Transcription:
Understanding Palliative Care

Melanie Cole (Host): Many people mistakenly think that palliative care is the same as hospice care and so they may be reluctant to seek advice about palliative care; however, it’s really an important medical care that focuses on people who are seriously ill. My guest today is Margie Atkinson. She’s the Director of Pastoral Care, Ethics, and Palliative Care at Morton Plant Mease Healthcare, part of Baycare Health System. Margie, I’m glad to have you with us again today. Please tell us a little bit about palliative medicine and care. Give us the definition. What is it?

Margie Atkinson (Guest): So Melanie thank you for having me, palliative care is care that focuses on expert assessment, management of pain and other symptoms, and also focuses on support of caregiver needs and coordination of care. So it attends to the physical aspects of care, but it also looks at the psychological, the practical, and the spiritual consequences of a serious illness. So palliative care is person centered, it’s a family centered approach to care, and it provides not only the person with the illness with care, but also their loved ones and their caregivers as well. Now palliative care ideally is integrated into care early in the serious illness that a patient may have because palliative care actually improves the quality of life, not only for the patient but also for the family.

Host: As I said in the intro Margie, some people mistakenly mix it up with hospice care, so they think oh I’m not going to get involved with this because that means it’s end of life. Tell us the difference.

Margie: Absolutely, so the difference is palliative care first of all is appropriate at any stage in a serious illness. It could be provided right alongside a curative or a life prolonging treatment or intent, whereas hospice care, by definition, for a patient to be – to quality for hospice care they have to be considered terminally ill, that is an illness which is going to end their life and two physicians say we believe this illness is going to be a terminal disease process for the patient, and that to the best of our guess, this is going to happen within the next 6 months. So of course it’s difficult to nail that down exactly, but in general hospice is really for the patient who is at the end of life or nearing the end of life, whereas palliative care, while we may move into the end of life with patients, we can begin at any stage of that patient’s illness.

Host: Thank you so much for clearing that up so that people know that they can reach out. Tell us about who can benefit, and how long can they be on it? Give us some of the specifics of palliative are as it relates to really any kind of an illness that someone’s going through.

Margie: Well that’s a great question. So if I could tell you first of all a little bit about what our team looks like, I think that might help with this understanding. So palliative care is provided by a team of experts okay? So in our health system and in our hospitals we have a team, which would include a physician who’s board certified in palliative medicine, a licensed clinical social worker or a licensed counselor and also a board certified chaplain. So people who come into a palliative care situation, it could be disease related. For example, they may have an illness where they’re experiencing extreme symptoms that are uncontrolled, that the palliative team comes in with their expertise and attend to, for example it could be pain management, it could be nausea, it could be depression, it could be shortness of breath, so we could literally get in there with that physical aspect. So those kinds of symptoms can really be manifested in many different types of illness. It’s difficult to say this illness or that illness, but certainly we do a lot of work with patients who are cancer patients, patients who may have disease processes such as congestive heart failure or COPD, chronic obstructive pulmonary disorder, those types of illnesses that – where patients experience a lot of distressing symptoms. Additionally palliative care ca be there for that patient who maybe needs some extra guidance and even just understanding what this illness means to them and how it’s going to impact their quality of life. So we may see a patient who has an illness for type for looking at discussing goals of care for example. The palliative physician and the palliative team are able to bring together the big picture of that patient’s illness or disease process. Typically in healthcare today we have specialists and one specialist might look at the lungs. One specialist might, for example, look at a cancer diagnosis. Another specialist might look at the heart and they’re focusing on those disease specific items. Palliative, and what we mean by saying it’s a patient centered and family centered care is we take – they may have three or four different complex things going on and we look at that as a whole, how do all those things together affect you as a person. It might be symptoms, it might emotional, it might be spiritual, it might psychological or it may have to do with what do I really want for myself? You know we do a lot of work with patients around advance care planning, and so we bring that set of expertise to the table as well.

Host: I think one of the most important questions that people have, and I had this myself when I was looking, if the palliative care for a family member is – suppose they have cancer, can they still get curative treatments?

Margie: Yes, that is a great question, absolutely. Cancer patients – one of the benefits of palliative care with patients with cancer is the fact that we can do and provide palliative care right alongside their chemotherapy. If you think about it, imagine the types of symptoms a person experiences along with chemotherapy where the palliative expertise is able to come in and perhaps provide a little more intent or a little more in depth work with the symptoms experience. Also remember with an oncology patient, a cancer patient, you don’t just have the symptoms and the curative treatment but you have the extreme stress that goes along with having any type of cancer. The fears, the concerns, the spiritual angst, all of those things are concerns that we would come alongside that patient who is working towards curative treatment and provide for those needs as well.

Host: And what do some of those treatments look like as far as palliative care? Is it, you mentioned a bunch of different kinds, spiritual and emotional and medicational – how is it administered Margie? And how does somebody find out or request palliative care?

Margie: Good questions Melanie. First of all, I’ll address your second question first – how does someone request palliative care? The majority of our Baycare Hospitals have palliative care teams working inside our hospitals. A patient can ask their attending physician about palliative care, and we do encourage patients to be proactive or the attending physician might suggest to the patient we would like the palliative care team to come in. So in that case, the physician would put in an order for our services and then we would see the patient. When palliative sees the patient, we do thorough assessment of various issues that might be going on. So the first thing that the palliative team’s going to do is do an assessment of the physical aspects of care, we’re going to have that licensed counselor who’s going to address the psychological and the psychiatric aspects of care, and perhaps the social aspects of care. So we start with an assessment to see what do they need, and what does that mean? We talk to you. We talk to our patients. We ask them questions. We let them tell us their story. Palliative care is a little bit unique in that we really do take the time that’s needed to hear what’s going on with these patients. If they don’t tell us their story, we don’t know what’s happening, and so we listen, we take to heart what they say. We listen to their ideas, we listen to their goals, and then we develop a plan of care that fits their goals of care, that fits their symptoms, that fits their needs.

Host: And how is the family involved?

Margie: Families are involved to the degree that the patient wants families involved. We recognize that in most cases, patient family members, or whoever they identify as their family or their caregivers, are an integral part of care. They’re the support system for the patient and sometimes the family members, as patients become more and more ill to family members are the ones who end up making a lot of serious decisions for patients. So we provide – we listen to the family members. We always encourage the patient. It’s really at the heart of any kind of care, it’s about the patient’s wishes, but often times, as you know, we have loved ones in our lives and we want their input. We want them to tell us what do you think about this? So we involve families every step of the way from the first visit to the patient to the last visit to the patient if that’s the patient’s wishes. We even will meet with family members alone. A family member may just need to talk to the chaplain or talk to the counselor and say I’m experiencing this. I don’t know what to do. I don’t know how to handle this and we can help them through some of those very challenging aspects.

Host: Does insurance cover palliative care?

Margie: Generally yes, generally in most cases in the inpatient setting, Medicare for example covers palliative care and most managed care plans that align are aligned with any kind of Medicare program, cover palliative care, other insurance programs cover palliative care and we never, ever refuse to see a patient based on their ability to pay, so we always seek any patient that needs our services.

Host: What a great service and a great type of medicine that you’re involved in Margie. Give us a summary, what you would like listeners to know, and the most important bits of information about palliative care, the importance of it, and your team.

Margie: I think the thing that I would most want people to hear is one thing that you mentioned earlier is palliative care is not the same as hospice. So when people hear palliative care, they should look at it as an additional layer of care that’s going to be provided for their needs. That’s number one. It’s an additional layer of care and it can be done at any stage of an illness. Number two, palliative care is a true team approach to care and we provide a team of experts, and not only are they experts in their field, they’re compassionate, they’re caring, they really, really are there for you as a patient and we’re going to do whatever it takes to make sure you are in the driver’s seat to the degree you want to be, and we’re going to get you the care that you need.

Host: Wow, great summary, wonderful information. What a great segment. So informative. Thank you so much Margie for joining us again. You are a great guest, and that wraps up this episode of Baycare Health Chat. Head on over to our website at baycare.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.