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Palliative Care Team eases burden for chronically ill

Personalized approach provides help with addressing complex needs

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.
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