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Physicians Update

 
Summer 2009

Palliative Care Emerges as Powerful Treatment Option

07/22/2009

Palliative Care Palliative care, which focuses on promoting quality of life, ensuring physical comfort and providing psychosocial support for patients and their families living with a serious chronic or terminal illness, is a relatively new specialty that represents a significant shift in treatment for these patients. “Today there is greater appreciation for the importance of symptom control and discussions with patients and their families about the natural history of their disease early in the course of the illness,” says Bruce Ferrell, M.D., director of palliative-care services at UCLA.

The goal, says Jane Elizabeth Whiteman, M.D., one of more than a dozen attending physicians who, among them, are available for inpatient consultations 24 hours a day, seven days a week at UCLA Medical Center, Santa Monica and at Ronald Reagan UCLA Medical Center, is for the palliative-care team to work closely with the treatment team “so that we are looking at the patient in a more holistic way than in the past. We know that all of these scans, surgeries and new chemotherapies may help prolong patients’ life expectancy, or even cure them, but at the same time it is important to pay attention to their symptoms, feelings and other issues during treatment.”

Palliative care is becoming very technical in terms of utilizing pain-management and other drugs for symptom control. And it requires expertise in knowing how to communicate with patients and distressed families and helping them to make decisions about which interventions are appropriate, Dr. Ferrell explains.

Palliative-care services at UCLA’s hospitals address the physical, psychological, spiritual and practical burdens of illness. Along with helping doctors determine treatment goals, the palliative-care team provides consultation on symptom management and interfaces with community-based services concerning the long-term management of patients after they are discharged.

Traditionally, physicians and patients alike have assumed palliative care is limited to end-of-life settings, but that should not be the case, Dr. Ferrell says. In fact, many of the patients seen by UCLA’s palliative- care team are undergoing treatments that may be curative. He explains that unlike hospice care, which is limited to the terminal phase of life, palliative care provides a continuum of care that begins early in the course of chronic and incurable illness, while the goals remain focused on altering the course of the disease. (Palliative care also encompasses and provides a continuum for principles of hospice and end-of-life care when it is appropriate.)

In addition to consulting with patients and families on strategies for control of symptoms, such as pain, nausea, shortness of breath, anxiety and depression, UCLA’s palliative-care service assists physicians in discussions about goals of care, advance directives and psychosocial support for patients and their families who are experiencing chronic illness and end-of-life care decisions. After a comprehensive evaluation to determine the underlying concern, they consult on a treatment strategy. At UCLA Medical Center, Santa Monica, the service was recently expanded to include nursing staff — a continuing-education course has trained more than 50 nurses in palliative-care issues, such as pain management, drug usage, advance directives and discussions about goals of care, with a similar effort being considered for Ronald Reagan UCLA Medical Center. UCLA also has a palliative-care clinic for outpatient follow-up.

“The relief of suffering and the cure of disease are both obligations of the medical profession,” Dr. Ferrell says. “People sometimes see a rigid healthcare system that can become disconnected from the mission of providing people with humane, respectful care. Our goal is to assist them so that patients don’t suffer needlessly.”





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