Palliative Care Consult Service
Improving Quality of Life
Newton-Wellesley recently announced the institution of a multidisciplinary, inpatient Palliative Care Consult Service. Palliative care supports patients and their families at any stage of a life-limiting illness. The goal is to prevent and relieve suffering and improve the patient’s quality of life.
"Palliative care is a medical specialty that focuses on improving overall quality of life for patients and families facing serious illness," says Julia Ragland, MD, Director of the Service. "We focus on intensive communication, pain and symptom control and coordination of care. We address a patient’s physical, emotional, intellectual, social and spiritual needs and provide them with information to make choices about their care."
The consult team at Newton-Wellesley is currently made up of Dr. Ragland; Steven Pestka, MD; Kathleen Heffernan, ACHP-SW, Palliative Care Social Worker; and Ann Lomuto, Palliative Care Chaplain. A full-time palliative care nurse practitioner is being added to the team in 2011.
When a consult is requested for a patient in the Hospital, the physician or nurse practitioner conducts a detailed review of the patient’s medical record and speaks with the physicians and other caregivers involved in the current care plan. The team then completes a full patient assessment with an emphasis on symptoms and patient and family knowledge about their illness.
"Palliative care complements a patient’s routine care by creating open communication around tough subjects as well as including the health and well-being of family members," says Dr. Ragland. "A consult can be requested by any member of the patient’s medical team or by the patient or a family member with the attending physician’s approval."
Care for All Stages of Illness
Palliative care can be used when a patient is receiving treatment for a disease as well as during the time when there are no longer curative treatment options.
"When people hear ‘palliative care’ they often think of hospice care," says Dr. Ragland. "Patients on hospice represent a small group of patients receiving palliative care. These are patients in their last weeks or months of life who agree to forgo further diagnostic and hospital-based care. In contrast, palliative care is appropriate at any point in a serious illness and can be provided at the same time as life-prolonging treatment to improve quality of life for those living with advanced illness."
Once the Palliative Care team has collected the necessary information, they meet with the patient and their family to help make treatment decisions and communicate these decisions with all care providers.
"Palliative care is not intended to hasten or postpone death," says Dr. Ragland. "Our team addresses the needs of patients and their families by helping them understand the process of a life-threatening illness and by opening up communication to discuss the decisions this situation often entails."
Dr. Ragland and her team are hoping that palliative care will become a regular part of a patient’s treatment for serious illness.
Physical and Emotional Comfort
"High-quality palliative care can make the difference between a comfortable existence and one that involves much suffering," says Dr. Ragland. "The Palliative Care team can help patients deal with symptoms such as shortness of breath, uncontrolled pain, depression or nausea that are having an impact on their quality of life."
Palliative care also can help a patient’s loved ones begin to deal with the issues of grief and bereavement.
"Palliative care focuses on treating symptoms people may have when they are living with a chronic life-limiting illness, such as cancer, heart failure and dementia," says Dr. Ragland. "Our goal is to provide the best quality of life possible – regardless of where the patient is in their disease trajectory."
The Palliative Care team helps patients communicate their wishes to their treatment team and helps physicians understand how the patient is feeling. Both hospice and palliative care focus on helping patients with serious or life-limiting illnesses by addressing issues causing physical or emotional pain or suffering.
The Palliative Care team helps patients think through decisions about treatment and their care plan. Many patients want to know what to expect as their illness progresses and their physical condition changes.
"We help the care team to determine a patient’s wishes and help those to be carried out as their illness progresses," adds Dr. Ragland. "Many of these patients have multiple hospitalizations, so we help coordinate their care during their visits to enhance continuity. Studies have shown that the earlier we can incorporate palliative care, the more it benefits patients and their families."
Educating the Newton-Wellesley Community
In addition to consultations, the team is actively involved in providing palliative care education to the Newton-Wellesley community, including physicians, nurses, case managers, social workers, house officers and medical students. The team is also working with others at Newton-Wellesley to institute a hospital-wide bereavement program to support families of patients who die at the Hospital. Future plans also include extending the current consult program to provide outpatient services.
"It can be difficult for patients, their families and their treatment team to have conversations around the topic of life-limiting illnesses," says Dr. Ragland. "We hope our team can create an atmosphere of open communication and comfort around these topics. We want patients to feel empowered to make their own decisions and enhance the quality of their life."
For more information about the Palliative Care Consult Service at Newton-Wellesley Hospital, please call 617-243-6573 or visit www.nwh.org/palliativecare.
Julia Ragland, MD
Director, Palliative Care Consult Service
Dr. Ragland is board certified in internal medicine. She received her medical degree from New York University School of Medicine and completed her residency at Beth Israel Hospital. She is also a hospitalist at Newton-Wellesley.
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