Palliative Care Volunteers: An Underutilized Way to Improve Patient Care

Never underestimate the power of a few committed people to change the world. Indeed, it is the only thing that ever has—Margaret Mead.

Growing up in Scranton, Pennsylvania, I frequently heard the refrain that life was about “making soup with the bones you got.” Often, things wouldn’t be perfect. Sometimes a situation would barely even count as acceptable. But time only marches forward, and you must make it work.

Like many other palliative care (PC) programs, we were being asked to grow clinicians with limited administrative support. Sixty-five half-day clinics per week with just two nurses supporting 8.5 clinical full-time positions made the “care” part of PC challenging.

One of our most vexing problems was our clinic’s no-show rate. Before COVID, the no-show rate in clinic, some weeks, could exceed 35%. New patients, in particular, missed appointments because they didn’t know precisely what we did or worried that we were the pre-hospice people. Because it often took 2, 3, or 4 new patient slots to actually see a particular patient, our new patient queue stretched out to 7 weeks. And, unfortunately, we didn’t have a solution, as our single scheduler and nursing staff were already overwhelmed.

As we all know, solving hard problems alone is, well, hard. But rallying a group to make that soup can turn the seemingly impossible into something possible. Around this time, our PC program was approached by a former patient’s spouse, KK, someone with deep experience in health care, an ability to have hard conversations, and a desire to give of her time and expertise to support our team’s mission. As a social worker and former hospice volunteer whose husband only connected with PC toward the end of his cancer journey, KK knew that getting folks through the door of the clinic is often the primary barrier that needs to be surmounted. She also knew that there are patients and family members in the hospital who are lonely, relishing visits from people with time and interest. It was over lunch that the plan to create the Palliative Partners volunteer program was hatched.

After receiving full-throated support from our program’s leadership, we went about the work of creating a vision for the program and navigating, with guidance, the bureaucracy of academic health care. We received wonderful mentorship from the volunteer program supervisor at the Medical University of South Carolina, which hosts one of the most established and impactful PC volunteer programs thanks to the vision of Ellie and Pat Coyne. Considerations included whether to host adult, medical and college student, or junior volunteers; whether to focus the program on inpatient-only or a combination of inpatient and outpatient; and the scope of potential duties for our volunteers.

We opted to begin with a program we could manage most easily, so focused initially on community-adult volunteers who would call new patients to put them at ease, explain PC, and talk through logistics of the visits. This seemingly simple plan raised several questions: how volunteers would access the most current appointment schedule, which phone number would appear on patients’ caller ID, what scripts would be needed, how scheduling would be notified when patients could not keep their appointments, and how newly opened slots could be filled quickly.

Ultimately, these issues were navigated over many, many months. No-show rates decreased, and patients we saw in the clinic frequently mentioned how meaningful it was to have someone reach out to answer their questions and offer support and guidance at a scary time. An unanticipated benefit we found was that we spent less time at the beginning of the visit explaining PC’s role and purpose, leaving us more time for rapport building, symptom management, and understanding goals, values, and preferences. Our first volunteer recruited two additional volunteers, both of whom were also family members of someone cared for by our PC team. The program eventually grew into a friendly visitor program to support patients and families on our hospital’s Comfort Care service ¹ and we are actively exploring other avenues to support patients and their families.

Ultimately, the creation of the Palliative Partners volunteer program is a story about resilience, flexibility, and grit. There were dozens of barriers that were encountered and surmounted thanks to mentorship and support from our program and hospital leadership and colleagues at other PC programs. A PC volunteer program offers a wonderful way for grateful family members of former patients (and maybe former patients themselves) to support your program and your patients. Hospice is miles ahead of PC in utilizing volunteers to support the clinical mission, but we hope that our story will encourage PC programs to spend the time and effort to build PC volunteer programs. Indeed, with a few committed people, we can change our little piece of the world.