The Overlake Hospital Foundation has received a $150,000 grant from the Regence Foundation to implement a hospital-based palliative care program at Overlake Hospital Medical Center. Palliative care is a medical specialty geared toward helping seriously ill patients find relief from the symptoms of their disease.
The Regence grant will help Overlake implement its palliative care program, planned with the help of foundation-provided training from the Palliative Care Leadership Center (PCLC) and a financial grant in 2010. PCLC is a national training and mentoring initiative to help hospitals start and expand high-quality palliative care programs.
“The Regence Foundation’s grant enables us to implement a Palliative Care Consult Service for patients and their families coping with advanced illness and in need of symptom management,” said Cathy Whitaker, vice president of patient care services at Overlake.
She estimated about 200 patients a year would benefit from the service, delivered by physicians, nurses and support staff including social workers, chaplains, pharmacists, care management and physical therapy.
Thursday, February 24, 2011
Overlake gets grant to implement palliative care - Bellevue Reporter
Discussing cancer treatment with the terminal patient
by Bruce Campbell, MD
For everything, there is a season…
- Ecclesiastes“Are you giving up on me?” My patient looks at me severely. “There must be other treatment options! Aren’t there some experimental drugs out there? I have beaten this cancer twice before. Are you saying that I can’t beat it again?”
No one can ever know with absolute certainty whether my patient’s newly recurrent cancer might miraculously disappear with one more treatment. His recurrence, however, has developed very quickly and is growing very rapidly. New cancer nodules are developing weekly. I have never seen a patient with a cancer this aggressive have a meaningful, sustained response to further treatment. The research literature confirms my impression.
It is always difficult to know what to recommend. Although “no further treatment” is always an alternative, I routinely run through all of the options, reviewing whatever is available, and hoping that we land on the combination that offers that improbable, one-in-a-thousand cure. However unlikely, we sometimes set up appointments and hope for the best.
Today, though, my sense is that it is time to focus on new goals.
The decision not to pursue more studies and more treatment can be very, very difficult. Surgeon and journalist Atul Gawande in an essay in The New Yorker entitled “Letting Go,” writes about how difficult it can be for physicians and patients to halt cancer treatment as the end of life draws near. The dilemma, he concludes, “arises from a still unresolved argument about what the function of medicine really is — what, in other words, we should and should not be paying for doctors to do.” In Gawande’s view, the profession should equip and supply doctors and nurses “who are willing to have the hard discussions and say what they have seen …”
In most circumstances, this moment might be the first occasion that the patient hears a physician say clearly, “I do not think we should continue with the cancer treatment. It is time to stop focusing just on the cancer and spend more of our effort focusing on the rest of you.”
Those are very difficult words to say. On the other hand, I cannot begin to imagine what it must be like to hear your physician utter them.
At some point, the topic of stopping cancer treatment must be approached clearly and compassionately. An essay by Albert Lim, MD, sent to me by a patient, reminds us that physicians often avoid these difficult discussions. We push on with futile treatments and expensive tests because “it is difficult to say ‘no’ in today’s world.” Coupled with our own doubts, the patient and family sometimes want us “to do something, anything, everything.” There are situations where we need to learn to think through the choices and then choose to do nothing.
A recently published article might help me navigate these difficult discussions in the future. Dr. Jennifer Temel and other cancer physicians at Massachusetts General Hospital followed two groups of patients who were suffering from advanced, uniformly fatal lung cancer. One group received “standard” cancer care with chemotherapy and aggressive treatment. The other group was offered the “standard” care but also met very early on with the Palliative Care team. Overall, the Palliative Care group went on to have less intense treatment, less futile cancer treatment near the end of life, an overall better quality of life, and significantly less depression. They were more likely to have talked with their relatives about their end-of-life wishes.
Surprisingly, the Palliative Care group, despite receiving less intense cancer treatment, also lived a bit longer! For this group of incurable cancer patients, less aggressive care actually resulted in longer and higher quality survival.
As the conversation wraps up, my patient reviews all of his options. His previous therapy was difficult and he is not interested in spending any more time at the hospital than absolutely necessary. He and his family go back and forth. Finally, they all decide against any further cancer treatment. They will continue the conversation at home.
I am relieved. He has made what I consider to be a good choice and appears to be at peace with the decision. The most difficult decision he and his family have ever had to make had, in the end, been simple. The time had arrived.
Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.
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Tagged as: Cancer, Specialist
Tuesday, February 22, 2011
Palliative care prolongs life, reduces suffering
-->Palliative care prolongs life, reduces suffering
1 | 2 Next Page »There are no secret passwords in medicine, no mysterious handshakes or signals to use when seeking the best care for a serious illness.
But experts say two words come close: palliative care.
Many people have never heard of palliative care, a comprehensive service that aims to relieve suffering in people with serious illnesses, such as cancer, lung disease or kidney failure.
Some patients — and even many doctors — confuse palliative medicine with hospice, a form of palliative care for people in the last six months of life. Other patients mistakenly worry that doctors won't work as hard to cure them if they ask for palliative care, says Gail Cooney, former president of the American Academy of Hospice and Palliative Medicine.
Those notions could change in light of recent research.
A study of 151 patients published last summer in The New England Journal of Medicine showed that getting early palliative care — in addition to regular medical treatment — helpedpeople with lung cancer live three months longer, compared with those given standard care.
In comparison, chemo can give newly diagnosed lung cancer patients an extra two to three months of life, says study co-author Thomas Lynch, director of the Yale Cancer Center.
"If this was a drug, this would be on the front page of every paper in the country, talking about 'New advance in lung cancer,' " Lynch says.
But palliative care patients didn't just live longer. They also lived better, with less depression and a higher quality of life, he says.
Tailored to the patient
It's never too early to ask about the service, doctors say.
People can begin palliative care as soon as they're diagnosed with a serious illness, even if they still hope to be cured, says Thomas Smith, medical director of palliative care at Virginia Commonwealth University's Massey Cancer Center in Richmond.
Teams that provide palliative care focus on talking to patients, trying to understand people's values and tailor care to the patients' goals, Cooney says.
These teams — which often include psychologists, social workers, pharmacists, nutritionists and chaplains — also coordinate treatment, which can be especially important if people are being seen at more than one center, says Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
The teams also support caregivers, who have a critical role in patients' health.
'People need to ask for it'
Because of her work, Cooney knew to ask for palliative care when she was diagnosed with advanced ovarian cancer nearly three years ago.
"I wanted it all," says Cooney, 58, who's also the assistant medical director of Hospice of Palm Beach County in Florida. "I received very aggressive chemo. But I used a program of palliative care to control my symptoms and allow me to tolerate the chemo."
In addition to undergoing surgery and chemo at a hospital, Cooney sought palliative care through an outpatient center, the Sari Asher Center for Integrative Cancer Care in Palm Beach.
Though about 80% of large hospitals offer some kind of palliative care, there are fewer ways for patients to get support outside the hospital, where cancer patients today receive much of their care, Cooney says.
She used both acupuncture and conventional drugs to avoid nausea and felt well enough to indulge in milkshakes to keep up her strength and weight.
Palliative care helped with many aspects of cancer therapy, which put her in remission for two years, Cooney says.
She joined an ovarian cancer support group, received one-on-one counseling with an oncology social worker and met with a nurse educator to better understand the many drugs she was taking.
After her cancer began growing again last fall, Cooney resumed intravenous chemo and hopes for a good response.
Cooney says she wishes that more patients and their caregivers knew to ask for palliative care. "People think, 'My doctor will ask if I need it,' " Cooney says. "But people need to ask for it. It can be tough to challenge a doctor. But if people begin asking and advocate for themselves, generally doctors will say OK."
Saving money
Palliative care also could help cut spiraling medical costs, Smith says. Studies show it can save hundreds of dollars a day, keeping patients out of the hospital or expensive intensive-care units.
Kaiser Permanante, an integrated system in which the same company operates hospitals and insurance plans, found that people cared for by a palliative team live just as long as or longer than others and had fewer symptoms.
Their caregivers also experience a lighter burden because the programs address their needs as well, Smith says.
"No death panels here — exactly the opposite," he says.
In spite of these benefits, palliative programs struggle to reach everyone who might need them, Smith says. That's because few health systems are as coordinated as Kaiser, he says.
The bottom line
In most cases, the cost savings from palliative care are spread throughout the system — saving money for Medicare, for example — instead of returning money to individual hospitals or programs, Smith says. So in the short term, individual hospitals may lose money, even if the country overall saves money.
"It would be terrific to have more family support, more chaplain support," he says. "Most programs don't have any way to pay for that."
The Massey Cancer Center pays for a psychologist partly by reducing physician salaries, Smith says. His team also does fundraising to pay for a chaplain, who he says "is critical to help people come to terms with their illness and often the end of life."
Without enough resources for everyone, palliative care programs often give first priority to people with advanced or fast-moving cancers, such as pancreatic tumors, Byock says.
"Even the most robust palliative care programs have limited resources," he says. "If someone has a serious diagnosis and they have only the 'ordinary' level of stress, we'd likely not see them."
But patients shouldn't give up.
"It really does take one-on-one advocacy," Byock says. "You have to be savvy enough to ask for it. Just say, 'We want the best care for our loved one.' "
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Monday, February 21, 2011
What's the Reason You Want to be a Hospice Volunteer?
When this student was asked why he wanted to take the hospice volunteer training, the reply was
I want to help others that are facing the end of life, or a loved ones life, find the peace and comfort that a hospice team helped me find.
It is wonderful to have a program that can be utilized for hospice volunteer training and now, after a couple of years, I continue to be in awe of the wonderful people who participate in the training. It is obvious with every answer that we are surrounded by people who want to be of service.
CM said, "The video on caregiving was the most valuable to me. It provided much insite into the lives of actual caregivers and their needs."
Whether it's a personal goal or a professional one, each potential volunteer presents awesome reasons for volunteering and great feedback for the most important aspects of the course.
As we begin our goodbyes to winter, there are still a few cool evenings to log in and begin training so you can find your reason for volunteering. Somebody is waiting just for you.
http://volunteertrainingonline.com/courses
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