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Finding comfort in pain
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Dr. Mike Finley, V.P. of Medical Affairs, Glenda Mason (right), Case Management Manager, (both of CHRISTUS St. Michael Health System) with Kathy Douthit (left), Palliative Care Liaison
Making people comfortable as they deal with chronic diseases like cancer and emphysema is the focus of the CHRISTUS St. Michael Hospital palliative care program, a collaboration with Hospice of Texarkana.
"Basically palliative care means to alleviate or reduce pain. It is designed for patients with conditions that limit their life," said Dr. Mike Finley, St. Michael chief medical officer. "Some of those patients may have cancer, some have emphysema or heart disease ... basically anything that really gives them pain or severe nausea and vomiting. Palliative care grew out of a need for us in the medical profession to be able ... to alleviate these symptoms in a very special group of people."
Teaming up with Hospice of Texarkana to implement the palliative care program was a good fit.
"At St. Michael we became very attuned to our patients who were nearing the end of their life for a variety of conditions ... This palliative care piece was something that we wanted to learn more about. We partnered with Hospice (of Texarkana) and began to explore ways to better relieve their pain and symptoms ... They have the expertise in dealing with a lot of end-of-life issues because that's what they do," Finley said.
The partnership has been good from Hospice of Texarkana's perspective.
"Five years ago ... St. Michael had the desire to include palliative care in the support they offered patients in their acute care setting. The goal of that program was to control symptoms and provide comfort for people with serious chronic illnesses. The outcome the palliative care team is trying to achieve is to enable more effective treatment to be delivered and higher quality care to be provided," said Cindy Marsh, Hospice of Texarkana executive director.
Hospice of Texarkana has a palliative care liaison nurse who works in the St. Michael case management department evaluating patient charts to determine who might be a candidate for palliative care.
"If I see someone with uncontrolled pain, then I ask for a consult," said Kathy Douthit, Hospice of Texarkana palliative care nurse liaison. "The main focus of our service is to provide symptom management, which might be for pain, nausea, vomiting, constipation, all those things that patients that have to take medicine chronically have. The symptom management piece is something they rely on us for because we've had more experience with it controlling symptoms in the home with our hospice patients. Also I'm called upon over there to explain hospice services and answer questions in general to patients and their families regarding hospice care. If the patient then qualifies for hospice care and the doctor orders hospice care, then they are always given a choice of hospices in the area to use."
In the palliative care program, different combinations of medications are used to alleviate pain other than what may normally be used.
"What we've learned is oftentimes it's actually a lower dose of pain medication," said Finley. "When you give patients a very high dose of pain medication, you basically knock them out. Our goal was to try to give them pain relief while keeping thinking intact and keeping them awake. Hospice brought us different combos of pain medication ... that allowed our patients to not be drowsy and not sleep all the time."
St. Michael's palliative care program was an innovative move at the time it was started.
"It was one of the first programs," Douthit said. "They're getting to be more widespread now. It's innovative in that the doctor has another resource, a team to use for symptom management. The team consists of a physician, who is certified in hospice and palliative care and a nurse practitioner that participates in program also."
St. Michael started the palliative care program because they saw a need for it in this area.
"We looked at our patient population and saw we had a lot of these patients," Finley said.
Nationwide, palliative care programs are being implemented at a rapid pace. In 2000, there were 632 programs in the United States, compared with 1,299 today, according to the Center to Advance Palliative Care Website.
For more information, visit the Center to Advance Palliative Care at:www.capc.org
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