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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Building the Workforce We Need for People with Serious Illness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25789.
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PREPUBLICATION COPY: UNCORRECTED PROOFS Building the Workforce We Need to Care for People with Serious Illness PROCEEDINGS OF A WORKSHOP Kaitlyn Friedman, Joe Alper, and Laurene Graig, Rapporteurs Roundtable on Quality Care for People with Serious Illness Board on Health Care Services Board on Health Sciences Policy Health and Medicine Division

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by Contract No. HHSN2632018000029I (Task Order No. 75N98019F00851) with the National Institutes of Health’s National Institute of Nursing Research and by the American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Arizona, Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Shiley Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Gordon and Betty Moore Foundation, The Greenwall Foundation, The John A. Hartford Foundation, Hospice & Palliative Nurses Association, Humana, Inc., Kaiser Permanente, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice & Palliative Care Network, Supportive Care Coalition, and the National Academy of Medicine. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25789 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2020 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Building the workforce we need to care for people with serious illness: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25789. PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

PREPUBLICATION COPY: UNCORRECTED PROOFS Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

v PREPUBLICATION COPY: UNCORRECTED PROOFS PLANNING COMMITTEE FOR BUILDING THE WORKFORCE WE NEED TO CARE FOR PEOPLE WITH SERIOUS ILLNESS: A WORKSHOP1 BRYNN BOWMAN (Co-Chair), Vice President for Education, Center to Advance Palliative Care BRENDA NEVIDJON (Co-Chair), Chief Executive Officer, Oncology Nursing Society JENNIFER BALLENTINE, Executive Director, The California State University Shiley Institute for Palliative Care ROBERT BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition GRACE B. CAMPBELL, Assistant Professor, Acute & Tertiary Care, University of Pittsburgh School of Nursing (Representing the Association of Rehabilitation Nurses) CLESE ERIKSON, Deputy Director, Health Workforce Policy Research Center, The George Washington University DENISE HESS, Executive Director, Supportive Care Coalition, representing the Association of Professional Chaplains AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care JERI MILLER, Chief, Office of End-of-Life and Palliative Care Research, Senior Policy Analyst, National Institute of Nursing Research, National Institutes of Health MIGUEL PANIAGUA, Medical Advisor, Solutions Design and Delivery, National Board of Medical Examiners, and Adjunct Professor of Medicine, Perelman School of Medicine, University of Pennsylvania PHILIP PIZZO, Founding Director, Stanford Distinguished Careers Institute, Former Dean and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford School of Medicine JOANNE REIFSNYDER, Executive Vice President, Clinical Operations, and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association JOE ROTELLA, Chief Medical Officer, CatalystHPM, American Academy of Hospice and Palliative Medicine TRACY SCHROEPFER, Professor, School of Social Work, University of Wisconsin JOSEPH SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society JOAN WEISS, Chief, Geriatrics and Allied Health Branch, Health Resources and Services Administration Project Staff LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness KAITLYN FRIEDMAN, Research Associate RUHAMA GARI, Senior Program Assistant (from October 2019 to February 2020) SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum ANDREW M. POPE, Director, Board on Health Sciences Policy Consultant JOE ALPER, Writer 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1 LEONARD D. SCHAEFFER (Chair), Judge Robert Maclay Widney Chair and Professor, University of Southern California JAMES A. TULSKY (Vice Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School KIRK ALLEN, President, Humana at Home, Humana, Inc. JENNIFER BALLENTINE, Executive Director, The California State University Shiley Institute for Palliative Care ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition LORI BISHOP, Vice President of Palliative and Advanced Care, National Hospice and Palliative Care Organization PATRICIA A. BOMBA, Vice President and Medical Director, Excellus BlueCross BlueShield; Chair, MOLST Statewide Implementation Team; Chair, National Healthcare Decisions Day, New York States Coalition GRACE B. CAMPBELL, Assistant Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, representing the Association of Rehabilitation Nurses JANE CARMODY, Program Officer, The John A. Hartford Foundation STEVE CLAUSER, Director, Healthcare Delivery and Disparities Research Program, Patient-Centered Outcomes Research Institute DAVID J. DEBONO, Medical Director for Oncology, Anthem Inc. CHRISTOPHER M. DEZII, Lead, Quality and Measure Development, State and Federal Payment Agencies, U.S. Value, Access and Payment, Bristol-Myers Squibb ANDREW DREYFUS, President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts CAROLE REDDING FLAMM, Executive Medical Director, Blue Cross Blue Shield Association MARK B. GANZ, President and Chief Executive Officer, Cambia Health Solutions DENISE HESS, Executive Director, Supportive Care Coalition, representing the Association of Professional Chaplains PAMELA S. HINDS, Director and Professor, Conway Chair in Nursing Research; Director, Nursing Research and Quality Outcomes, Children’s National Health System HAIDEN HUSKAMP, 30th Anniversary Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School KIMBERLY SHERELL JOHNSON, Associate Professor of Medicine, Senior Fellow in the Center of Aging and Human Development, Duke University School of Medicine REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation TOM KOUTSOUMPAS, Cofounder, Coalition to Transform Advanced Care; President and Chief Executive Officer, National Partnership for Hospice Innovation SHARI M. LING, Deputy Chief Medical Officer, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services BERNARD LO, President and Chief Executive Officer, The Greenwall Foundation DIANE E. MEIER, Director, Center to Advance Palliative Care; Gaisman Professor of Medical Ethics, Vice Chair for the Public Policy and Professor, Icahn School of Medicine at Mount Sinai AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care 1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vii PREPUBLICATION COPY: UNCORRECTED PROOFS

JERI L. MILLER, Chief, Office of End-of-Life and Palliative Care Research, Senior Policy Analyst, National Institute of Nursing Research, National Institutes of Health R. SEAN MORRISON, Co-Director, Patty and Jay Baker National Palliative Care Center; Director, National Palliative Care Research Center; Director, Hertzberg Palliative Care Institute; Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai BRENDA NEVIDJON, Chief Executive Officer, Oncology Nursing Society JUDITH R. PERES, Long-Term and Palliative Care Consultant, Clinical Social Worker and Board Member, Social Work Hospice and Palliative Care Network PHILIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute, Former Dean and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford School of Medicine THOMAS M. PRISELAC, President and Chief Executive Officer, Cedars-Sinai Health System KITTY PURINGTON, Senior Program Director, National Academy for State Health Policy RUBINA RAJA, Medical Director Operations, Blue Cross Blue Shield of Arizona RAHUL RAJKUMAR, Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield of North Carolina JOANNE REIFSNYDER, Executive Vice President, Clinical Operations and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association JOE ROTELLA, Chief Medical Officer, CatalystHPM, American Academy of Hospice and Palliative Medicine JUDITH A. SALERNO, President, The New York Academy of Medicine, Senior Vice President, Patient and Caregiver Support, American Cancer Society JOSEPH W. SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society SUSAN ELIZABETH WANG, Regional Lead for Shared Decision-Making and Advance Care Planning, Southern California Permanente Medical Group, Kaiser Permanente DAWN WIATREK, Director, Public Health Strategy, American Cancer Society BALIGH YEHIA, Chief Medical Officer, Ascension Health Roundtable on Quality Care for People with Serious Illness Staff LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness KAITLYN FRIEDMAN, Research Associate RUHAMA GARI, Senior Program Assistant (from October 2019 to February 2020) MICAH WINOGRAD, Senior Financial Business Partner SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum ANDREW M. POPE, Director, Board on Health Sciences Policy viii PREPUBLICATION COPY: UNCORRECTED PROOFS

ix PREPUBLICATION COPY: UNCORRECTED PROOFS Reviewers This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: LAURA DINGFIELD, Hospital of the University of Pennsylvania BETTY FERRELL, City of Hope National Medical Center DIANE PORTMAN, Moffitt Cancer Center Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by MARK LAZENBY, Yale School of Nursing. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Acknowledgments The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to the Planning Committee Co-Chairs Brynn Bowman and Brenda Nevidjon for their valuable contributions to the development and organization of this workshop. The roundtable also wishes to thank all of the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the roundtable wants to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants. Support from the many annual sponsors of the roundtable is critical to its work. The sponsors include American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Arizona, Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Shiley Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Gordon and Betty Moore Foundation, The Greenwall Foundation, The John A. Hartford Foundation, Hospice & Palliative Nurses Association, Humana, Kaiser Permanente, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Institute of Nursing Research, National Palliative Care Research Center, National Patient Advocate Foundation, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice & Palliative Care Network, Supportive Care Coalition, and the National Academy of Medicine. xi PREPUBLICATION COPY: UNCORRECTED PROOFS

xiii PREPUBLICATION COPY: UNCORRECTED PROOFS Contents ACRONYMS AND ABBREVIATIONS xvii PROCEEDINGS OF A WORKSHOP INTRODUCTION 1 OVERVIEW OF THE CURRENT STATE OF THE WORKFORCE FOR SERIOUS ILLNESS CARE AND FUTURE NEEDS 7 DEVELOPING THE WORKFORCE TO SPECIALIZE IN CARE FOR PEOPLE WITH SERIOUS ILLNESS 9 Projections for the Palliative Care Specialty Workforce, 9 University-Based Certificate Programs, 12 Interprofessional Palliative Education and Its Integration into Undergraduate Curricula, 15 Panel Discussion, 17 Audience Discussion, 19 PREPARING ALL HEALTH PROFESSIONALS TO CARE FOR PEOPLE WITH SERIOUS ILLNESS 20 ELNEC: 20 Years of Providing Palliative Care Education, 20 Equipping Mid-Career Clinicians with Core Skills for Serious Illness Care, 22 The Role of an Accrediting Organization, 24 Educating Nurses in Palliative Care, 27 Audience Discussion, 28 DEVELOPING THE WORKFORCE FOR COMMUNITY-BASED CARE 29 The Current and Projected Workforce for Community-Based Care, 29 Maximizing the Role of the Home Care Worker, 32 Advancing a Well-Trained Workforce to Care for an Aging America, 35 Innovations in Community-Based Care, 37 Audience Discussion, 39 USING INTERPROFESSIONAL TEAMS EFFECTIVELY TO CARE FOR PEOPLE WITH SERIOUS ILLNESS 41 Creating and Sustaining a Culture of Palliative Care in Long-Term Care Settings, 41 Caring for the Seriously Ill Child at Home, 42 Reaching Rural Areas Through Technology, 43 Panel Discussion, 45 Audience Discussion, 46 CLOSING REMARKS 46 REFERENCES 47 APPENDIX A: In Memoriam: Ruth McCorkle 51 APPENDIX B: Statement of Task 53 APPENDIX C: Workshop Agenda 55

xv PREPUBLICATION COPY: UNCORRECTED PROOFS Boxes, Figures, and Tables BOXES 1 Suggestions Made by Individual Workshop Participants for Building the Workforce Needed to Care for People with Serious Illness, 3 2 Accreditation Council for Graduate Medical Education (ACGME) Training Milestones for Competencies in Patient- and Family-Centered Communication, 25 FIGURES 1 Funneled approach to palliative care delivery in patients with serious illness, 10 2 Projected numbers of certified specialty palliative care physicians, 2018–2058, 11 3 Projected numbers of Medicare patients eligible for palliative care per certified specialty palliative care physician, 2018–2058, 12 4 Number of people employed in jobs that are involved in community-based care, 30 5 The community-based health care workforce is economically vulnerable, 32 6 The 16 domains in which to engage individuals in bedside care planning, 38 TABLES 1 Differences Between Certificate and Certification Programs, 13 2 Education and Licensing of the Community-Based Health Care Workforce, 30

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The United States faces a significantly aging population as well as a growing share of the population that is living longer with multiple chronic conditions. To provide high-quality care to people of all ages living with serious illness, it is critical that the nation develop an adequately trained and prepared workforce consisting of a range of professionals, including physicians, nurses, social workers, direct care workers, and chaplains. To explore some of the key workforce-related challenges to meeting the needs of people with serious illness, the National Academies of Sciences, Engineering, and Medicine hosted a workshop on November 7, 2019. This publication summarizes the presentations and discussions from the workshop.

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