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Taking Advantage of Palliative Care

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iStock 000009796381SmallIn my primary care geriatric practice, I sometimes see patients with serious medical conditions who are struggling with difficult symptoms and pain that can be alleviated. While we primary care physicians do the best possible job to help during the time we have with our patients, at times it isn’t enough. And that’s where palliative care can be an invaluable resource. Sadly, the patients who need help may not even be aware of the good services they can access by using a palliative care team. Or, they may have a negative perception about palliative care and what it means. So I’d like to clear up the misconceptions and encourage you to use palliative care services when they are appropriate for you or someone you love.

Let's start with a simple definition. Palliative care is a team approach to medical care focused on managing or alleviating the patient’s symptoms (vs. curing the underlying problem, although the two sometimes go hand-in hand) to make them feel better and relieve suffering. It is most often used with patients who have some type of chronic disease or condition, or as transitional care phase for patients who may be nearing the end of life but are not yet ready for hospice care. (Although it’s important to note here that using palliative care services does not necessarily signal the beginning of the end!)

The palliative care team can include a cadre of professionals such as nurse practitioners, physician assistants, nurses, social workers, psychologists, nutritionists, clergy, and others. There may also be a physician who is a palliative care specialist involved. This team of healthcare providers, along with the patient and family, collaborates to design a care plan to suit the patient’s individual needs. They stay in close communication with the patient’s primary care physician and specialists. The team looks at the whole person and life situation, encompassing physical, emotional, social, and spiritual dynamics with the goal of maximizing the patient’s quality of life. It also provides a support system to the patient’s family members and loved ones.

Here’s the difference between hospice care and palliative care: in order for a patient to qualify for hospice care (that is, to have Medicare or other insurance pay for it), two physicians must certify that the person likely has less than six months to live. The palliative care model is similar to the hospice model and, in fact, it originated in the realm of hospice. However, palliative care services are appropriate and helpful for many patients with serious medical problems and who need help managing pain and other difficult symptoms, whether or not they are expected to recover.

As a geriatrician, I see many patients with multiple, complex, chronic medical problems and related symptoms. Now, if I were able to visit these folks at homes or in their nursing homes 3 or 4 times a week, I would be able to do a good job of helping them manage their symptoms effectively. Unfortunately, that’s just not possible. And that’s where the palliative care team comes in. I can call on these experts to help me care for those patients who need a higher level of help and attention. They will keep me in the loop and we will collaborate on the care and services they provide to my patient. The patient is more comfortable and at ease, the family members are relieved, and I feel confident in the excellent care being provided. It is a win-win-win. What’s more, Medicare and other insurance companies will usually pay for palliative care services.

Here’s a great example. I have a patient who is a 95-year-old retired physician. She’s as determined and independent as they come and has very strong opinions about her own medical care. I went to visit her at home recently and I knew she’d been having some episodic back pain symptoms. On the day I was there, she felt great and had no complaints (she may have been putting on her game face for me). But a couple of days later, I got a call from her daughter who said, “Gosh, Dr. Murphy, mom is really struggling with this.” Ultimately, we decided to call on palliative care to address the daughter’s concerns. With their help, my patient can continue to stay in her own home where she wants to be. The team will adjust her medications to help with symptom control and will work with the daughter to prepare for what might be coming down the road. I will stay informed and involved.

Now, I mentioned that palliative care can be viewed as a transitional care phase. I saw a hospice patient in my office recently who was doing exceptionally well—much better than we expected. When he comes up for hospice recertification next month, his hospice nurse and I will have to make a decision. It’s difficult to say whether he will be able to sustain the improvement. But if we feel he no longer qualifies for hospice, we will transition him into palliative care. It is not uncommon for patients to go back and forth between hospice and palliative care.

How do you know if it’s time for palliative care? I believe that, as a medical community, we tend to wait too long to access these services. I think we should have a lower threshold for calling in the palliative care team. If you (or someone you know) are really struggling with symptoms and your medical team has not been successful in controlling them adequately, then palliative care could provide great relief. Now, if you’re suffering from acute symptoms, such as pain related to a minor fall or injury, they might resolve given a little time. But if those symptoms continue beyond a few weeks and perhaps begin to worsen, it’s a good time to consider palliative care. 

If you think that you or a loved one might benefit from palliative care services, by all means, take the initiative and ask your primary care provider or specialist! It is possible that your doctor may not be accustomed to thinking about palliative care and may not consider it until you bring it up. He or she will know if you are a good candidate and will be able to put you in touch with a palliative care team.

In geriatric medicine, we focus on maximizing functionality and quality of life for our patients. Often, palliative care is just what the doctor ordered in that regard. Don’t suffer needlessly. Please speak up and ask for the help you deserve--the help that is readily available to you.

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