Maintaining Quality Of Life

The patient was in the hospital undergoing a regimen of chemotherapy that was successful 10 percent of the time. When the palliative care team met with her, they asked how she was doing and if she needed help dealing with side effects. And to her relief, they also asked the unspoken question. What if she was one of the 90 percent for whom the chemo didn't work?

"We support the patient's and the family's hope for a successful outcome. But we also suggest that they prepare for what will happen if the treatment isn't successful," says Jennifer Johnson, a palliative care nurse practitioner at Regions Hospital.

Caring For The Whole Person

Palliative care specializes in the relief of the pain, symptoms and stress of chronic, life-threatening illness. The goal of care is to improve the quality of life for patients and their families.

Patients can receive palliative care at any point in their illness. And unlike hospice, palliative care can be provided at the same time as curative or life-prolonging care like chemotherapy.

"We look at the whole person, not just the disease," says Danielle TenCate, a palliative care social worker at Regions. "We're concerned with how the patient and the family are coping with the illness and what their goals are for treatment."

Members Of The Team

The physician, nurse practitioner, social worker and chaplain form the core of the palliative care team. They coordinate care as the patient moves between settings like hospital, home, long-term care or hospice.

The team can also include pharmacists; physical, occupational and speech therapists; music and art therapists; dietitians; and complementary practitioners such as massage therapists and acupuncturists.

Planting Seeds

The Regions team recently cared for a man with end-stage congestive obstructive pulmonary disease. "Given the seriousness of his illness, you might have thought that his quality of life was very poor," Johnson says. "But he actually got a lot of enjoyment out of life."

He looked forward to going out to breakfast every morning with his cronies and spending time with family at the cabin. So the team focused on controlling symptoms like chest tightness, coughing and shortness of breath. But the team also raised the question of what he might want to do when he could no longer eat out or go on vacation. What kind of care did he want to receive? And at what point would he choose to stop receiving life-prolonging care?

"Our job is to plant seeds, and then walk the walk with patients and their families until they go into remission or are ready for hospice," say Rob Ruff, palliative care chaplain at Regions.

A Growing Need

In the years ahead, the need for palliative care will grow. According to the U.S. Census Bureau, by 2020 there will be 55 million people aged 65 and over. Many of them will develop age-related illnesses like heart failure and dementia.

"As the boomers come of age, they will want pain and symptom management, and they will also want to be involved in their own care," says Dr. Howard Epstein, medical director of palliative care at Regions.