Death, although a natural part of life, usually elicits feelings of fear, anxiety and confusion. The thought of one’s own mortality is at best an unsettling subject that many people try to avoid thinking about until absolutely necessary.
These feelings can intensify when a person has a terminal illness, not only for the person, but for the family and friends of the terminally ill. Difficult questions arise, as does generally the pain and suffering of the ill. Should treatment of the illness continue? Is the person suffering needlessly? Can the quality of this person’s life improve for the last days of his or her life?
Crozer-Keystone Health System has been educating the community, as well as doctors and nurses, on these types of end-of-life decisions for several years through the Peaceful Journey Partnership. The partnership has used presentations, programs and literature to provide this education.
This month, a three-month palliative care consult service program will be piloted in the Shock/Trauma Unit (formerly known as the Intensive Care Unit) at Crozer-Chester Medical Center.
“We hope that the pilot program will allow patients, their families and our staff to become familiar with the resource that a palliative care program can bring to patient care,” says Michael Soojian, M.D., a specialist in Hematology/Oncology at Crozer. “The palliative care model can be integrated into patient care at all levels, and the ICU setting is a place which often has patients and families confronting end-of-life care issues.”
Palliative care, while very widespread in England and Australia, often remains a relatively scarce and unfamiliar option for people and families dealing with a terminal illness in the United States. It focuses on the control of pain, the relief of suffering and the improvement of the quality of life for the terminally ill. Palliative care also works as a support system for the family and loved ones of the terminally ill, providing answers, information, assistance, counseling and comfort.
“We hope to make the experience of losing a loved one an experience in which the family and loved ones would feel more understood and more of their needs would be taken care of, such as providing them with information about the dying process, what to expect, and when to let go and stop aggressive treatment,” says Susan Ball, M.D., director of Geriatric Psychiatry at Crozer and chair of the Peaceful Journey Partnership.
The consult team currently consists of Soojian; Stanley Savinese, D.O., a specialist in family medicine, geriatric medicine, and hospice and palliative medicine for the Crozer-Keystone Health Network; and Maria Ash, a nurse practitioner. Both Savinese and Soojian are board-certified palliative care physicians.
Upon request by the Shock/Trauma Unit attending physician or Ash, either Soojian or Savinese will meet with the patient and his/her family. Patients recommended to meet with the team include patients with serious, potentially terminal illnesses; patients with complex pain; patients considering hospice who would like further information; patients and/or family of the patient who are having difficulty understanding available treatment options and making treatment decisions; and patients who have opted for comfort-directed care. For many of these patients and families, relief of illness-related symptoms is a primary concern.
“We start by improving symptom management,” Savinese says. “Once trust has been forged between us and the patient, we then can tackle more delicate issues, such as treatment options and advance directives.”
“Many of the interventions which have become routine in an ICU setting may not be of benefit to some of the patients there. Some interventions may be futile or of limited utility to these patients,” Soojian says. “We hope to help patients, their families and the ICU staff come to a consensus about which of these measures are appropriate and which will not be of benefit, and hence can be withdrawn.”
Upon discharge from the hospital, Ash or a social worker will follow-up with the patient and family to address any new or remaining concerns. With patient and family verbal consent, any significant information gathered during the palliative care consultation will be discussed with the patient’s hospice, nursing home or residence nursing staff.
“We hope to bridge the gap between aggressive, invasive care and hospice,” Savinese says.
In addition to providing patients and their families with this service, educational programs and support will be extended to health care providers and staff, as well as the programs already offered by the Peaceful Journey Partnership.
“We hope that we can provide a service that will help all professionals in the hospital ease patients’ experiences at the end of life,” Ball says.
Although the consult services currently only have a three-month span, hopes are high that palliative care will become a mainstay at CKHS.
“Our hope is that if the program goes well, we can offer it system-wide,” Savinese says. “Palliative care is one of those things that we feel is most useful to our end-of-life patients.”
“Our expectation is that both staff and patients and their families will benefit from the added information that the palliative care team will bring to the patient care setting,” Soojian says.