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 is important medical care that focuses on people who are seriously ill. It is meant to help patients get relief from their symptoms, pain and stress; whatever their diagnosis.
Listen as Dr. Manjula G. Vaghjiani, board certified internist and member of the medical staff at Palmdale Regional Medical Center, discusses palliative care and when it may help you or a loved one with the symptoms of a severe illness.
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Palliative Care for Symptom Management
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Learn more about Manjula Vaghijani, MD
Manjula Vaghijani, MD
Manjula G. Vaghjiani, MD., is board certified in internal medicine and palliative care and a member of the medical staff at Palmdale Regional Medical Center.Learn more about Manjula Vaghijani, MD
Transcription:
Palliative Care for Symptom Management
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 is important medical care that focuses on people who are seriously ill. It is meant to help patients get relief from their symptoms, pain and stress, whatever their diagnosis. My guest today is Dr. Manjula Vaghjiani. She's board-certified in palliative care and internal medicine and she's a member of medical staff at Palmdale Regional Medical Centre. Welcome to the show, Dr. Vaghjiani. What is palliative care or palliative medicine?
Dr. Manjula Vaghjiani (Guest): Thank you, Melanie. Palliative care is an essential component of serious illness care, much further upstream than from terminal care. It should be viewed as valuable care components for patients with cancer, dementia, end-stage chronic kidney disease, liver failure, neurological disorders like ALS, severe congestive heart failure and severe COPD. It's especially true for any patients going through rigorous therapy such as chemotherapy or radiation for metastatic cancer. This multidisciplinary approach is for symptom management, psychosocial support and assistance for treatment, decision making for patients and their families, with emphasis on well-being of patients and families at any point along the disease trajectory, regardless of their illness state. Palliative care does not refer to a particular place, or a specific stage of illness, but rather it describes the philosophy of care. It is provided by a specially trained of doctors, like me, nurses, social workers, chaplains, nutritionists and pharmacists, who work together with the patient's other doctors and provide extra layer of support. It typically improves quality of life, decreases patient's pain, and addresses physical, psychosocial and spiritual needs.
Melanie: So, what's the difference between palliative care and hospice care?
Dr. Vaghjiani: The term palliative care is often incorrectly used as a synonym for end of life care or hospice care. Unfortunately, even well-meaning doctors incorrectly mix these two treatment approaches. Palliative care often offers upstream symptom management. You can get curative treatment, along with palliative care. Hospice care is late stage terminal treatment, compassionately delivered by hospice agencies. Medicare does cover it, as a Federally funded program, and hospice programs help patients and families during the process of dying.
Melanie: So, do they have to give up their own doctor to work with a palliative care specialist? And, you mentioned that they can have curative treatment together with palliative care, so please tell us how that works together.
Dr. Vaghjiani: You do not have to give up any doctors that you have a relationship taking care of you. It is alongside with the specialists, your primary care and hospice care is a further downstream treatment that is also very great care that your patients and your families do need at the end of life.
Melanie: So, if somebody is in chemotherapy, palliative care is meant for symptom management for what, and how does it work? Is it medicational? Is it mental health and counselling? Is it nutritional? Explain the actual access of palliative care.
Dr. Vaghjiani: Palliative care specialists are specially confident in symptom and quality of life assessment. Complex symptom management, communication skills, social assessment, family-centered care and high quality of life. Just take for an example, oncologists, who are highly trained in treating cancer but might be less so in managing complex time-consuming psychosocial issues. We all know that cancer can sometimes be a very painful disease. Hematologists/oncologists often find complex pain management quite challenging and welcome additional expertise in the difficult yet vital area of pain management that is an ongoing concern with patients undergoing serious illness. It is certainly not meant to replace care already being provided by specialists. Palliative teams can also serve as an effective communication bridge between the specialist team and the patient. Patients may engage in different conversations with different clinicians. For example, focusing on cancer with the cancer specialist and the curative treatment while pain and psychosocial distress addressed by palliative care specialists. They often express and open up with the palliative care clinician rather than the specialist. The palliative care team provides an extra layer of support and works in partnership with your primary care doctors and specialists.
Melanie: So, who else besides the patient can benefit from palliative care? Is the family involved, doctor?
Dr. Vaghjiani: Yes. Absolutely. The family is involved and the family is part of this whole team. The goal is to improve the quality of life. By addressing and relieving symptoms, you can expect close communication and have more control over your care. The palliative care team will spend time talking, listening to you and your family. They will make sure you completely understand your disease, treatment options and your choices. The team will assist you with making medical decisions, as well as prognostic understanding with deeply exploring your personal goals, and then help you match those goals to the options. They understand and support your ability to cope with your illness. They might also make sure that all your doctors are coordinated and know and understand what you want. This gives you more control over your care. Your doctors and nurses benefit, too, because they know they are meeting your needs by providing care and treatment that reduces your suffering and improves your quality of life.
Melanie: Is there nutritional counselling involved, doctor, with palliative care? And, how would that work as far as nutrition and exercise as extra and palliative side-along care to whatever treatment somebody is going through?
Dr. Vaghjiani: This is one of the goals of quality of care. You do not stop doing the exercises that you would like to do. However, with a serious ongoing illness you might feel weak. You might have not done exercises for a while, so this is a great program which will guide you what is the level that you can start with and how far you can push yourself to do exercise. Nutritional support is also important. We give all that advice on nutrition supplements: what should be taken, what should be avoided. These are all advice that the nutrition as well as the palliative care team can take care of.
Melanie: And, where would somebody find palliative care? How do they go about the process of finding this type of care to go along with their treatment?
Dr. Vaghjiani: A little bit of background: back in 2000, less than one quarter of US hospitals with 50 or more beds had a palliative care teams. In 2015, larger hospitals, which is more than 300 beds, palliative care teams can be found in estimated 85% of hospitals. In 2006, hospice and palliative care medicine was recognized as an official medical subspecialty. There are greater than about 6500 physicians who are board-certified palliative care physicians, and more than 100 accredited fellowship trainee programs in the US. An example is the ASCO, which is an American Society of Clinical Oncology, recommended in 2012 that concurrent palliative care be offered to all patients with metastatic cancer and/or high symptom burden. Most insurance plans cover all or part of palliative care just as with other hospital and medical services. This is also true of Medicare and Medicaid. If costs concerns you, then a social worker or a financial consultant from the palliative care team can help you with payment options. This can be provided for while you are undergoing other therapy.
Melanie: In just the last few minutes, doctor, what would you like to tell people who are in need, or considering, palliative care?
Dr. Vaghjiani: I would say ask your doctor. Ask your doctor where you can find these services. They do also have services that are outpatient clinic settings. They also have settings where you can go have treatment at home. I would like to end by saying that we shall hold your hand and walk you through our comprehensive, supportive care. Enjoy your life, no matter how hard it may seem. When life gives you a thousand reasons to cry, show the world you have a million reasons to smile. Thank you.
Melanie: What a lovely sentiment. And, can you finish, please, by telling the listeners why they should come to Palmdale Regional Medical Centre for their care.
Dr. Vaghjiani: Palmdale Regional Medical Centre is a beautiful center. I am hoping that some of you have visited as visitors and certainly as patients. It has individual room settings, beautiful scenery and wonderful, hardworking staff that are there to give you compassionate, care for you when you are going through difficult situations and difficult, life-threatening illnesses.
Melanie: Thank you so much for being with us today. You're listening to Palmdale Regional Radio, Palmdale Regional Medical Centre. For more information you can go to www.palmdaleregional.com. That's palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Centre. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Palliative Care for Symptom Management
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 is important medical care that focuses on people who are seriously ill. It is meant to help patients get relief from their symptoms, pain and stress, whatever their diagnosis. My guest today is Dr. Manjula Vaghjiani. She's board-certified in palliative care and internal medicine and she's a member of medical staff at Palmdale Regional Medical Centre. Welcome to the show, Dr. Vaghjiani. What is palliative care or palliative medicine?
Dr. Manjula Vaghjiani (Guest): Thank you, Melanie. Palliative care is an essential component of serious illness care, much further upstream than from terminal care. It should be viewed as valuable care components for patients with cancer, dementia, end-stage chronic kidney disease, liver failure, neurological disorders like ALS, severe congestive heart failure and severe COPD. It's especially true for any patients going through rigorous therapy such as chemotherapy or radiation for metastatic cancer. This multidisciplinary approach is for symptom management, psychosocial support and assistance for treatment, decision making for patients and their families, with emphasis on well-being of patients and families at any point along the disease trajectory, regardless of their illness state. Palliative care does not refer to a particular place, or a specific stage of illness, but rather it describes the philosophy of care. It is provided by a specially trained of doctors, like me, nurses, social workers, chaplains, nutritionists and pharmacists, who work together with the patient's other doctors and provide extra layer of support. It typically improves quality of life, decreases patient's pain, and addresses physical, psychosocial and spiritual needs.
Melanie: So, what's the difference between palliative care and hospice care?
Dr. Vaghjiani: The term palliative care is often incorrectly used as a synonym for end of life care or hospice care. Unfortunately, even well-meaning doctors incorrectly mix these two treatment approaches. Palliative care often offers upstream symptom management. You can get curative treatment, along with palliative care. Hospice care is late stage terminal treatment, compassionately delivered by hospice agencies. Medicare does cover it, as a Federally funded program, and hospice programs help patients and families during the process of dying.
Melanie: So, do they have to give up their own doctor to work with a palliative care specialist? And, you mentioned that they can have curative treatment together with palliative care, so please tell us how that works together.
Dr. Vaghjiani: You do not have to give up any doctors that you have a relationship taking care of you. It is alongside with the specialists, your primary care and hospice care is a further downstream treatment that is also very great care that your patients and your families do need at the end of life.
Melanie: So, if somebody is in chemotherapy, palliative care is meant for symptom management for what, and how does it work? Is it medicational? Is it mental health and counselling? Is it nutritional? Explain the actual access of palliative care.
Dr. Vaghjiani: Palliative care specialists are specially confident in symptom and quality of life assessment. Complex symptom management, communication skills, social assessment, family-centered care and high quality of life. Just take for an example, oncologists, who are highly trained in treating cancer but might be less so in managing complex time-consuming psychosocial issues. We all know that cancer can sometimes be a very painful disease. Hematologists/oncologists often find complex pain management quite challenging and welcome additional expertise in the difficult yet vital area of pain management that is an ongoing concern with patients undergoing serious illness. It is certainly not meant to replace care already being provided by specialists. Palliative teams can also serve as an effective communication bridge between the specialist team and the patient. Patients may engage in different conversations with different clinicians. For example, focusing on cancer with the cancer specialist and the curative treatment while pain and psychosocial distress addressed by palliative care specialists. They often express and open up with the palliative care clinician rather than the specialist. The palliative care team provides an extra layer of support and works in partnership with your primary care doctors and specialists.
Melanie: So, who else besides the patient can benefit from palliative care? Is the family involved, doctor?
Dr. Vaghjiani: Yes. Absolutely. The family is involved and the family is part of this whole team. The goal is to improve the quality of life. By addressing and relieving symptoms, you can expect close communication and have more control over your care. The palliative care team will spend time talking, listening to you and your family. They will make sure you completely understand your disease, treatment options and your choices. The team will assist you with making medical decisions, as well as prognostic understanding with deeply exploring your personal goals, and then help you match those goals to the options. They understand and support your ability to cope with your illness. They might also make sure that all your doctors are coordinated and know and understand what you want. This gives you more control over your care. Your doctors and nurses benefit, too, because they know they are meeting your needs by providing care and treatment that reduces your suffering and improves your quality of life.
Melanie: Is there nutritional counselling involved, doctor, with palliative care? And, how would that work as far as nutrition and exercise as extra and palliative side-along care to whatever treatment somebody is going through?
Dr. Vaghjiani: This is one of the goals of quality of care. You do not stop doing the exercises that you would like to do. However, with a serious ongoing illness you might feel weak. You might have not done exercises for a while, so this is a great program which will guide you what is the level that you can start with and how far you can push yourself to do exercise. Nutritional support is also important. We give all that advice on nutrition supplements: what should be taken, what should be avoided. These are all advice that the nutrition as well as the palliative care team can take care of.
Melanie: And, where would somebody find palliative care? How do they go about the process of finding this type of care to go along with their treatment?
Dr. Vaghjiani: A little bit of background: back in 2000, less than one quarter of US hospitals with 50 or more beds had a palliative care teams. In 2015, larger hospitals, which is more than 300 beds, palliative care teams can be found in estimated 85% of hospitals. In 2006, hospice and palliative care medicine was recognized as an official medical subspecialty. There are greater than about 6500 physicians who are board-certified palliative care physicians, and more than 100 accredited fellowship trainee programs in the US. An example is the ASCO, which is an American Society of Clinical Oncology, recommended in 2012 that concurrent palliative care be offered to all patients with metastatic cancer and/or high symptom burden. Most insurance plans cover all or part of palliative care just as with other hospital and medical services. This is also true of Medicare and Medicaid. If costs concerns you, then a social worker or a financial consultant from the palliative care team can help you with payment options. This can be provided for while you are undergoing other therapy.
Melanie: In just the last few minutes, doctor, what would you like to tell people who are in need, or considering, palliative care?
Dr. Vaghjiani: I would say ask your doctor. Ask your doctor where you can find these services. They do also have services that are outpatient clinic settings. They also have settings where you can go have treatment at home. I would like to end by saying that we shall hold your hand and walk you through our comprehensive, supportive care. Enjoy your life, no matter how hard it may seem. When life gives you a thousand reasons to cry, show the world you have a million reasons to smile. Thank you.
Melanie: What a lovely sentiment. And, can you finish, please, by telling the listeners why they should come to Palmdale Regional Medical Centre for their care.
Dr. Vaghjiani: Palmdale Regional Medical Centre is a beautiful center. I am hoping that some of you have visited as visitors and certainly as patients. It has individual room settings, beautiful scenery and wonderful, hardworking staff that are there to give you compassionate, care for you when you are going through difficult situations and difficult, life-threatening illnesses.
Melanie: Thank you so much for being with us today. You're listening to Palmdale Regional Radio, Palmdale Regional Medical Centre. For more information you can go to www.palmdaleregional.com. That's palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Centre. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.