Maggie McKay (Host): When it comes to the topic of palliative care, how much do you know? Today, Dr. Colin Scibetta a Palliative Care Doctor, joins us to tell us about Community Memorial Healthcare's program. Welcome to Wise and Well presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Thank you so much for being here today, Dr. Scibetta.

Colin Scibetta, MD: Thank you for having me. It's my pleasure to be here with you.

Host: So, for listeners who may not be familiar, can you explain what palliative care is and how it differs from say, hospice care?

Colin Scibetta, MD: Palliative care is specialized medical care that focuses on providing patients from the relief of symptoms and the stress of living with a serious illness. There's a range of settings in which palliative care is practiced. It can be done in the home setting, a clinic, or in a hospital, in an inpatient facility, which is where I and my palliative care team are focused.

So the goal of palliative care really is to provide quality of life for both patients and their families, and it can be provided at any stage of illness, early or late, and it's really focused, like I said, on helping to address what's most important to patients, focusing on improvements in quality of life.

I think it's also important to note, palliative care is often misunderstood. It's often conflated with hospice care, which is probably where your question came from. It differs from hospice care in a couple significant ways. One is hospice is care that's focused, and tailored to people who are at the end of their life or who are approaching the end of their life.

Often, they have a six month prognosis or less, whereas palliative care is much broader. It is not just end of life care. It is really focused on patients and families who are living with a serious illness but may have a long time to live and want to focus on improving symptoms, the stresses that come along with the serious illness, providing additional support to family and caregivers and like I said, focusing on quality of life and what's most important to patients.

Host: And you touched on this a little bit, but let's get more into it. When people hear palliative care, they might believe it's just for end of life, like you mentioned, but it can also be to help someone during an illness for severe pain situations. Can you provide an example of use of palliative care that's not for end of life?

Colin Scibetta, MD: Absolutely. So, our program being an inpatient focused program, we do see people who are hospitalized. So most of the time patients that I'm asked to see are going through a serious complication of their illness. Common scenario that I'm asked to get involved with is, for example, somebody living with cancer, for example, and they're admitted with an infection or with pain and they're in the middle of getting chemotherapy or radiation or some other treatment for their cancer, but it's been complicated by the symptoms that they're having.

So often I'm asked to get involved to see if we can better control the pain that is resulting from their serious illness, their cancer, from significant nausea or GI distress that they've suffered as a result of their cancer treatments. And so I work to better control their pain, better manage their symptoms so that people can be more comfortable and more able to return to the treatment plan that their doctors have recommended.

Another example I'll give you is, we partner very closely with our cardiologists and our cardiothoracic surgeons. Sometimes I'm asked to see a patient who has come into the hospital with a heart attack and they may be faced with some difficult or big decisions about how to proceed with their care.

For example, sometimes someone who's found to have multiple coronary arteries that are blocked or that have disease in their coronary arteries and they're facing the option of possibly going through bypass surgery, which is a very big commitment and it's a invasive surgery versus, choosing a more conservative or medical approach, focusing on just using medications and doing less invasive interventions.

That's a difficult, complex decision that involves discussion, not just with the patient, but their family, often brings up emotional, psychological, spiritual stressors. And the palliative care team, which, I should say is, staffed by myself and one of my colleagues, Dr. Pankratz. We also rely on our expert social workers and nurses, as well as our chaplains.

And we come together and provide the support that patients and their families need to think and talk through these complicated decisions, focusing on whatever areas are most important and concerning to those patients. So if that's spiritual or emotional distress, our chaplains and social workers, tend to lean in a little bit more heavily.

And if it's really concerned about symptoms and the medical hoops that somebody's going to have to jump through with a surgery versus a more medical or conservative approach, we have discussions that are focused on that. And our goal is really to provide maximal support to patients and their families as they make difficult medical decisions, help them understand what to anticipate, and tend to the medical, but also the non medical stresses that come along with being hospitalized.

Host: Palliative care focuses on improving quality of life, as you mentioned. Can you share some examples of how you've achieved this for your patients at Community Memorial Healthcare?

Colin Scibetta, MD: Well, I think it's important to say off the bat that our team approaches patients from a multidisciplinary angle. So it's not just me, it's my dedicated nurses and our social workers and chaplains that work together to really focus on quality of life issues for patients.

And one anecdote that I think really illustrates this is a patient that I took care of last year. Her name was Michelle and she was hospitalized with complications of very advanced colorectal cancer. She was admitted with an obstruction in her intestines, as a result of the cancer. And despite a pretty prolonged hospitalization and aggressive medical care to try to help relieve that obstruction, it was clear that things were not moving in the direction that we all hoped they would, and certainly that she and her family hoped they would.

In one of my visits with her, I asked a question, which I often ask, which is, in the event that things get more complicated with your health, what is most important to you, Michelle? And in one of those intimate moments, she shared with me that her longtime partner, Hector, and she who shared three beautiful children, had never actually been married.

And it was one of her main priorities that they get married, in the event that she didn't survive. She wanted her kids to know, that her parents were married. They had lived in a loving and committed relationship for many years, but as she put it, life got in the way and things got busy.

So as we really focused on that and thought about how we can honor that request, particularly given that increasingly it appeared that Michelle was not going to survive for a whole lot longer. I had shared that I had actually officiated a wedding for a friend of mine a couple years before and casually suggested, what if we, tried to see if we can get you two married while you're here in the hospital?

 As soon as mentioned that, it was incredible. The whole tone of our dynamic shifted. And I think she felt seen, by not just me, but I think the doctors and nurses caring for her in a way that went beyond just her medical needs and she jumped at the idea. And, within a few days, I was at the courthouse in Ventura with Hector, uh, getting a marriage certificate.

Host: Oh my God, you're going to make me cry.

Colin Scibetta, MD: It was, it was a real privilege, but, I want to say, our nursing staff here on the palliative care team worked with her family and the nurses on the floor where she was being taken care of to, get her hair ready and we got her kids in and our social worker coordinated visitation and, actually the CEO at the time and some of our top administrators came and in the end we had a really beautiful and brief wedding ceremony at her bedside and it required a lot of different people pulling it together and I was just privileged and touched to be part of that. And it was sort of a new role for me as a doctor. I'm not typically doing that, but it was a reminder that for some people, particularly facing serious illness, particularly sometimes at the end of life, what's most important kind of transcends medical outcomes. And, it's a privilege to get to talk about those issues with families every day, which is what we do in palliative care.

Host: That's amazing. Good for your team. I mean, that had to be so rewarding to everybody involved. How does the Community Memorial Palliative Care team work alongside a patient's primary doctor and other specialists?

Colin Scibetta, MD: We call this care coordination, but it's a big part of what we do. So, the short answer is we work very closely with patients' primary care doctors when that's possible, but often sort of their hospital doctors. We are consulted to see patients by the primary doctor. So somebody has asked us to get involved and my standard practice is to communicate before I meet a patient with the doctors involved, understand what their perspectives are, what their concerns are, what their medical plan is.

 And sometimes that's talking to one doctor, sometimes it's talking to three or four. And that gives me context for understanding the situation before I introduce myself to a patient and their family. And then of course, as the discussions and treatment plan evolves, I'm constantly touching base with the doctors, who are primary on a patient's case, making sure that we're all, communicating openly and actively and keeping the patient and their family at the center of all that communication. So, very, very closely is the answer.

Host: That's great. Many people are afraid to discuss end of life care, understandably. So how do you approach these conversations with patients and their families?

Colin Scibetta, MD: Very thoughtfully and very gently. I think historically, medicine as a field has been physician driven, in terms of how we manage patients. And I think increasingly over the past couple of decades we've come to see that patients need to be at the center of decisions and of putting together their care plan based on what their priorities are.

So whenever I'm asked to meet with a patient or family member and someone who's approaching the end of their life or critically ill, I do so first by asking their permission, and introducing myself and my role, and trying to give the patient and their family, who are often in a vulnerable stressful situation, as much control and power in the dynamic as possible.

I always come into those conversations really without an agenda and to try to make it clear that my role and our role as the palliative care team is to make sure that patients understand we are their advocates and that the focus of these discussions, primarily in patients who are approaching the end of their life, is to focus on what is most important to that patient at that moment in time, what is most important to their family, really so that we can respect their wishes and give them a clear sense of what their choices are, as a way to give them as much control in a situation where often patients feel like they've lost all control.

Host: And how do you de stress from the end of the day? It's got to be so emotional every single day. How do you deal with that?

Colin Scibetta, MD: It is a privilege to do what I do. I think I speak for the nurses and social workers and chaplains on my team. I think when I say that working in these vulnerable spaces with patients who are seriously ill, often, getting better or going to survive and sometimes at the end of their life, it is a privilege to be entrusted with that role and to be present and to hold space with patients and families who are going through some of the most vulnerable moments in their life. So it is stressful, but I also want to say it's deeply rewarding and deeply soul filling, but it is, hard to see people suffer. And, a lot of what we do is seeing people who are suffering.

And I think it makes you feel grateful for what we have, for what I have with my health at the moment, knowing that things can change. And, try to take good care of myself and exercise and breathe fresh air and eat healthy food when I can, but also palliative care is a team sport.

And so I rely on my team for support and to help process the stresses that we witness and I try to provide that same support to them, and to other members of the staff here at Community Memorial Health System.

Host: I really think it's a calling, Dr. Scibetta. Because the people I've encountered through the years who do this are just amazing individuals. And I think you'd have to be so compassionate and empathetic and just a certain kind of person to do this and do it well. But what resources would you recommend for listeners who want to learn more about palliative care or say, find a provider in their area?

Colin Scibetta, MD: Well, there's a lot of resources online. One that I'll mention is the Center to Advance Palliative Care, CAPC, is how it's pronounced. CAPC.org is a national organization, one of the leading organizations advocating for palliative care services in our country. There's also website called getpalliativecare.org, which has a lot of information that's really aimed at patients and families for people who may be weary or unsure of what palliative care is. It also does have a provider directory for people to access services in their community. So getpalliativecare.org and the Center to Advance Palliative Care or CAPC.org is another great resource.

Host: In closing, what message would you like to give listeners who may be hesitant to seek out palliative care for themselves or a loved one?

Colin Scibetta, MD: I would just reinforce the message that the goal of palliative care is to help improve the quality of life of patients who are living with a serious illness and also their family and caregivers. Illness and the stress of illness is a universal human experience. We all either experience it ourselves or are supporting a loved one who's going through difficult times with their health.

And I think we can all attest and understand that those experiences come with stress, physical, emotional, spiritual, and the role of palliative care is really to name that, to address it and to try to be helpful, to people who are going through that, going through the stress of a serious illness.

And so I, would say it is not just end of life care by any means. And I think that is often a barrier that people worry about when, they hear palliative care. So we're here to help and we're here to provide support.

Host: Thank you so much. Again, that's Dr. Colin Scibetta and if you'd like to find a doctor, you can visit mycmh.org/findadoctor and search palliative care.

And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thank you for listening to Wise and Well presented by Community Memorial Healthcare.