Living with chronic illness can be a stressful
balancing act to deal with symptoms and
maintain quality of life. There can be multiple
specialists and differing priorities of the patient
and family members. At CalvertHealth
Medical Center, the Palliative Care team’s
mission is to ease those burdens.
“Palliative care is there to provide relief for
patients suffering from a chronic illness.
Different from hospice care, palliative care
helps patients with serious illnesses manage
their symptoms in a manner that brings
them comfort and a quality of life that is
meaningful to them. The team is also there to
determine what a patient and their family’s
goals are and try to ensure the patient,
family, and treatment team are all working
together to achieve those goals,” said David
Sacks, LCSW-C, ACHP-SW, Palliative Care
Coordinator at CalvertHealth Medical Center.
Unlike hospice care, palliative care is not
end-of-life care. Hospice is care for patients
who are not responding to treatment or have
decided to discontinue current treatments.
Hospice patients have a prognosis of six
months or less. In contrast, palliative care
is for patients at any stage of their illness
and can be provided alongside curative
treatments.
“Patients do not need to be terminally ill.
Many of our palliative patients have normal
life expectancies, but are wrestling with
symptoms like pain, shortness of breath,
or anxiety to name a few, or are simply
overwhelmed by multiple illnesses or a
complicated medical regimen,” said
Dr. Stephanie Carpenter, Director of
Palliative Medicine of Southern Maryland.
Palliative care is provided both inside
and outside the hospital setting. The
interdisciplinary palliative care team
consists of a provider (a physician or nurse
practitioner), a social worker, a chaplain, and
when necessary, a pharmacologist.
Focusing on Quality of Life
Palliative care is highly individualized
for the patients and their families.
Palliative visits allow more time
than a typical doctor’s office visit to
work through complex issues and
for patients and loved ones to ask
questions.
For example, a patient with
advanced cancer may have failed
first- or second-line treatment and
may need to make a decision to
pursue third-line treatment, which
will increase symptoms and risks
or adverse outcomes with less of a
benefit. Or, a patient with dementia
may not be eating and is getting
weaker and the family has to make
a decision whether or not to place
a feeding tube. Palliative care helps
patients and families such as these
explore what quality of life looks like
for them.
Palliative care also helps to fill
the gaps that patients frequently find
themselves in when they have several
different specialists who focus on one
specific part or system of the body.
Palliative care focuses on the person
and coordinates care between those
specialists and manages symptoms.
“Palliative care is better at seeing
the bigger picture, seeing how things
impact people emotionally, physically
and spiritually. Palliative care takes
that step back and asks what matters
to the patient...there is no one size
fits all. Each patient is different. Each
patient dynamic is different,” said
Marzi Viverette, CRNP, Palliative
Care Nurse Practitioner.
The palliative care team can
adjust medications, have a family
meeting about goals of care, address
the psychosocial needs and challenges
of the patient, address spiritual needs,
determine if the patient requires
more follow-ups or referrals to other
providers, assist in decision-making
for current and future treatment
options, manage symptoms and more.
Advocating for What’s
Important to Patients
Viverette said it’s important for her to
help patients and families feel at peace
with their decisions and to advocate for
what is important to them. This takes
extra time and an interdisciplinary
team. Visits with patients usually last
much longer than a typical 15-minute
doctor’s office visit. This time is needed
to gain the trust of the patients and their
families to find out what they
need and their motivations in order to
help everyone.
“Palliative care is not hospice.
It can be done alongside active
treatments like chemotherapy, with
progressive illnesses like heart failure
and dementia. It’s not end-of-life care.
What provides me the most joy in being
able to do this is to bring to light and
advocate for patients what’s most
important to them,” said Viverette.
The process to receive palliative
care depends on the location of the
individual and whether or not they
are in the hospital. In the hospital,
usually, the treating provider places a
referral for palliative care services or a
referral is entered through a screening
tool. However, individual patients may
request a consult on their own. Patients
in a nursing home are identified by a
screening tool, provider assessment,
RN observation or family request. If at
home, the patient may be referred by
their treating provider or self-referred.
Patients receiving palliative care
while in the hospital meet with their
palliative care team initially for an
evaluation and then follow up as needed.
Outside the hospital, the frequency
is determined based on the patient’s
specific needs. In Calvert County,
palliative care is provided at
CHMC, local nursing homes and in
partnership with physician offices.
If you or a loved one would benefit
from palliative care, contact
410.535.0412 or request a referral
from your physician.