Christiana Care social worker, physician honored for palliative care excellence

In recognition of their work helping patients live as well as they can for as long as they can, a Christiana Care social worker and Emergency Department physician have been honored by the Delaware Quality of Life Coalition, an all-volunteer non-profit association of providers, educators, clergy and caregivers.

Emergency Department physician Julie Cooper, M.D., and social worker Jaynnette Tirado, LCSW, received Excellence Awards in the physician and counseling professional categories, respectively, at the coalition’s April 20 conference and awards ceremony. Awardees were chosen solely based on their nominations, both of which came from John J. Goodill, M.D., FACP, FCCP, chief of Christiana Care’s Hospice and Palliative Medicine Section.

Dr. Goodill said Tirado is a compassionate, skilled listener who takes the time to work with families. And he called Dr. Cooper a “palliative care champion” for her work teaching Emergency Medicine residents how to have conversations about goals of care near the end of life with patients and their families.

“Christiana Care has been a supporter from the beginning,” said Keagen Brown, president of the Delaware Quality of Life Coalition (formerly the Delaware End of Life Coalition). “Christiana Care has been good at sharing knowledge. They’re really known as a thought leader.”

Under the direction of Roshni T. Guerry, M.D., medical director of Inpatient Supportive and Palliative Medicine, Christiana Care offers specialty services in palliative care, also known as comfort care or supportive care.

“Palliative medicine adds value to our care by providing opportunities to learn about what is important to our patients,” Dr. Guerry said. “This allows our team to collaborate with patients and their families to craft a care plan that’s tailored to each patient’s goals.”

Through this program, Christiana Care seeks to improve the quality of life of those living with serious illness and works to integrate its principles across other disciplines.

The program also seeks to dispel myths about palliative care. Palliative care is not the same as hospice care. Palliative care is generally given in addition to — not in place of — prescribed treatments.

Christiana Care also has supported the use of the Delaware Medical Orders for Scope of Treatment form, or DMOST, which offers a new way for patients to communicate their preferences regarding medical care near the end of life. The DMOST form reconciles a patient’s preferences with sound medical judgment and then documents those preferences in a clear, standardized medical order. It is intended to be used by those who have less than a year to live.

In the Emergency Department, where the DMOST will most often be carried out, Dr. Cooper has been something of an evangelist for palliative care, spreading the word about how to have these difficult conversations. She helps teach the Emergency Department’s approximately 50 emergency medicine residents how to focus on patients’ goals and values.

“We spend a lot of time talking about the end of life. Most of us weren’t taught how to do that,” Dr. Cooper said.

For Tirado, a Christiana Care social worker since 2000, the key is spending the time it takes with patients to become their advocate. During group meetings, she reads families’ body language to ensure they truly understand what the care team is saying. And she stays after the rest of the team leaves to debrief the family, often gleaning information that wasn’t shared in a more formal setting.

It’s this trust that Tirado values most.

“You’re available to a family at their most vulnerable time,” she said. “For them to allow me to talk with them is something I don’t take for granted.”

Tirado also helps patients express their hopes in terms of the “Five Wishes,” which tell the family and doctors:

• Who you want to make health care decisions for you when you can’t make them.
• The kind of medical treatment you want or don’t want.
• How comfortable you want to be.
• How you want people to treat you.
• What you want your loved ones to know.

Christiana Care staff who have been honored at the conference in the past include Dr. Goodill, Shirley Brogley, ACHNP, ANP-BC, of the Supportive and Palliative Care Program, and Anne Mueller, MBA, MBE, who earned the Program Administration Award.