Improving Patients’ Quality of Life through Palliative Care
A 69-year-old man* has been receiving dialysis at Penn State Health St. Joseph for five years. He’s recently experienced an increasing number of hospital stays due to infections and other problems.
Understanding the seriousness of his condition, the patient is understandably anxious and distressed. He is not eating well and has very limited mobility. The patient is nearing the end of options for curative medical treatment, an idea that his family cannot comprehend.
For this patient, palliative care is a sound and viable option.
A 56-year-old woman* is admitted to Penn State Health St. Joseph after suffering a major stroke while at work.
Her recovery is slow, complicated by issues concerning nutrition, mobility and expectations of the patient and her family.
Despite difficulties, the patient does slowly recover and rehabilitation goals are made. Once medically stable, she is discharged to a rehabilitation facility.
During this extreme crisis, the Palliative Care Team helps the patient and her family with coping, education and other means of support. As a result, treatment is enhanced and the comfort and condition of the patient is improved.
Palliative care is a complex and often misunderstood medical specialty that plays an important role in caring for patients who suffer from serious illnesses. Members of the palliative care team at Penn State St. Joseph also address the needs of patients’ families, working to improve quality of life as much as possible.
“We work as a team to address some of the most complex cases at the hospital,” said Deborah Nicholson, palliative care navigator at St. Joseph.
Palliative care, according to Nicholson, helps those suffering a serious illness or chronic disease to lead a better life. It is not hospice care, or just for patients who are nearing the end of their lives.
Palliative care specialists work in conjunction with other providers, often as patients undergo medical treatment that is meant to cure them. At least 50 percent of palliative care patients move on from the hospital to a rehabilitation center, residential health care facility or return home.
Studies have shown that patients who receive palliative care in combination with treatment that is meant to cure live longer than those who do not. A palliative care team works along with the patient’s primary physician and other specialists.
“We say that the whole hospital is part of our palliative care team,” Nicholson said.
St. Joseph’s palliative care team includes physicians, nurse practitioners, rehabilitation specialists, registered dieticians, chaplains, nursing educators, pharmacists, home health managers and representatives of St. Joseph’s outpatient cancer center.
Members of the team meet weekly to discuss patient care and any challenges they may be facing.
The hospital recently began an outpatient palliative care clinic for oncology patients. Dr. Teresa Mercurio, a palliative care provider, sees patients at the clinic each Wednesday. In addition to medical care, palliative care providers deal with social and financial issues, living wills, discharge plans, family dynamics, spiritual care, pain and other symptom management, home care and many other topics.
A patient must be referred to palliative care by his or her physician.
“We get requests for consults from all areas of the hospital,” Mercurio said. “We work with every medical specialty and subspecialty and discipline to provide the best possible care for patients.”
Members of St. Joseph’s palliative care team spend much of their time getting to know, and talking with patients and their families.
The goal, said Stacey Hittner, a nurse practitioner who works in palliative care, is to help patients set goals and establish answers to some very important questions, such as “What is your understanding or your condition?” and “How do you want to spend your time if your health worsens?”
Having patients and their loved ones think about these types of issues in advance of a crisis is advantageous to everyone.
“If we can get patients and their families to make these decisions before a time of real emergency, then they do not have to make decisions in a vacuum or during a time of the worst anxiety they’ll experience,” Hittner explained.
Dr. Trina Abla, a hospitalist who serves as medical director of St. Joseph’s palliative care program, said that, as a physician, her goal is to help patients recover from a serious illness. Sometimes, however, that is not possible.
In either instance, palliative care can play an integral role in keeping patients comfortable and helping them to achieve their goals. “Our intent certainly is to cure illness, but we also want to alleviate suffering in the event that there is no cure,” Abla said. “Palliative care can help with both of those goals.”
* The patient scenarios portrayed in this article do not represent actual patients, but a compilation of cases the palliative care team has treated.