Palliative care brings comfort
Courtesy The Denver Hospice, East Denver LIVING WELL Magazine
Mitch Todd sits quietly with a patient who was recently diagnosed with a serious illness. Other family members are there, too. He listens.
“I spend time with my patients and their families to find out who they are, what their fears are and to understand their concerns,” says Todd, a social worker with The Denver Hospice’s 8-year-old Pathways Palliative Care program. “A lot of times I find that people don’t want to challenge the healthcare system so I’m also there to help them through the process.”
Palliative care is specialized medical care for people with serious illnesses. This relatively new field of medicine focuses on providing patients with relief from symptoms, pain and stress of a serious illness––whatever the diagnosis.
The goal of palliative care is to improve quality of life for both the patient and his or her family. Palliative care is provided by a team of doctors, nurses and other specialists who work with a patient’s other doctors to provide an extra layer of support.
“Palliative care primarily focuses on symptom management such as pain, increasing fatigue and weakness or gastro-intestinal problems and stress,” says Dr. David Koets, chief medical officer for The Denver Hospice. “But it also helps a patient determine what’s important for him or her. And at times, even more importantly, it addresses the psych-social dynamics that come into play when people are ill.”
Palliative care is appropriate at any stage in a serious illness, and can be provided together with curative treatment. Throughout the continuum of the illness, palliative care addresses physical, emotional, social and spiritual needs. Palliative care improves quality of life by reducing unwanted treatment and repeat hospitalizations.
Koets says palliative care begins with a full assessment by a physician or nurse practitioner who helps each patient develop goals. Together they do everything from reviewing medications to drawing up treatment plans. Families early on are brought into the process.
“Family-centered palliative care works best when discussions take place early on in the disease process,” says Koets, noting that hospitals are increasingly incorporating palliative care services while patients are still hospitalized.
In fact, a Massachusetts General study of cancer patients indicated that those who received palliative care early on, along with cancer treatments, showed marked improvement in their overall quality of life and lived more than two months longer than those who received cancer treatment without palliative services.
“Palliative care helps patients define their options and it often helps them to re-prioritize what’s important in life when dealing with a chronic or terminal illness,” says Koets. “Palliative care programs ensure access to the best available treatments for symptom management and helps facilitate the difficult discussions, as family conferences define goals.”
Primary care physicians often are the place to start discussions about palliative care and advance directives.
“Patients should actively participate in their choices and a family conference to set goals early on,” says Koets. “When it comes to hospice and palliative care, the family is as much our patient as the patient is.”
Pathways Social Worker Todd said he’s worked with patients ranging from 22 years old to 102 years.
“When you meet them, their life is on hold until we have the family discussions,” he says. “And it’s not about me presenting how you should live your life but offering choices. Hopefully by removing some of the physical symptoms, you see their spirit return.”
Todd recalls helping a 38-year-old mother of three who had a brain tumor and wanted to die at home. He helped her write letters to her children and record audio storybooks.
“It was sad and wasn’t easy but emotionally she had done everything she could and was ready,” he says. “Palliative care tries to define what quality of life is and then matches the medical intervention to that.”
Most of Todd’s counsel focuses on emotional goals and bringing support to families whether it be coming up with caregiver plans, understanding medical options, or dealing with finances and issues of anxiety and depression. He also does a lot of health advocacy––helping patients define questions to ask their doctors.
“We’re kind of like a tour guide,” he says. “We don’t have you look at the end point but want you to look around the corner then plan point a, point b and point c. We want people to make decisions not out of desperation but out of informed knowledge.”
The Denver Hospice is located at 501 So. Cherry Street, Suite 700. You may reach them at 303-321-2828.
