Transcription:
What is Palliative Care?

Bill Klaproth (Host): Do you know the difference between palliative care and hospice? With us is Donna Butler, a nurse practitioner at Schneck Medical Center. Donna is certified in oncology, advanced hospice and palliative care nursing and a fellow of the American Academy of Pain Management. Donna, thank you so much for being on with us. So, let's start with the general definition of palliative care.

Donna Butler (Guest): Okay. Palliative care is a comprehensive medical treatment for the discomfort and symptoms related to any type of serious or chronic illness. It's provided alongside other medical care to treat symptoms that a patient may experience and to improve their quality of life.

Bill: So, this would take the place of being in the hospital? So, this is more for long-term patients with serious complications?

Donna: It may take the place of being in the hospital. Our care is provided in the out-patient clinic. We also see patients as consults in the in-patient arena. Our focus is primarily on providing patients and their families with the support they need for symptom control such as pain; it may be for nausea, vomiting, anxiety or depression that is related to their chronic health problems.

Bill: So, when is the decision made that somebody is a good candidate for palliative care?

Donna: Any time the patient or their physician feels that they are having symptoms, either physical, emotional, social, or spiritual symptoms that are interfering with their quality of life and the patient has any type of chronic health problem.

Bill: So, people in palliative care, then, in general, have serious injuries or chronic conditions but, with the right care, can and eventually will recover?

Donna: Well, we see patients who may have chronic health problems such as COPD, heart failure, cancer and these folks can have a lot of symptoms either related to the disease itself, or sometimes the treatment. And so, what our palliative care team does is we see those patients, provide them the extra layer of support they need in order to treat those symptoms so that they are able to continue the care for their chronic illness. We also focus a lot on helping patients with care coordination because with chronic illness, people are dealing with these symptoms for months to years. So, our services are able to provide the patient and their family with that support in helping with coordination of care, helping them also with choices in treatment to give them that support they need.

Bill: So, palliative care, then, can be a long-term commitment to a patient's health, then? It's not just "Okay, three weeks and you're out." This can be, as you mentioned, years long?

Donna: Absolutely. Our team is not only made up of nurse practitioners but we have social workers, chaplains, and psychologists on our team so that we can provide those services that a patient needs according to what symptoms they have--whether it be physical symptoms, emotional, or psychological symptoms, or spiritual or social concerns.

Bill: So, it's a whole team in charge of the care of the patient. Speaking of the team, does the team work with the patient's physician?

Donna: Yes, we do. We don't replace their family doctor or their specialist. We're kind of an extra layer of support in providing that symptom control and helping them with even understanding, educating them on their condition and their disease trajectory.

Bill: So, it sounds like the palliative care team is in charge of the patient's care plan, then?

Donna: Well, we support. We provide care along with their physician. We don't replace their physician. So, we kind of walk side-by-side with their medical doctors to provide the symptom support while they're receiving treatment for whatever chronic disease they have.

Bill: Okay and then, you talk with the patient's family members as well? You interface with them?

Donna: Correct. Our focus and the unit of care for our patients is the patient and their family.

Bill: Oh, so you're counseling and helping the family through this as well, then?

Donna: Right.

Bill: So, does it matter how old you are when it comes to palliative care? Is it just for elderly people or can it be any age?

Donna: It can truly be any age. The only requirement is that somebody has some type of chronic illness that's causing symptoms that are interfering with their quality of life.

Bill: And I'm just thinking in my head, so you said out-patient clinics, but it sounds like some patients are at home but do you go into their home for their care or do they come to see you? How does that work?

Donna: Patients do come to our outpatient clinic. We have a clinic that's located in the cancer center here at Schneck Medical Center. Our nurse practitioners also will make some house calls on patients if they're just functionally not able to come into the clinic.

Bill: And does insurance generally pay for palliative care?

Donna: Insurance typically pays on a fee-for-service based on the care that we're providing. So, it would be very similar to any other physician visit.

Bill: So, you talked about the whole team earlier. Could you just kind of briefly tell us again, who makes up the members of a palliative care team?

Donna: Okay. Here at Schneck Medical Center, we have a medical director, Dr. David Hartung. He's our medical director. We have two nurse practitioners, myself and Anita Collins who are both certified nurse practitioners. We also have a social worker, Leanna Crenshaw, and Steve Barrett is our chaplain. We have a psychologist, Dr. Erin Bannister that provides psychological counseling for our patients. We also have two R.N.'s-- one that works in hospice and so she acts as kind of the liaison, or a go between palliative care and hospice--and we also have an R.N. that works in oncology or in cancer treatment, and she works alongside us to support the patients in the cancer center.

Bill: So, the difference between hospice and palliative care is hospice is end-of-life needs and palliative care is just providing a quality of life as that person struggles with a chronic illness or condition?

Donna: Correct. Palliative care actually started in the hospice movement because it's all about symptom control and quality of life. Hospice care is more focused on those final months of a person's life, where palliative care can begin at any point in their chronic illness.

Bill: And then, who initiates that? Does the physician suggest palliative care or is it the family that inquires about it first?

Donna: We have both. Our physicians locally refer regularly to palliative care but patients and their families, if they hear about palliative care, can also let their physicians know that they would like to be seen by palliative care.

Bill: And, Donna, is there anything that we need to know about palliative care that I haven't asked you?

Donna: You just have to remember that palliative care really supports the patient and their family throughout many symptoms that they may need support and to provide them with that quality of life, that ability to live their life, spend time with their families and support them through that chronic health journey.

Bill: Donna, why should someone choose Schneck Medical for their palliative care needs?

Donna: Well, at Schneck Medical Center, we have a wonderful experienced palliative care program. Our team works very closely with the patients. We have a good working relationship with the medical community to support these patients in their journey.

Bill: Donna, thank you so much for your time today. For more information, visit schneckmed.org. That's schneckmed.org. This is Schneck Radio. I'm Bill Klaproth. Thanks for listening.