Hospitals starting to adopt palliative care

Hospitals starting to adopt palliative care
By Jill Coley (Contact)
The Post and Courier
Sunday, October 26, 2008

As her husband's health problems compounded — a kidney transplant, heart issues and a broken hip — Susan Kelley told the increasing cadre of doctors, "We are going to handle it."

When his primary doctor mentioned "palliative care," she flat-out refused. Susan Kelley equated the phrase with hospice. "You only have two weeks to live, and hospice comes in," she said. "(But) it wasn't like that at all."

Palliative care used to be synonymous with hospice but has grown over the years to include comfort care for anyone with a serious illness. Hospital-based programs are not the same as hospice, in which patients have a life expectancy of six months or less.

Recipients of palliative care do not have to be dying and can continue to receive curative treatments, such as radiation and chemotherapy. The focus of palliative care is the control of pain and symptoms while preserving quality of life. A multi-disciplinary team addresses physical, emotional and spiritual issues patients and families may have.

About six years ago, Susan Kelley gave her husband one of her kidneys, an operation that went well, she said. But in 2006, his health began to grow precariously complex. Heart issues surfaced, requiring a pacemaker and defibrillator. "He was talking to me and dropped — twice," she said.

In October, when Bob Kelley fractured his hip, they finally agreed to meet with the Roper St. Francis palliative care team. Doctors, nurses, social workers and chaplains availed themselves to the Kelleys and directed them to even more resources.

"They shore you up mentally. As a wife you can breathe again," Susan Kelley said.

A study published in the October Journal of Palliative Medicine said South Carolina is in need of greater access to palliative care. Only 13 out of the state's 44 mid- and large-size hospitals offer programs.

Researchers gave South Carolina a "D" grade for access to hospital-based palliative care. And that need is only expected to increase as baby-boomers get older, living longer with chronic diseases.

Local hospitals, meanwhile, are focussing more on palliative care programs.

The Roper St. Francis Palliative Medicine Consultation Service performed 97 consults in 2005, its first year. This year, the program will top 600 consults, said program Director Lynn Brennan.

Medical University of South Carolina's program also has seen tremendous growth since it began five years ago, from 64 consults its first year to 760 for the fiscal year ending June 30, 2008, said Winnie Hennessey, program manager for palliative care and pain management.

The primary tool of the palliative care team is the family consult, said Dr. R. Scott Lake, medical director of the Roper St. Francis palliative care team. "We ask the family spokesperson or patient, 'What do you understand about the disease?'" Lake said. "That way we can meet the family where they are. We have met some that don't understand what's going on at all."

Hennessey, who has a doctorate in nursing with a specialty in palliative care, said, "Surgeons have a knife. Our tool is conversation. Our procedure is the family meeting."

Marti Anderson met with the Roper team after her 88-year-old mother broke her hip twice within one month. "It's like a hail storm, there's so much coming at you," the former social worker said. "Dealing with so many doctors, you need someone with a comprehensive view of the case."

Team members gather weekly to share notes on patients and navigate the complex family dynamics. Ethical dilemmas arise for patients — will stopping dialysis be tantamount to suicide — and for doctors — could de-activating a pacemaker be construed as assisted suicide.

Dr. Angus Baker, a palliative care physician consultant with Roper St. Francis, said, "When a family makes a decision we worry about, we still respect it."

While reducing cost is not the purpose of palliative care, savings can be a side effect. MUSC's program saved the institution more than a $1 mil lion last year, Hennessey said. Roper's palliative care team is estimated to have saved $2 million in 2007, Baker said.

"Doing the right thing happens to save money," he said.

Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.

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