Transcription:
What is Palliative Care?

Melanie Cole (Host): A chronic illness or life-threatening health condition can present an array of tough questions and challenges. Palliative care can relieve symptoms of a disease while maintaining the highest possible quality of life for patients. My guest today is Dr. Hunter Groninger. He’s a palliative care specialist at MedStar Washington Hospital Center. Welcome to the show, Dr. Groninger. What is palliative care?

Dr. Hunger Groninger (Guest): Thank you. Thank you for asking. Palliative care is specialized interdisciplinary care that focuses on prevention or relief of suffering for patients with a serious progressive illness. It focuses on support for their loved ones, families and caregivers as well. It’s a specialty that is relatively new in the United States, but it has really been catching on strong because people who have a serious progressive illness really need a lot of whole person, holistic support that focuses on quality of life.

Melanie: A lot of times people confuse palliative care and hospice care and they think that if they get involved in palliative care that means end of life. Please explain this difference to them.

Dr. Groninger: That’s a great question, and you’re right, there are a lot of people who have that understandable misconception. Palliative care is a supportive care specialty, like I defined, and anybody who has a serious progressive illness, who has pain management needs, who needs expert management of other symptoms, who needs psychosocial, spiritual support or counseling is eligible for palliative care compensation. And so, palliative care really is a service that’s available to people based on their need for it as long as they need it. They deserve to have it. That could be for people who have a disease that is serious or life-threatening but potentially curable. That could be for people who have a chronic serious progressive illness. But, it is importantly different from hospice care. Hospice care is a type of palliative care but it’s really that type of supportive care for people who really are at the end of life to the best of our ability to prognosticate or predict the future. So, hospice care is an insurance benefit in this country that is covered under Medicare and under most other insurances, but it’s a benefit that really is focused on estimating someone’s prognosis. So, people are eligible for hospice care if their physician estimates the time that they have left with the disease that they have to be six months or less if the disease runs its usual course. So, there are important differences between the two. Palliative care is for anybody who needs that type of supportive care. Hospice care is for people who are specifically approaching end of life.

Melanie: Can you have curative treatments together with palliative care?

Dr. Groninger: You certainly can. A good example of a patient that my team is helping to take care of now, this is a gentleman who is relatively young. He’s in his early 40s. He has a new diagnosis of a type of lymphoma. We met him because he was having out of control pain from the disease itself and from complications from the disease. He also has a lot of needs for psychosocial support, for spiritual counseling support. So does his wife. So does his family. But, in the context and the predicted trajectory of this disease, we believe that his disease will respond to treatment; we believe that his disease will go into remission; and we hope that he will live a long, healthy, productive life. So, this is somebody, again, that is in need of these holistic supportive care services, but is someone that we believe will actually do quite well with treatment. We’ve talked with him about the fact that we look forward to the time when he’s feeling so much better that he actually doesn’t continue to need our services.

Melanie: Who else besides the patient? Can their families be involved in palliative care?

Dr. Groninger: That’s a good question. I think when we think about palliative care, we really focus mainly on the patient. I think that is what most providers do. But, we’re very interested in who is part of the illness experience around the patient as well. So, this is really family-focused care. When anybody gets the diagnosis of a serious illness or a life threatening illness, it impacts the community around them. It impacts what their home life is like; it impacts their professional life; it impacts their relationships. And so, part of what we really try to do when we’re thinking about the whole person is really thinking about at least the immediate community and family around the individual. So, when we think about targeting our interdisciplinary support, we think about what are the needs of the patient, but what might a spouse need, or an adult child, or some of their closest friends and family around the individual as well because it’s been well-documented that when an individual is diagnosed with a serious illness, that it seriously impacts the function of the family unit; it can seriously impact the finances of the family; and so, we want to be mindful of what the entire illness experience is like. If we’re really going to support an individual through a difficult time, we have to be thinking about, not only the individual, but sort of the aftershocks of what’s happening around that person as well.

Melanie: And you’ve mentioned interdisciplinary, multidisciplinary, what services actually do you offer in palliative care? What can people expect? Is there nutrition advice, spiritual counseling, mental health and psychological counseling? Speak to the services a bit.

Dr. Groninger: When somebody has — I’ll continue with the example of the patient I was referring to before — when someone has serious physical pain and that’s the physical component of suffering is something that needs attention, but you can imagine that if someone is seriously physically affected by pain other discomfort, that’s going to affect how their emotional state feels. It’s going to affect their relationships. They may not able to do what they would normally do for daily activity. A patient who is in serious pain can’t go to church once a week like he would normally do. So, when we think about suffering we really try to think about a model of total pain or total suffering, meaning that when people suffer they suffer in different modalities together, and that could be physical, emotional, social or relational and spiritual. And, our interdisciplinary team intends to reflect those needs. So, we’re very lucky here at MedStar Washington Hospital Center to have a very deep interdisciplinary team that consists of physicians, nurse practitioners, social workers, spiritual care, clinical pharmacists, and special volunteers. So, we really try to attend to all the different domains of suffering, so to speak, so that we really can help people to improve the quality of life in spite of what’s happened to them.

Melanie: Do they have to give up their own doctor?

Dr. Groninger: Absolutely not. I think we work very, very closely and very collaboratively with their primary doctors, whether that’s their primary care physicians or their a primary specialty doctors. Our model here at MedStar Washington Hospital Center is one of integration. So, we are continuing the process of integrating into the care of people with advanced heart failure, people with new diagnosis of cancer, different types of cancers. We are just embarking on a collaborative model for patients who have advancing kidney disease. So, we believe that patients and their families get the best care when teams are working together. So, this is not a model of you choose one or you choose the other. With us you get both and we will work really closely with your primary medical doctors to make sure that we’re working symbiotically to give you the best care possible.

Melanie: Can patients get palliative care if they are at home?

Dr. Groninger: They can. For the most part, the patients that we see are patients who have been hospitalized and, happily, we have a growing presence in the outpatient setting. Helping patients to receive palliative care at home is an ongoing evolution in medical culture in the United States. Our program here is piloting different ways to do that. An example that I share with you is a pilot program that we have with advanced heart failure patients who we’ve joined in their care during a hospitalization. We’re piloting a tele-health or virtual clinic, so to speak, program, so that we can continue to provide ongoing support needs when they are at home through telecommunication, through video-conferencing in order to maintain that connection, to maintain that support for them without patients having the extra burden of needing to come back to see us for additional clinic appointment. Most patients who are living with a serious illness have a lot of medical appointments. They’re at high risk of coming to the emergency room or being hospitalized, and so we really want to think about, “What can we do to help support you so that you can, hopefully, avoid those complications and those episodes, and how can we also help to maintain support to the best way possible without you having to be further burdened with more visits to a medical care setting?” Those are some examples of pilot programs that we’re working on to see how we can do this best. I think that that will be a really important component of the future of home-based palliative care.

Melanie: In just the last few minutes, Dr. Groninger, best advice for people who are trying to understand palliative care, going through some problems, chronic health issues, with loved ones. Tell them what you tell them every single day.

Dr. Groninger: I think that we do a lot of education with patients and families about palliative care and about what it is that we do and aim to do try to help individuals have a better quality of life. I think that our mission is really focusing on helping patients and family members to think about what is it that we can help with today that would make today a little bit better? And, maybe think about tomorrow as well. What is it that’s important to you? And, I often have a conversation with patients or family members about how can we understand who you are as a person and what your goals are in the context of what’s happening? I know that people don’t come to the hospital just to get medical care. They come to the hospital or they come to an emergency room or they take their medication in order that they can achieve something better; that they can feel better; that they can be more functional. And, even that is to achieve other goals that are important like to be able to work, or to be able to enjoy time with family, or to finish high school. People go through these experiences and it’s hard having a serious illness. In order to achieve life experiences and life goals. And, I think at the end of the day what, we really want to do is understand what are your specific life goals? What are the experiences that you’re looking to be able to do? How can we think about it in the context of what’s happening realistically right now, whatever the medical situation happens to be today or this week, and how can we aim to make that better? How can we help you feel better than before? I think that’s a conversation that, in one way or another, we have with all of our patients.

Melanie: Thank you so much, Dr. Groninger, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information you can go to MedstarWashington.org. That’s MedstarWashington.org. I’m Melanie Cole. Thanks for listening.