BACKGROUND: Palliative care is a multidisciplinary approach to specialized medical care for people with complex and serious illnesses. While hospice focuses on end of life care, palliative care should start at diagnosis. Palliative care, which focuses on the relief of symptoms and stress to improve quality of life, should be integrated into chronic disease management. To better understand the state’s need and capacity for palliative care, an assessment was conducted by surveying Florida’s hospitals and hospice/palliative care programs.
METHODS: The survey was designed to obtain information about the number and demographics of palliative care patients served, capacity (e.g., physician, registered nurse), services (i.e., cancer care), and funding structure. Palliative care capacity was calculated for each county in Florida based on the number of patients served (inpatient and outpatient) in 2015, as reported by each survey respondent. Inpatient capacity was calculated proportionally for each hospital. Programs that provided outpatient services indicated which counties they served and the number they reported was distributed proportionally to those counties (by county population size). The estimated palliative care need was calculated using 2015 mortality data. While mortality data may not be the ideal way to determine need for palliative care in Florida (underestimating the need), it did allow for a starting point. A low estimate was calculated using deaths due to cancer, diabetes, Alzheimer’s disease, coronary heart disease, cerebrovascular disease, chronic lower respiratory disease, and chronic liver disease. A high estimate was calculated using all deaths except accidents, homicides, and suicides. The final estimated need was calculated by taking the average of the low and high estimates. To calculate the sufficiency for each county, palliative care capacity was divided by estimated need.
RESULTS: A total of 312 hospitals and 56 hospice/palliative care programs were identified in Florida. Among these, 80 hospitals and 43 hospice/palliative care programs actually had a palliative care program and completed the survey. Inpatient sufficiency varied greatly by region, with much of the Panhandle having <25% sufficiency. Outpatient sufficiency was <25% for all counties except Orange (28%). Only six counties had total sufficiency ≥75%, with the majority of counties (61%) having <25% sufficiency.
CONCLUSIONS: The availability of palliative care services in Florida hospitals and outpatient settings has continued to increase, but is still insufficient to meet the need, especially in rural areas. Findings helped inform recommendations from the Palliative Care Ad Hoc Committee (appointed by the State Surgeon General) to advance palliative care provision in Florida.