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Palliative Care Programs Expand at Strong

Friday, December 19, 2003

Anyone who has been seriously ill or had a loved one who was terminally ill knows how difficult a hospital stay can be. Pain, anxiety, depression, and boredom are great barriers to treating an illness. Patients who suffer from severe and life-threatening illness will find new relief at Strong Memorial Hospital, thanks to a grant for massage therapy, live harp music, and bereavement coordination programs.

These types of care, under the direction of the Palliative Care Program, can often give patients much needed relief from the rigors of severe medical treatment. This grant, from a source that wishes to remain anonymous, will give the program additional tools to address the effects of severe illness, and give patients more treatment options.           

Because palliative care is a relatively new field, many patients and their families may not understand what it offers. “If you look at the patients who could benefit from this type of consultation, we see the tip of the iceberg,” says Timothy Quill, M.D., the director of the Palliative Care Program. The program currently sees about one out of every seven people who are dealing with end-of-life issues.

“A lot of these people are dying at the end of very severe, chronic illnesses, and could potentially benefit from our care. Once we are involved, virtually all of the symptoms that we measure – pain, shortness of breath, anxiety, insomnia, and depression – over time, do better.”

This type of care also has benefits that can’t be measured. It can reach patients who are not usually receptive to traditional caregivers. A bone marrow transplant patient, tired of necessary but difficult visits from her doctors, posted a sign outside her room: “No visitors except the harp lady.” Music practitioner Sandy Gianniny attributed this receptiveness to the passive nature of her service. “It’s nice for patients to have a visitor that allows them to relax and drift off,” she says. Massage therapy can also help break down barriers between caregivers and patients. Even family members are invited to participate in massages, helping to create a trusting, healing environment.

Because of the diverse treatments that fall under the umbrella of palliative care, the program must draw on the skills of a diverse group of professionals. The program has steadily expanded since its founding two years ago. The team includes 11 physician consultants, nurses, nurse practitioners, researchers, medical residents, social workers, spiritual counselors – and now a music practitioner, massage therapist, and a bereavement coordinator.

The team’s most straightforward task is the relief of pain. A palliative care physician consultant will usually suggest pain medication and other services. Massage therapy decreases pain and anxiety, and has the added benefits of improved blood circulation and the relief of soreness and stiffness. Live music offers a much needed distraction from pain.

One of the most important services is simply talking with patients to help them clarify their care goals. “Is the goal to fight the disease as hard as they can, is it mainly pain or symptom management, or is it some mix of the two?” says Quill. Unlike hospice care, patients do not have to forgo aggressive treatment to enjoy the benefits of palliative care. Physician consultants and the palliative care team help the patient and family explore medical options, weighing the risks and benefits of each.

            The program also assists in making end-of-life decisions for terminally ill patients, and helping families deal with the loss of a loved one. This can include consultation with clergy, ethicists, and the use of a bereavement coordinator who follows up with grieving families and directs them to support services. The medical center will soon hold a twice-yearly memorial service to give families a chance to “have their loved one’s death recognized in a public way, and let them know that they are not forgotten,” says bereavement coordinator Nancy Rice.

            A long-term goal of the program is to encourage patients to seek palliative treatment earlier in their stay. Typically patients are in the hospital more than two weeks before they request palliative care services. “There’s this myth that to get palliative care, you have to be dying. That is simply not true,” says Quill. “The earlier we see them, the better treatment we can offer.”

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