Palliative care is specialized medical care that helps to relieve the pain, treatment side effects and stress often caused by a serious illness.
Through its multidisciplinary, holistic approach for body, mind and spirit, palliative care focuses on quality of life for patients with a serious illness.
Dr. Michelle Cajulis, Summit Medical Group internist, shares the vital role palliative care plays in treatment for serious illness and how patients and their families can benefit.
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Palliative Care
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Before joining Summit Medical Group, Dr. Cajulis was Associate Chief of Hospital Medicine, Hospice Medical Director, Associate Director of Integrated Palliative and Hospice Care, and an associate attending physician in the Department of Medicine at St. Luke's - Roosevelt Hospital Center in New York City. She has practiced privately with University Medical Practice Associates in New York City. Dr. Cajulis has been a member of the St. Luke's - Roosevelt Pain Satisfaction Improvement Project, Palliative Care Committee, Hospital Flow Evaluation and Management Team, and Admission / Discharge Redesign Initiative.
Dr. Cajulis says, "I became inspired to be a doctor after watching my parents and grandmother care for their patients. Medicine is gratifying because it allows me to use my knowledge to care for others." She adds, "I believe that focusing on each patient as a whole person, with consideration for the life circumstances. I empower them with education about ways to manage their health."
A gifted teacher, Dr. Cajulis has been a faculty member for the St. Luke's - Roosevelt Integrated Palliative and Hospice Care Program and University Medical Practice Associates Primary Care Program. She is the course director for the St. Luke's - Roosevelt Medical Consult Core Curriculum Lecture Series. She has delivered local invited presentations on transition of care, palliative care, and end-of-life care.
When she is not working with her patients, Dr. Cajulis enjoys spending time with her family, traveling, reading, and playing the piano.
Michelle Cajulis, MD
Michelle, Cajulis, MD, specializes in internal medicine.Before joining Summit Medical Group, Dr. Cajulis was Associate Chief of Hospital Medicine, Hospice Medical Director, Associate Director of Integrated Palliative and Hospice Care, and an associate attending physician in the Department of Medicine at St. Luke's - Roosevelt Hospital Center in New York City. She has practiced privately with University Medical Practice Associates in New York City. Dr. Cajulis has been a member of the St. Luke's - Roosevelt Pain Satisfaction Improvement Project, Palliative Care Committee, Hospital Flow Evaluation and Management Team, and Admission / Discharge Redesign Initiative.
Dr. Cajulis says, "I became inspired to be a doctor after watching my parents and grandmother care for their patients. Medicine is gratifying because it allows me to use my knowledge to care for others." She adds, "I believe that focusing on each patient as a whole person, with consideration for the life circumstances. I empower them with education about ways to manage their health."
A gifted teacher, Dr. Cajulis has been a faculty member for the St. Luke's - Roosevelt Integrated Palliative and Hospice Care Program and University Medical Practice Associates Primary Care Program. She is the course director for the St. Luke's - Roosevelt Medical Consult Core Curriculum Lecture Series. She has delivered local invited presentations on transition of care, palliative care, and end-of-life care.
When she is not working with her patients, Dr. Cajulis enjoys spending time with her family, traveling, reading, and playing the piano.
Transcription:
Palliative Care
Melanie Cole (Host): Palliative care is a specialized medical care that helps to relieve the pain, treatment side effects, and stress often caused by serious illness. Through its multidisciplinary holistic approach for body, mind, and spirit, palliative care focuses on quality of life for patients with serious illnesses. My guest today is Dr. Michelle Cajulis. She’s a Summit Medical Group internist, here to share this vital role. Tell us about palliative care in treatment for serious illness and how patients and their families can benefit from it. Thank you so much for being with us.
Dr. Michelle Cajulis (Guest): No, thank you for having me, Melanie.
Melanie: Tell us a little bit about palliative care, what it is, and the difference between it and hospice care.
Dr. Cajulis: Absolutely. Palliative care is often mistaken for hospice care. Palliative care really focuses more on comfort measures while patients who have potentially chronic medical problems are going through a tough time in their lives. Palliative care does not mean that you are terminal. One of the differences between hospice and palliative care is that through hospice, you would be considered to have about six months prognosis or six months of life left, but with palliative care, there are no time restrictions. You can receive palliative care at any time. What palliative care focuses on is making sure that you have good symptom control during any stage of your disease. For example, making sure that you’re not having any pain, that your shortness of breath is controlled, that your appetite is good, that you are really trying to live as well and as best as you can while you are undergoing chronic diseases or you’re undergoing, for example, cancer treatments, things of that nature.
Melanie: When you discuss palliative care with people and they’re not necessarily terminally ill, this is just quality of life treatment, correct? Do people have trouble having this discussion with you?
Dr. Cajulis: Actually, it’s all about quality of life, and I think that once people hear palliative care, they automatically think hospice and think, “Oh my gosh! Am I going to die?” Absolutely not. I mean, there have been studies that have shown that when people who have lung cancer, for example, enroll in palliative care program, their life expectancy is longer than patients who are just undergoing normal, conventional treatment. Because palliative care does focus not only on the medical part, but on the spiritual part, on the psychosocial part, palliative care can be a very good support, not only to the patient, but to the family members, in helping them get through this difficult time.
Melanie: Is palliative care typically covered by insurance, Dr. Cajulis?
Dr. Cajulis: Yes, it is. Palliative care is covered by most insurance. Here at Summit Medical Group, we have a palliative care team run by Dr. Betty Lim and she is working with some other physicians, Dr. Profeta is one of them, and she has nurse practitioners and social workers. What we are doing right now is offering more of a community-based palliative care with also home visits for people who are homebound and it is covered through insurance.
Melanie: It is. Tell us about the medications because that’s another area of confusion for patients and their families when hearing about palliative care. Does it strictly involve pain medications? Or is it really a multidisciplinary holistic approach treating many different aspects including mental health and social support and family support?
Dr. Cajulis: No, it is a multidisciplinary approach. There is not only medications for pain so if someone is having pain then whatever narcotics or morphine will be used to help them treat the pain, but also there is spiritual counseling, helping with shortness of breath management, whether that be for someone, for example, with COPD, making sure of the correct inhaler dose, for someone who is undergoing cancer treatment to see if we can help with their appetite. Depression is another common symptom of patients who are chronically ill so this is also treated, again, with not only just medications but with also social and spiritual support.
Melanie: Now, tell us how that support comes in the form of helping the families. Because if somebody is very sick and whether they’re in a rehabilitation center or at home or in the hospital, how can palliative care help the family deal with this type of illness?
Dr. Cajulis: I think that one of the problems that family members have when their loved one is ill is feeling guilty of whether or not they are doing enough for that family member, and the palliative care team is there to support them through that. One of the other ways that palliative care could be helpful is that helping the patient and the family member discuss what the patient’s wishes are so that everybody is on the same page, because there are times especially when people are very sick that no one wants to talk about what the patient wants, how the patient would want to live the rest of their life. Palliative care can help collaborate with the families and the patients to help improve understanding and make people feel more comfortable about their goal or course of treatment.
Melanie: Can you have curative treatments together with palliative care or are they separate?
Dr. Cajulis: No, absolutely. With palliative care, you can still continue getting your chemotherapy and medication, getting all of your heart failure medication. That’s the one difference between palliative care and hospice. Under hospice, there are no curative therapies that are paid for, but under palliative care, you can still undergo curative treatments.
Melanie: Can you sort of graduate, Dr. Cajulis, from palliative care if you’re doing curative treatments and something is really working well for you? Whereas hospice, you’re not going to, it’s kind of something to do, but for palliative care, can you then get out of it and say, “Okay, I don’t need this anymore”?
Dr. Cajulis: Yes, we support people through the palliative care program as long as we’re needed. If someone is having uncontrolled symptoms that need to be addressed while they’re undergoing these chronic illnesses, then once the symptoms are resolved and once the patient, whether they are cured or they are feeling better, then they can graduate from palliative care. In various circumstances, people can actually graduate from hospice as well, not as common or not as frequent as with palliative care, but with palliative care, it is more of an overall evaluation of how you’re doing with constant reassessment, so you can do well on palliative care and have no more needs for the services. That’s what we try to do.
Melanie: Can you get it if you’re at home?
Dr. Cajulis: Yes. If you are homebound, the Summit Medical Group palliative care team will do home visits for you, but we also do palliative care consultations in our office for the patients who are able to get to the office.
Melanie: How does somebody begin, Dr. Cajulis? Is this something that if they’re in the hospital, that they have to request, or is it something that comes to them and you explain exactly what it is and how you can help them?
Dr. Cajulis: I think it’s a combination of patients requesting for palliative care evaluation. Also, more physicians are becoming more and more aware of palliative care and the benefits that it has towards their patient’s overall care. A lot of the physicians are requesting for palliative care consults as well. It definitely helps when the patients are informed and open to palliative care, but I think that it doesn’t necessarily have to be through the patient or it could be a family member, but it can also be through their primary care doctor. One of our goals is to really raise awareness through all physicians in general about their patients who are chronically ill who may benefit from palliative care.
Melanie: In just the last few minutes, Dr. Cajulis, tell us a little bit about Summit Medical Palliative Care and the multidisciplinary approach that you give families of people of severe illness.
Dr. Cajulis: Well, as I’ve mentioned, Dr. Lim is starting up the palliative care program at Summit Medical Group. She has physicians working with her. Dr. Profeta is one and there are three nurse practitioners who do not only outpatient visits or home visits, but they also round in some of the sub-acute rehab facilities in the area. One of the members of her team has a chaplaincy background so again that helps to address some of the spiritual aspects of palliative care. Through different referrals, we can help address symptoms, whether or not they are helping any uncontrolled pain or shortness of breath and help you guide through your current treatment, your chronic illnesses while you’re on palliative care.
Melanie: Thank you so much, Dr. Michelle Cajulis. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. You are listening to SMG Radio. This is Melanie Cole. Thanks so much for listening. Have a great day.
Palliative Care
Melanie Cole (Host): Palliative care is a specialized medical care that helps to relieve the pain, treatment side effects, and stress often caused by serious illness. Through its multidisciplinary holistic approach for body, mind, and spirit, palliative care focuses on quality of life for patients with serious illnesses. My guest today is Dr. Michelle Cajulis. She’s a Summit Medical Group internist, here to share this vital role. Tell us about palliative care in treatment for serious illness and how patients and their families can benefit from it. Thank you so much for being with us.
Dr. Michelle Cajulis (Guest): No, thank you for having me, Melanie.
Melanie: Tell us a little bit about palliative care, what it is, and the difference between it and hospice care.
Dr. Cajulis: Absolutely. Palliative care is often mistaken for hospice care. Palliative care really focuses more on comfort measures while patients who have potentially chronic medical problems are going through a tough time in their lives. Palliative care does not mean that you are terminal. One of the differences between hospice and palliative care is that through hospice, you would be considered to have about six months prognosis or six months of life left, but with palliative care, there are no time restrictions. You can receive palliative care at any time. What palliative care focuses on is making sure that you have good symptom control during any stage of your disease. For example, making sure that you’re not having any pain, that your shortness of breath is controlled, that your appetite is good, that you are really trying to live as well and as best as you can while you are undergoing chronic diseases or you’re undergoing, for example, cancer treatments, things of that nature.
Melanie: When you discuss palliative care with people and they’re not necessarily terminally ill, this is just quality of life treatment, correct? Do people have trouble having this discussion with you?
Dr. Cajulis: Actually, it’s all about quality of life, and I think that once people hear palliative care, they automatically think hospice and think, “Oh my gosh! Am I going to die?” Absolutely not. I mean, there have been studies that have shown that when people who have lung cancer, for example, enroll in palliative care program, their life expectancy is longer than patients who are just undergoing normal, conventional treatment. Because palliative care does focus not only on the medical part, but on the spiritual part, on the psychosocial part, palliative care can be a very good support, not only to the patient, but to the family members, in helping them get through this difficult time.
Melanie: Is palliative care typically covered by insurance, Dr. Cajulis?
Dr. Cajulis: Yes, it is. Palliative care is covered by most insurance. Here at Summit Medical Group, we have a palliative care team run by Dr. Betty Lim and she is working with some other physicians, Dr. Profeta is one of them, and she has nurse practitioners and social workers. What we are doing right now is offering more of a community-based palliative care with also home visits for people who are homebound and it is covered through insurance.
Melanie: It is. Tell us about the medications because that’s another area of confusion for patients and their families when hearing about palliative care. Does it strictly involve pain medications? Or is it really a multidisciplinary holistic approach treating many different aspects including mental health and social support and family support?
Dr. Cajulis: No, it is a multidisciplinary approach. There is not only medications for pain so if someone is having pain then whatever narcotics or morphine will be used to help them treat the pain, but also there is spiritual counseling, helping with shortness of breath management, whether that be for someone, for example, with COPD, making sure of the correct inhaler dose, for someone who is undergoing cancer treatment to see if we can help with their appetite. Depression is another common symptom of patients who are chronically ill so this is also treated, again, with not only just medications but with also social and spiritual support.
Melanie: Now, tell us how that support comes in the form of helping the families. Because if somebody is very sick and whether they’re in a rehabilitation center or at home or in the hospital, how can palliative care help the family deal with this type of illness?
Dr. Cajulis: I think that one of the problems that family members have when their loved one is ill is feeling guilty of whether or not they are doing enough for that family member, and the palliative care team is there to support them through that. One of the other ways that palliative care could be helpful is that helping the patient and the family member discuss what the patient’s wishes are so that everybody is on the same page, because there are times especially when people are very sick that no one wants to talk about what the patient wants, how the patient would want to live the rest of their life. Palliative care can help collaborate with the families and the patients to help improve understanding and make people feel more comfortable about their goal or course of treatment.
Melanie: Can you have curative treatments together with palliative care or are they separate?
Dr. Cajulis: No, absolutely. With palliative care, you can still continue getting your chemotherapy and medication, getting all of your heart failure medication. That’s the one difference between palliative care and hospice. Under hospice, there are no curative therapies that are paid for, but under palliative care, you can still undergo curative treatments.
Melanie: Can you sort of graduate, Dr. Cajulis, from palliative care if you’re doing curative treatments and something is really working well for you? Whereas hospice, you’re not going to, it’s kind of something to do, but for palliative care, can you then get out of it and say, “Okay, I don’t need this anymore”?
Dr. Cajulis: Yes, we support people through the palliative care program as long as we’re needed. If someone is having uncontrolled symptoms that need to be addressed while they’re undergoing these chronic illnesses, then once the symptoms are resolved and once the patient, whether they are cured or they are feeling better, then they can graduate from palliative care. In various circumstances, people can actually graduate from hospice as well, not as common or not as frequent as with palliative care, but with palliative care, it is more of an overall evaluation of how you’re doing with constant reassessment, so you can do well on palliative care and have no more needs for the services. That’s what we try to do.
Melanie: Can you get it if you’re at home?
Dr. Cajulis: Yes. If you are homebound, the Summit Medical Group palliative care team will do home visits for you, but we also do palliative care consultations in our office for the patients who are able to get to the office.
Melanie: How does somebody begin, Dr. Cajulis? Is this something that if they’re in the hospital, that they have to request, or is it something that comes to them and you explain exactly what it is and how you can help them?
Dr. Cajulis: I think it’s a combination of patients requesting for palliative care evaluation. Also, more physicians are becoming more and more aware of palliative care and the benefits that it has towards their patient’s overall care. A lot of the physicians are requesting for palliative care consults as well. It definitely helps when the patients are informed and open to palliative care, but I think that it doesn’t necessarily have to be through the patient or it could be a family member, but it can also be through their primary care doctor. One of our goals is to really raise awareness through all physicians in general about their patients who are chronically ill who may benefit from palliative care.
Melanie: In just the last few minutes, Dr. Cajulis, tell us a little bit about Summit Medical Palliative Care and the multidisciplinary approach that you give families of people of severe illness.
Dr. Cajulis: Well, as I’ve mentioned, Dr. Lim is starting up the palliative care program at Summit Medical Group. She has physicians working with her. Dr. Profeta is one and there are three nurse practitioners who do not only outpatient visits or home visits, but they also round in some of the sub-acute rehab facilities in the area. One of the members of her team has a chaplaincy background so again that helps to address some of the spiritual aspects of palliative care. Through different referrals, we can help address symptoms, whether or not they are helping any uncontrolled pain or shortness of breath and help you guide through your current treatment, your chronic illnesses while you’re on palliative care.
Melanie: Thank you so much, Dr. Michelle Cajulis. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. You are listening to SMG Radio. This is Melanie Cole. Thanks so much for listening. Have a great day.