Between 1900 and 2000, life expectancy in the United States rose from 47 to 77 years - equivalent to the gain in longevity between the Stone Age, more than 10,000 years ago, and 1900. A gain of this magnitude in a relatively short time frame has had dramatic effects on the human experience of illness, dying and death. Where illness and death were once routine community experiences, modern medicine and technology have made them seem to be unseemly failures, associated with the belief that they could and should have been prevented.
In the last two decades, Americans have begun to recognize the limitations of technology and modern medicine in meeting the needs of chronically and seriously ill patients. There is also a need to fundamentally restructure the care that people require during the last years of their lives. This has led to the development of a new field of medicine called palliative care.
Palliative care (pronounced pal-lee-uh-tiv) is the medical specialty focused on relief of pain, stress and other debilitating symptoms of serious illness. Palliative care is not dependent on prognosis and can be delivered at the same time as treatment that is meant to cure you. In this respect, it is not as limited as hospice care, a component of palliative care focused on the care of the terminally ill who have opted to stop life-prolonging treatments. The goal of palliative care is to relieve suffering and provide the best possible quality of life for patients and their families.
Usually a team of experts including palliative care physicians, nurses and social workers provides this type of care. Chaplains, pharmacists, dietitians and others might also be a part of this team that focuses on the whole person. Working in partnership with your primary physician, the palliative care team provides:
Expert treatment of pain and other symptoms,
Close, clear communication to patients and families,
Assistance while navigating through the health care system,
Guidance with difficult and complex treatment choices,
Detailed practical information and guidance and
Emotional and spiritual support for you and your family.
Palliative care benefits both patients and their families. How to make the right medical decision is one example. What about end-of-life care and whether or not they want to be aggressively treated with chemotherapy, dialysis and even resuscitated if they should stop breathing or their heart stop functioning? Is there any benefit to a feeding tube? When is the best time to seek hospice care? What are the advantages and disadvantages of continuing treatment in the face of a relentless progression of their disease?
Palliative care has grown rapidly in the United States in recent years. In a recent article in the New England Journal of Medicine, it was stated that more than 80 percent of large (greater than 300 bed) and 70 percent (with 50 or more bed) hospitals in this country have palliative care teams. But, unfortunately, for the most part these teams don't get called in to help until very late in the course of the illness. Many doctors fail to make use of it, often because they see it as giving up. Our medical system is excellent at trying to stave off death, but ultimately death comes, and no one is good at knowing when to stop.
Yet evidence for the benefits of palliative care is growing. People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware and not being a burden to others. Our system of technological medical care has failed to meet these needs. We have now begun to look at how we can build a health care system that can actually help dying patients achieve what's most important to them at the end of their lives.
Trinity Regional Medical Center began an inpatient palliative care consult team in January of this year. Dr. Dan Cole is the medical director. He is taking an examination this week to become certified as a specialist in hospice and palliative care. There are also a registered nurse, social worker and chaplain on the team. We work closely with pharmacists, dietitians, speech, physical and occupational therapists. The team meets with patients at the request of their primary physician to discuss their advance directives, identify goals of care and help to find ways to achieve these goals throughout the course of their chronic debilitating illness. We have found that often their goals are finding true comfort, which sometimes is physical and other times emotional or spiritual.
In our first 10 months of offering palliative care, we have met with over 125 patients and their families. They have been very welcoming to the palliative care team. We have given them the opportunity to talk about difficult subject matter. We treat death as a natural part of life.
We have begun to realize that palliative care is a form of medicine that we don't utilize enough. Genuine caring and support for someone in distress is our goal. The impact of a healing hand, a willingness to listen and an opportunity to provide support and guidance can truly make a world of difference to the patients and families we serve.
Nadine Schlienz, RN, CHPN, is the nurse coordinator of the Palliative Care Consult Team at Trinity Regional Medical Center.