-19
By Melanie Marshall
In early March, Jennifer Ballentine was watching the COVID-19 crisis emerge in the United States with growing alarm. Ten days earlier, a nursing home outside Seattle had reported the first U.S. death from the virus. Within a week, 24 states had logged their first cases.
The highly infectious nature of the disease and its disproportionate impact on the frail, elderly and those with underlying health conditions was especially troubling. As executive director of the California State University Shiley Institute for Palliative Care – a statewide initiative headquartered at Cal State San Marcos – Ballentine leads an organization that provides online education to health-care professionals caring for those vulnerable populations.
To her, it was clear that palliative care, which focuses on managing symptoms and easing suffering for people with serious illnesses, would be desperately needed during the pandemic on a scale not currently available.
Ballentine articulated those beliefs in a March 11 blog post that quickly garnered the attention of palliative care leaders from around the country. She then started on a plan to make more than 20 of the Institute’s online courses available at no charge to frontline health-care workers responding to the crisis.
In the weeks since:
- More than 26,000 people have viewed Ballentine’s blog, which has been shared on social media by national and international organizations and clinicians from as far away as Australia and the Philippines.
- Enrollments in the offered courses have topped 3,000 and have come from doctors, nurses, social workers, chaplains and other clinicians across the U.S. and around the world. (The Institute typically logs about 2,000 enrollments in its comparable self-paced courses in an entire year.)
- National and international media outlets, including The New York Times, The Washington Post and USA Today, have published articles on the increasing need for palliative care amid the pandemic.
The ambitious response has both challenged and inspired the Institute’s staff of roughly 18 full-time and part-time employees who, like millions of other Americans, transitioned to working from home in mid-March to help slow the spread of the disease. The select courses will remain available at no charge through June 30.
Ballentine said she is “incredibly proud” of the way her staff has stepped up to handle the flood of enrollments, noting that “a deep desire to support health-care workers and the people they serve is part of the Institute’s collective DNA.”
Urgent Need for Palliative Skills
For the Institute, launching an effective response to the crisis meant identifying what palliative care skills would be needed most, and then getting that education into the hands of providers as quickly as possible, Ballentine said.
“It’s been very clear from the start that COVID-19 care is palliative care — all our frontline clinicians are helping patients understand their condition, make difficult treatment choices, communicate with loved ones, and manage their symptoms, with incredible heart and courage in the midst of overwhelm. That’s what palliative care is, and does, always, and that’s what every nurse, doctor, social worker, chaplain and first responder needs to do now.”
With many COVID-19 patients dying alone, separated from loved ones to reduce the risk of new infections, health-care workers would have to address not only the physical and psychosocial suffering of each person in their care, but act as a bridge between patients and distraught families. Courses on communication, managing symptoms and care at the end of life needed to be part of the Institute’s response, Ballentine said.
Because clinicians in hospitals, nursing homes and community-based care settings would be working under extreme circumstances – and potentially traumatized by a high volume of patient deaths – courses on self-care and resilience were also critically important.
Another priority was giving generalist physicians, physician assistants, registered nurses, advance practice nurses, social workers, and others, a better understanding of palliative care and how to apply it in practice. The Institute relied on its series of one-hour “What Every … Needs to Know About Palliative Care” courses to fill that need, Ballentine said. So far, the response has been powerful.
“This course was amazing because, in my country, we don't talk about palliative care. I thought it was the same as hospice,” said Valeria Rivera Oyola, a licensed clinical social worker in Las Piedras, Puerto Rico. “(The course) provided a lot of information, based on the current literature, which makes you confident about what you are learning.”
Adding Telemedicine Training
Almost as soon as the Institute unveiled its COVID-19 response, Ballentine was ready to expand it by addressing another urgent need: helping clinicians quickly utilize telehealth technology to care for patients at a distance.
The Institute had already been working for months to develop a telemedicine master class with Dr. Michael Fratkin, a renowned palliative care physician and telehealth expert who operates ResolutionCare, a palliative care program that serves patients in urban and rural communities of Northern California. The six-week master class would be limited to 25 participants and offer a deep dive into the clinical skills and organizational strategies needed to launch a telemedicine palliative care program.
But COVID-19 fast-tracked the need for at least a basic level of telehealth training on a much larger scale. Fratkin and his colleague, Brian Mistler, Ph.D., approached Ballentine with the idea of hosting a series of free one-hour Telemedicine Open Forums on Zoom, where physicians and others could query the experts about how to create the best patient experience using telehealth technology.
Ballentine enthusiastically agreed, and the California Health Care Foundation offered its support. The Institute launched the first open forum on April 9 and the second on April 16. More than 350 clinicians registered for those events; additional forums are scheduled for noon Thursdays through May 14.
Clinicians on the front lines have expressed their gratitude for the Institute’s support and for the courses that are already making a difference in the lives of patients and practitioners.
“In light of the COVID-19 pandemic, this education will be invaluable for my growth as a palliative care provider,” said Stephanie McGarity, a nurse practitioner from Springfield, Mo., in a thank you to the Institute. “I have transitioned to inpatient care to help where needed (during the crisis), and this free education has been a huge help to my colleagues and myself.”
Eric Breier, Public Affairs Specialist
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