UPJ INSIGHT Primary Palliative Care in Urology: Quality Improvement Summit 2021-2022

By: Jonathan Bergman, MD, MPH, The David Geffen School of Medicine at University of California, Los Angeles, Los Angeles County Department of Health Services, California, Veterans Health Administration, Los Angeles, California; Pauline Filippou, MD, Kaiser Permanente Northern California, Santa Clara Medical Center; Anne M. Suskind, MD, MS, University of California, San Francisco; Karen Johnson, PhD, American Urological Association, Linthicum, Maryland; Emily Calvert, MSN, RN, American Urological Association, Linthicum, Maryland; Katherine Fero, MD, The David Geffen School of Medicine at University of California, Los Angeles; Karl A. Lorenz, MD, MSHS, Veterans Health Administration, Los Angeles, California, Stanford University, California; Karleen Giannitrapani, PhD, MPH, Veterans Health Administration, Los Angeles, California, Stanford University, California; Lee Hugar, MD , Lexington Medical Center, West Columbia, South Carolina; Kevin Koo, MD, MPH, Mayo Clinic, Rochester, Minnesota; John Leppert, MD, MS, Veterans Health Administration, Los Angeles, California; Charles D. Scales Jr, MD, MSHS, Duke University, Durham, North Carolina; Martha Terris, MD, Medical College of Georgia, Augusta; Matthew Nielsen, MD, MS, University of North Carolina at Chapel Hill; John L. Gore, MD, MS, University of North Carolina at Chapel Hill | Posted on: 20 May 2024

Bergman J, Filippou P, Suskind AM, et al. Primary palliative care in urology: Quality Improvement Summit 2021-2022. Urol Pract. 2024;11(3):529-536. doi:10.1097/UPJ.0000000000000538

Study Need and Importance

Palliative care is underutilized in many specialties, including urology. The AUA convened a 2021-2022 Quality Improvement Summit to bring together interdisciplinary providers to inform the current state and to discuss potential strategies for integrating primary palliative care into urology practice.

What We Found

Participants agreed that palliative care is needed early in the disease course for patients with advanced disease, including those with benign and malignant conditions. The group agreed about the important domains that should be addressed as well as the interdisciplinary providers who are best suited to address each domain. There was consensus that a primary “quarterback” was needed, encapsulated in a conceptual model—UroPal (Figure)—with a urologist at the hub of care.

IMAGE

Figure. UroPal conceptual model. ACP indicates advance care planning; Pall, palliative; PMD, primary medical doctor; Psych, psychiatry; SW, social worker; Uro, urology. Reprinted with permission from Cabri et al, AUANewsExtra. 2023;28(10):19-20.

Limitations

Despite broad agreement during the Summit that further education is needed for urologists about palliative care, modules and teaching sessions have yet to be built and broadly disseminated. Likewise, the UroPal conceptual model needs to be operationalized within variegated health care systems, and its efficacy, effectiveness, and implementation, including needed adaptations, studied over time. Also, implementation of primary palliative care principles throughout urology is a necessary next step to achieving the promise discussed during the Summit. Additionally, many urologists may practice in settings with limited access to the UroPal hub specialists.

Interpretation for Patient Care

The 2021-2022 AUA Quality Improvement Summit provides the field of urology with a framework and specific steps that can be taken to move urology-palliative care integration forward. Urologists are uniquely positioned to provide primary palliative care for their many patients with serious illness, both in the surgical and chronic care contexts, and the Summit helped build not only a model of care to pursue, but also a community of practitioners interested in helping urology lead the way in achieving a primary palliative care model within surgery and specialty care.