Page 13 - Focus March 2018

“As palliative medicine specialists, our procedure is the family meeting.”
| Hospice and Palliative Medicine
and values,” said Vinay Maheshwari, M.D., MHCDS, FCCP, vice chair of the Depart- ment of Medicine. “We deliver patient- centered care that meets their goals, which at times leads to less aggressive but more supportive care.”
Ensuring patients understand the possible results of their treatment choices is key. In the COPD example, it’s not enough to simply ask if a patient wants a tracheostomy (the insertion of a breathing tube through the windpipe) without ensuring they fully understand the potential consequences.
No matter the patient’s choice, a palliative care team can communicate this care plan to the primary team in a way that focuses everyone on the patient's perspective, goals and needs.
John J. Goodill, M.D., FACP, FCCP
Shirley Brogley, ACHPN, ANP-BC, who joined Christiana Care's palliative care team in 2005, said the precursor to a productive conversation is symptom relief.
“You see the patient, manage their symptoms, build a rapport and ask permission to have a difficult conversation to talk about their illness with their loved ones,” Brogley said.
Creating an advance care directive to guide a patient’s long-term care is often a priority in these meetings, though the conversations that lead to this document tend to be just as important.
“It’s critical to choose a person to make decisions for the patient and to talk about the values that guide them,” she said.
To understand how palliative care works in practice, consider a patient with
Helping more patients and families
The inpatient palliative care consult service started small in 2004, with two part-time providers, before growing into an interdisciplinary team that’s on pace to provide
more than 3,000 consults in 2017. Meanwhile, the service’s educational outreach has spread the practices and principles of palliative care throughout the health system.
“Our goal is that all clinicians can provide a generalist’s level of care to our patients,” said Roshni T. Guerry, M.D., inpatient medical director and a Value Institute scholar.
In 2012, Christiana Care began offering palliative care services to infants with potentially life-limiting illness and their
advanced-stage chronic obstructive pulmonary disease, or COPD, who has been hospitalized before. A palliative care provider will likely discuss the risks and benefits of aggressive treatment options, including a ventilator. Managing distressing symptoms such as shortness of breath and fatigue is also a priority of palliative medicine.
“Our conversations focus on what the patient considers important, as it relates to their quality of life and their own beliefs
“Our conversations focus on what the patient considers important, as it relates to their quality of life and their own beliefs
and values.”
Vinay Maheshwari, M.D., MHCDS, FCCP
Roshni T. Guerry, M.D.
families through the IMPACT program. Its all-volunteer team celebrates new life with families while all too often bearing witness to its loss.
Then, in 2016, Christiana Care expanded its palliative care practice to the Helen F. Graham Cancer Center & Research Institute, where it can reach nearly 1,000 patients with advanced cancer.
Now, the health system is extending palliative care services to the outpatient treatment of serious non-cancer illness, such as heart failure.
New Christiana Care data are backing up palliative care as a systemwide priority.
Dr. Maheshwari said 7-, 30- and 90-day readmission rates were significantly lower in patients who had a palliative care consult compared with those who did not.
Though palliative care is most often associ- ated with older adults, it can complement treatment of serious illness at any age. It affirms the centrality of a patient’s quality of life — no matter how long the life lasts.
In short, Christiana Care’s growing use of palliative care is helping to deliver better care and a better experience for patients and families while lowering health care costs. And while nationally there is a short- age of palliative care physicians, Christiana Care is growing this important workforce through a shared fellowship program with the Nemours/Alfred I. duPont Hospital for Children that trains two physicians a year.
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