Expanding Palliative Care Capacity Through an Intentional Transdisciplinary Model

Key Message: The intentional transdisciplinary model distributes core palliative care duties among chaplains, social workers, nurses, and providers. This approach reduces burnout, enhances teamwork, efficiency, and patient satisfaction. It increases program capacity by reducing dependence on a single role and empowering team members to address all palliative care domains.

Abstract: Palliative care faces an unprecedented workforce crisis, with provider shortages projected to create a "workforce valley" through 2045 (1). To ensure staffing sustainability and financial viability, new care delivery models must be explored. Implementing a cohesive, flat team structure within a transdisciplinary model promotes more cost-effective capacity expansion by formally recognizing and empowering contributions outside the traditional billable scope of care. Through intentional cross-training and sharing of core responsibilities among team members, palliative care and hospice programs can build resilient, high-performing teams that are less dependent on any single role (2).

Staffing shortages hinder equitable, patient-centered services by overburdening providers with both core and discipline-specific care tasks, many of which non-prescriber team members are qualified to perform. By carefully identifying and training core skills across all palliative care team members (such as basic symptom assessment, psychosocial and spiritual screening, serious-illness communication, and rapport building), as distinguished from discipline-specific expertise (including symptom management, complex advance care planning, ethical consultation, and intricate care transitions), each team member is empowered to function as a trusted colleague capable of addressing all palliative care domains while also offering the unique expertise of their discipline (2).

Using intentional cross-training to redistribute tasks among all disciplines decreases provider non-billable task burden, strengthens team resilience through support and mutual understanding of roles, and reduces redundancy. A well-trained transdisciplinary team, including chaplains, social workers, nurses, and providers, improves care for complex cases while boosting patient satisfaction by enabling each team member to address patient needs more holistically (3).

This model also poses challenges, as success depends on mutual trust and humility among team members, who need to share responsibilities and adapt their roles. Role overlaps and uncertainty can occur, so clear communication and continuous feedback are crucial to address these issues and recognize each discipline’s unique contributions.

References: 1. Kamal, Arif H., Steven P. Wolf, Jesse Troy, et al. “Policy Changes Key to Promoting Sustainability and Growth of the Specialty Palliative Care Workforce.” Health Affairs 38, no. 6 (June 2019): 910–18. https://doi.org/10.1377/hlthaff.2019.00018.
2. Saks, Naomi Tzril, Cara L. Wallace, DorAnne Donesky, and Michelle M. Milic. “Profession-Specific Roles in Palliative Care.” In Intentionally Interprofessional Palliative Care, edited by DorAnne Donesky, Michelle M. Milic, Naomi Tzril Saks, and Cara L. Wallace, 41–80. New York, NY: Oxford University Press, 2024. https://doi.org/10.1093/med/9780197542958.003.0003.
3. Schlosser-Hupf, Sophie, Elisabeth Aichner, Marcus Meier, et al. “Evaluating the Impact of Interprofessional Training Wards on Patient Satisfaction and Clinical Outcomes: A Mixed-Methods Analysis.” Frontiers in Medicine 11 (February 19, 2024). https://doi.org/10.3389/fmed.2024.1320027.