Palliative care focuses on the quality of patients’ lives/ Rita Watson
Although we live in an age of dramatic technological advances in medicine, the value of palliative care is ever more prominent. Palliative care has evolved since the mid-1960s when Dr. Cicely Saunders established St. Christopher’s Hospice in London, designed for those who were terminally ill. Today palliative care focuses on providing relief from the pain and stress of serious illness. It is provided by a multi-disciplinary team to improve quality of life for both patients and families. Nonetheless, some issues are misunderstood.
Kate Lally, M.D, is medical director of palliative care for KentHospital and hospice medical director at the VNA of Care New England. She explained: “Palliative care is symptom-focused care for patients with serious illnesses. We focus on relieving symptoms such as pain and nausea and help patients talk about their preferences for care and treatment options.”
Currently there is a renewed interest in palliative care. The Association of Health Care Journalists held a national Internet seminar titled “Covering Medical Ethics, End-of-Life, and Palliative Care” this month and, at the Institute of Medicine, there was a recent third meeting of the Committee on Approaching Death: Addressing Key End of Life Issues.
However, Dr. Lally emphasized: “Palliative care is not hospice and is not only focused on end of life. I think people sometimes hear the words, ‘palliative care’ and they are afraid to get a service that might really help them, because they think it is associated with end of life. Hospice is a type of palliative care that we provide to patients at the end of life, but many patients who are not dying can also benefit.”
In terms of the intrinsic value of a team approach to care, Dr. Lally said: “We know that it is really hard being sick. Patients with serious illnesses such as cancer, heart failure, and chronic obstructive pulmonary disease are often in and out of the hospital. They have many symptoms associated with their illness and often want their symptoms addressed while getting aggressive treatment. Also, they want to think about the next steps in their illness.”
She pointed to questions of concern often raised: “What will I do if this treatment doesn’t work? What are my options? What will I do if I get sicker? Can my pain be controlled at home? Can I get extra help at home?”
Palliative care specialists are trained in addressing options with patients and their families. And, as Dr. Lally said, “We also work closely with their regular doctors to help develop a full treatment plan.”
In order to deal with such issues, hospice and palliative care nurses and physicians receive specific training. “There is special certification in hospice and palliative medicine for doctors and nurses,” said Dr. Lally. “Physicians often attend specialized fellowships in palliative care and then become board certified. They then work as part of comprehensive teams to further their education.”
In talking with palliative care and hospice teams, what resonates is listening. One physician explained that patients often convey their wishes in words and signs and told the story of a dying woman who was deemed delirious because she kept talking about waiting in line. As a hospice physician, he took her words seriously and asked the woman, “Who is ahead of you in line?” She answered, “My husband.” Shortly thereafter, she joined him.
Rita Watson, MPH, is a Journal columnist and recipient of the 2012 MetLife Foundation Journalism Fellowship through the Gerontological Society of America and New America Media.
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