Georgia State Law to Promote Palliative Care

Problem

Too few cancer patients in Georgia receive palliative care and support from the time of diagnosis through survivorship. The 2015 State-by-State Report Card on Access to Palliative Care gave Georgia a 55.2 or C grade compared to the U.S. average 66.3 or B grade (Dumanovsky et al., 2015).*

PSE Solution

Support the development of legislation to establish a statewide Palliative Care Council.

Actions/Results

Actions

The Georgia Cancer Control Consortium’s (GC3) Palliative Care Work Group led and supported the development of a state law that would establish a Palliative Care Council. Other stakeholder organizations represented on the Work Group included Georgia Hospice and Palliative Care Organization (GHPCO), Hospice Savannah, St. Mary’s Health Care System, Northeast Georgia Health System, American Cancer Society (ACS), American Cancer Society Cancer Action Network (ACS CAN), Children’s Healthcare of Atlanta, Georgia Society of Clinical Oncology (GASCO), Georgia Gerontological Advanced Practice Nurses Association (GAPNA), Hospice and Palliative Nurses Association (HPNA), American Academy of Hospice and Palliative Medicine (AAHPM) and local medical oncologists. The Georgia Health Policy Center played a pivotal role in facilitating and collecting information for the state’s 2014-2019 Comprehensive Cancer Control Plan and currently provides staff support to GC3’s Steering Team, two subcommittees and five implementation work groups.

The Consortium took the following actions to educate constituents about the need for PSE change:

1. In 2015, GC3 Palliative Care Work Group, GHPCO and ACS hosted Georgia’s first Palliative Care Coalition Conference, attracting 100 attendees from across the state. The purpose of this meeting was to develop a statewide network to promote palliative care throughout Georgia. This was the initial grassroots organizing effort (Step 1: Engage).
2. The Work Group contacted Commission on Cancer (CoC) accredited cancer centers in the state in an attempt to survey their palliative care program directors to collect information on how their patients access palliative care at their respective centers. In addition, ACS CAN provided data on existing inpatient and outpatient palliative care programs across the state. The Work Group was able to use both sets of data to make the case for the need for palliative care services in the state (Step 3: Assess).
3. Work group partners developed talking points and a one-page flyer that was used to educate the community and stakeholders about palliative care in Georgia, and how to effectively educate state legislators about the benefits of creating a statewide palliative care network. The document was distributed through palliative care listservs and at the 2015 Palliative Care Coalition Conference (Step 5: Promote).
4. Multiple stakeholders, including a representative of the GC3 Palliative Care Work Group, met with State Representative Jesse Petrea to provide data, collected by the Palliative Care Work Group, ACS CAN and other sources, that illustrated the need for enhancement of state palliative care services in the state. Representative Petrea became the lead sponsor of a bill intended “to improve quality and delivery of patient-centered and family-focused palliative care in this state” (GA Code § 31-7-190 et seq., 2016) (Step 4: Review; Step 6: Implement).

Results

Georgia House Bill HB 509 went into effect on July 1, 2016. The law created the Georgia Palliative Care and Quality of Life Advisory Council (Council) to provide advice about state palliative care initiatives. It also established a consumer and professional education program to provide education about palliative care to the public, health care providers, and health care facilities. As required by the law, the Governor appointed members to the Council, and the Council met to establish an agenda and structure.

Success Factors and Key Questions Addressed

How did you frame your message for each audience?

The intended audiences included legislators, stakeholders and members of stakeholder organizations. During the 10-month effort, messages were crafted and delivered in the following ways:

• Stakeholders were organized using email campaigns and updates regarding the progress, status and actions required to promote HB 509.
• Members of stakeholder organizations (GHPCO, ACS/ACS CAN, GASCO, Georgia GAPNA, HPNA, AAHPM) were mobilized using legislative updates and calls to action.
• Legislators were contacted by ACS CAN and asked to support the bill once it was introduced.
• Messages being disseminated about palliative care by national organizations, such as the American Society of Clinical Oncology, were connected to state advocacy efforts to validate Georgia’s request and strengthen the ask.
• ACS CAN organized a Cancer Day on the Hill for stakeholder organizations and their members to visit their legislators.

What cultural and/or community norms were incorporated to strengthen the message and make it more acceptable to your intended audience(s)?

ACS CAN crafted and branded much of the messaging, as that organization is generally recognized as being connected to the community, able to advocate on behalf of patients and able to speak on behalf of oncologists. Additionally ACS CAN was advocating for similar bills in other states across the country.

Based on state demographics, the need for rural care was one of the focused messages. While it was known that CoC accreditation would address palliative care, the Coalition had a special interest in ensuring that residents in rural Georgia were not left without access to quality palliative services.

Which media platform(s) were best suited to promoting your message and why?

Members used Twitter (#GAPalliative), which was effective due to the broad use of Twitter in community, legislative and organizational settings. Email campaigns were effective because they could be widely disseminated and easily duplicated. Member organizations also promoted the initiative using their newsletters, websites and email.

Related Resources

Learn more about GC3 Palliative Care Work Group’s effort by reading the law or an article related to its passage. You may also follow the hashtag #GAPalliative to see Tweets that promoted the initiative.

REFERENCES

Dumanovsky, T., Augustin, R., Rogers, M., Lettang K., Meier D. E., & Morrison, R. S. (2015). The growth of palliative care in U.S. hospitals: A status report. Journal of Palliative Medicine, 19(1):815. https://doi.org/10.1089/jpm.2015.0351

GA Code § 31-7-190 et seq. (2016).

*As reported in 2013 American Hospital Association Annual Survey. An “A” grade is defined as 80% or more of a state’s hospitals with 50 or more beds reporting a palliative care program (Grade B=60%, Grade C=40%, Grade D=20%, Grade F<20%).