Maggie McKay (Host): We hear the term palliative care, but how much do we know? Like how does it help manage symptoms for cancer patients and more? Today we'll find out with Palliative Care Nurse Practitioner, Colleen Taylor. Welcome to Wellness First, a St. Joseph Hospital podcast, where we hear and learn directly from the experts on all things health and wellness. I'm Maggie McKay. Welcome, Colleen. It's so great to have you here.

Colleen Taylor, APRN, FNP-C: Thanks so much, Maggie, I'm happy to be here.

Host: So, let's just start off with, is there a difference between palliative care and hospice? Because I know I get those mixed up and a lot of other people do.

Colleen Taylor, APRN, FNP-C: Yes, so that's a very common question that I get asked a lot of times. Palliative and hospice are used interchangeably, but there is a significant difference. So with hospice, as a lot of people think of it; it's for end of life care, focusing on comfort, no longer going through curative treatment regardless of what the diagnosis is and that's generally something that you receive in your home from a team or at a facility such as a hospice house.

Palliative care, while we do palliate symptoms or manage symptoms similarly to hospice, this can be done while you're still going through curative treatment or while you haven't decided if you want to go forward with hospice, if you still want to continue seeing specialists for any chronic life limiting illnesses you may have.

Host: So your doctor doesn't decide for you. You have the choice?

Colleen Taylor, APRN, FNP-C: Correct, yes. As with anything in healthcare, the patient should be the driver, and especially in palliative care, that is something we really encourage. Our job is to help facilitate goal setting with patients.

Host: Colleen, what is the goal of palliative care?

Colleen Taylor, APRN, FNP-C: The goal is really to allow patients to live with the best quality of life while they're going through whatever treatments they may be going through. We want to make sure that they're able to enjoy time with their family, enjoy going out and going on trips, going out and eating the foods that they most love, you know, seeing their children, grandchildren, and not have to be taken away from that by symptoms that are really bothersome and don't allow them to leave the home.

Host: Colleen, you mentioned patients who are on curative therapy. Would they benefit from palliative care?

Colleen Taylor, APRN, FNP-C: Yes, they would benefit greatly from palliative care. A lot of treatments that are provided for patients, whether it's curative or to extend life, come with side effects. Specifically with cancer treatments, the big ones are nausea, vomiting, you can have diarrhea, and nerve issues where you have numbness, tingling, pain in the hands and feet.

And what we do is through various modalities, help manage those symptoms so that even if they're not fully gone, patients get relief and can actually live their life without being hampered by these things.

Host: Colleen, what types of modalities do you use for symptom management?

Colleen Taylor, APRN, FNP-C: Well, the most well known you know, when you think of going to see a medical provider is, of course, pharmacologic or prescription medications. There are multiple options that we have for managing any symptom with regular prescription or over the counter medications. Less well known are what we call complementary therapies, although I think many patients may be even more familiar than some medical providers. Because there's a lot of information on using things such as herbal remedies, teas, massage, and of course, we don't perform massage here in palliative care, but we'll make recommendations on where to go for that type of massage. We have connections out in the community.

Same with acupuncture or acupressure. There's been a lot of data, especially for acupuncture for a myriad of health conditions and symptoms from treatment such as chemotherapy. So we're not boxed in by Western medicine standards.

We really try to think outside the box when it comes to providing symptom control and helping to make people feel better.

Host: You mentioned chemotherapy. What are the top three chemo side effects that you manage?

Colleen Taylor, APRN, FNP-C: So I would say nausea, vomiting, diarrhea, those are the big ones. There's also like the fourth one would be what we call neuropathy, which is that nerve damage that can occur from chemo and it can cause primarily pain, numbness in the hands and feet.

Host: And Colleen, what does palliative care assist with other than symptom management?

Colleen Taylor, APRN, FNP-C: So, as I alluded to earlier, we assist with goals of care, and what that means is we start talking about what are the long term goals. So not just while you're on this chemo regimen or while you may be on this current treatment regimen for a chronic disease, but what do you hope to gain from it, and talking about if things don't go the way that we hope, what would you want to focus on most for your care? So, would you want to look at trying to gain more time with your family through certain treatments that are not first line? Would you want to focus on quality of life, which can then lead into discussion on is there a point that you would prefer to transition to hospice care?

The other service we provide is advanced care planning, which is slightly different. Patients may have heard their primary care providers ask them if they have what's called an advanced directive or durable power of attorney for health care. Especially since it is an initiative that the Centers for Medicare are really looking to push and so are we here at St. Joseph.

It's a really important document. I call it a gift to your family. It is you explaining what your wishes would be for your care if you are no longer able to communicate with your medical providers or make decisions for yourself. So things like, would you want to be on any form of life support, like with a feeding tube or a tube going down into your lungs to breathe for you.

And also, who would you want to make decisions on your behalf? And that can be anybody that's close to you and that you can, that you feel you can have those conversations with. And, the difference with palliative care is we actually will go through those documents with the patient, have those discussions, we usually like to have the person that they would choose to make decisions for them come in for that visit, and we fill out the paperwork there at the visit, and we have a notary come in and notarize the paperwork so they don't have to go home and have homework that they have to try and remember to do. Because when you're going through a stressful illness, you already have so many things to think about. We try to make it easier on people.

Host: You know, it's such a personal decision and everybody's different and it, the conversation doesn't get more real than this topic and end of life and your wishes. And I think it is so useful that at St. Joseph, you do that for patients. Because like you said, it's such a stressful time. And that's the last thing you, it's overwhelming, seriously.

Like my husband and I did it even though nobody was ill, because we are on totally opposite sides of the spectrum. He's like, the second I'm sick, just let me go. And I'm like, you keep me going for 20 years if you can. Not really, but you know what I'm saying? I mean, there's so many ways to go and you've got to have that in order.

And like you said, it's a gift to your family because if they're left with it and have no idea what you wanted, that's a tough spot to be in. So in closing, Colleen, is there anything else you'd like people to know about palliative care?

Colleen Taylor, APRN, FNP-C: We are here to support you in whatever decisions you want to make. We're not here to make decisions for you. So if you do want to be kept alive for 20 years, I want to help support you in the best way that I can. If you are one of those people that's like, Hey, if I'm going bye, just let me go, I want to support you. And then anywhere in between. We are not here to push. We are not here to put our own feelings into the matter. We just want to help our patients reach their goals for their care.

Host: That's amazing. Well, thank you so much for sharing your expertise on this very important topic. We appreciate you and the work you do. I mean, have always thought the few times I have met people in my life who do this work, that you are angels.

Colleen Taylor, APRN, FNP-C: Thank you. I really appreciate it. And I really love what I do. It's very, very rewarding.

Host: You must, well, keep it up. Again, that's Colleen Taylor. To find out more, please visit stjosephhospital.com/services/palliative-care. 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, thanks for listening.

This is Wellness First, a podcast from St. Joseph Hospital.