Transcription:
What is Palliative Care

Melanie Cole (Host): Many people mistakenly think that palliative care is the same as hospice care, and as a result, they may be reluctant to seek advice about palliative care. However, it is an important medical care that focuses on people who are seriously ill. My guest today is Dr. Elaina DiOrio. She's an emergency medicine and palliative care physician at Hendricks Regional Health. Dr. DiOrio, tell us what is palliative medicine? Give us sort of the evolution of how this came about.

Dr. Elaina DiOrio, MD (Guest): So you're absolutely right. Palliative care is very often mistaken for hospice, and I think that that's the biggest misconception that there is. Palliative care comes before hospice. We are a supportive team, a supportive care group that helps patients and their families who have been diagnosed with a life-limiting or a life-altering illness.

Our main concern and main goals are to focus on a patient's symptom management as well as their quality of life. And quality of life looks different for each patient and is based on conversations with them and their family, and we kind of tie in their goals as well as their history and their values, and that affects the care as well as the side effects profile that they're willing to accept.

Host: Then define hospice for us, because that's more something that has to do with end of life, right? But palliative, not so much.

Dr. DiOrio: Exactly. So hospice is a service that is given to patients who are expected to have six months or less to live. And they also do a wonderful job with symptom control and family support. The palliative care comes before that, and we are involved in patients who often are still seeking curative treatment whether it's for their cancer, or COPD, or heart failure, and we kind of walk the path along with them, coordinate with their physician so that we are giving them the best care that we possibly can.

Host: Well, I'm glad you made that distinction about the fact that hospice can use palliative medicine to help with symptom management, but that chronic diseases, way before hospice, can be dealt with, with palliative medicine. Who provides palliative care? You're an emergency medicine physician, but there's a lot of people involved, right? What kinds of providers are involved?

Dr. DiOrio: And that, I think, is one of the most important parts of palliative care, is that there are a lot of different components to their care team, and each have a little bit of a different focus. So there is oftentimes a physician involved in a patient's care, and they are able to write prescriptions to help with symptom management, as well as to kind of be the quarterback and the coordinator for the team.

Oftentimes there is a nurse practitioner who works very closely with the physician, and there is a social worker who is able to help with a lot of the things that are very important to getting care provided but that we often forget. They are able to help with transportation, for pain and prescriptions, they can help get any sort of nutritional supplements for a patient. They often help us when we are speaking with families about the emotional support, the stress that goes into caring for someone who has a very significant illness.

And then typically there is a chaplain support involved. They are able to offer spiritual support for the patient and their family if that is something that they desire, especially if a religious or spiritual component affects their decisions on what they would want for their medical care.

Host: And as you mentioned, it's so important to reiterate that they can seek curative treatments while receiving palliative care. What kinds of care might be involved besides that? Can they work with their own doctors, Dr. DiOrio?

Dr. DiOrio: Yes, and that is an important thing to keep in mind as well, that oftentimes patients have these wonderful long-term relationships with their primary care physician who they've known for many years and who they trust, and it's important to realize that we don't replace their primary doctor, nor could we. And we work very closely with their primary care doctor, especially if they come here to the hospital, oftentimes their primary care doctor follows them when they're released, so we help kind of coordinate their care when they're here in the hospital, communicate with their primary doctor who knows them so well, and oftentimes we come up with a plan for the patient together.

We will typically see patients when they are being seen in their oncology clinic, and we work closely with their cancer doctors, or their heart failure doctors as well, to make sure that we're providing the best care possible.

Host: And who else can benefit from palliative care? You mentioned a little bit about the families earlier. So can the family get involved in the palliative care? Because meetings and support groups, because as you said, it can be difficult caring for someone who's living with a chronic illness that needs palliative care.

Dr. DiOrio: I think that for awhile we as a medical field were struggling with how to support a patient's family. They're the one who is watching their family member go through all of these medical processes, and tests, and kind of struggling to wrap your head around what it means to live with something that can be very debilitating; congestive heart failure, COPD, cancer. So to be able to get the family involved, whether it's in family meetings, or at appointments that the patient has, oftentimes they are the advocate for the patient. They are telling us what symptoms they're noticing, they're talking about the concerns that the patient's brought up that maybe they had forgotten about telling their medical team about, or may be a little bit hesitant to start talking about that. They are really the patient's best support system, and then we also help the family kind of cope with the illness and be better able to help care for their family member.

Host: I think one of the more important questions that patients often have, Dr. DiOrio, is will insurance cover palliative care? And can they get palliative care if they're at home? Or is this something only if they are hospitalized that they can get?

Dr. DiOrio: Every palliative care team looks a little bit different. So palliative care is covered by Medicare, Medicaid, and most insurance plans. So there is no additional cost to the patient to have this supportive team involved in their care, and really to keep the focus on the patient and their history, and not as much on their disease process. Oftentimes we forget, and we're so focused on the disease, that we don't- we're not always cognizant that the patient has their own goals, has their own struggles, and that's the best way to treat the patient.

Our program is in-patient, meaning that we see patients who are admitted at the hospital. We do have an out-patient clinic, and most palliative care programs do have that, where you can make a clinic appointment, or we can continue to follow you after you've left the hospital. There are a lot of programs who will also be able to visit you in your home if you are homebound and not able to come back to the clinic for any follow-up appointments.

Host: Then wrap it up for us. How does somebody get palliative care? Who do you call? How do they find out the services that Hendricks Regional Health offers for palliative care, and what would you like them to know as the most important thing? When people ask you what this is, and I'm sure you get this question all the time, what is it and what do you want them to know?

Dr. DiOrio: So the easiest way to get a palliative care program involved in your care is to ask. You ask your primary doctor, you ask the medicine doctor who is primarily involved in your care if you're in the hospital if they would be willing to ask the palliative care program to see them. Even if it's just for one or two visits just to offer support and make sure that the care that the patient desires is the care that is delivered to them.

In summary, the most important thing that I want the listeners to keep in mind is that palliative care is a supportive program. We do not replace the doctors or the providers who you have come to know and to trust, but we work alongside them to give you extra support both for you and your family when you are facing a complicated diagnosis, or to identify patients who we might be able to keep the focus on them and their values instead of just their disease process.

Host: Thank you so much. It's great information, Dr. DiOrio, and thank you for sharing your expertise and explaining the difference between hospice care and palliative care, and that it can really help people that are dealing with long-term illness, or chronic illness, pain management. So many caring health professionals involved. So, thank you so much for being with us. This is Health Talks with HRH: Henricks Regional Health. For more information, please visit www.Hendricks.org. That's www.Hendricks.org. I'm Melanie Cole, thanks so much for listening.