Palliative Care in Rheumatology: Perspectives of Rheumatologists and Palliative Care Clinicians Across the United States

Objective To explore perspectives of rheumatologists and palliative care (PC) clinicians on the role of PC in rheumatic disease (RD).

Methods We developed 2 questionnaires, 1 for rheumatologists and a second for PC clinicians, exploring education about the opposite specialty, frequency of advance care planning (ACP) discussions and referrals, and clinician comfort with PC skills in RD. Questionnaires were distributed to clinicians across the US in a variety of clinical practice settings.

Results In total, 201 rheumatologists and 217 PC clinicians completed the questionnaires. Few clinicians had received more than a lecture about the opposite specialty. Most rheumatologists reported never or rarely discussing ACP (71.6%), many had not referred a patient to PC in the last year in the outpatient (67.2%) or inpatient (47.5%) setting, and they reported low comfort with many PC skills. However, the majority agreed that more of their patients could benefit from PC (66.2%). Most PC clinicians felt less comfortable providing care for rheumatology patients than for other patients in their practice (75.6%), but the majority felt they could be helpful across many common referral indications for people with RD. Clinicians with more advanced education in the opposite specialty reported higher comfort across PC skills.

Conclusion There is a clear gap in cross-disciplinary education and collaboration between rheumatologists and PC clinicians, with low rates of referral and low rates of clinician comfort. Nonetheless, clinicians feel collaboration would be beneficial. Further partnership is needed to improve this gap.