—as told to Alyssa Brandt
All hospice care is palliative care but not all palliative care is hospice care. Even a lot of physicians get confused. Hospice care is more end-of-life care for patients who have less than six months of life expectancy. But we don’t see palliative care as only for the end of life and advanced illness. It could be for any serious illness—a bad liver, a bad lung, a bad heart, or dementia. Patients with dementia are living longer, but they have a lot more issues going on. How do you navigate through it all?
Palliative care should be given to patients right at the time that serious illness is diagnosed. Irrespective of diagnosis, irrespective of how long they’re going to live. Because palliative care helps patients manage their symptoms so that they’re able to tolerate their treatment better. It approaches from a complete view [by addressing] not just physical symptoms; it could be emotional symptoms, it could be psycho-social symptoms, it could be spiritual symptoms. It’s a team approach. There is a physician, a nurse, a social worker, a chaplain; we all work together as a team. It’s real inter-disciplinary care.
If somebody is diagnosed with stage-four heart disease, or heart failure, that patient could live for five or six years. We’re able to prolong life and at the same time prolong the quality of life. Our toolbox has gotten bigger; there are a lot more palliative procedures that can be done depending on what the issue is and what the patient wants. For example, for patients with ALS who have trouble breathing, there are now ventilators that are non-invasive that help them breathe better. In the case of a young patient with pancreatic cancer, it’s pretty painful, and we had him on oral medication. It was helping, but he was getting [mentally] confused because of the high dose. Lowering the dose made the pain worse. So we talked with him and pain management consultants and got a pain pump installed on him so his pain could be managed without causing confusion.
At Hospice of Cincinnati we have a program called Creating Conversations of a Lifetime. We are also training medical residents on how to have effective communications. As the public becomes more aware that palliative care isn’t just about dying, but about living and how to live better, I think people will become warmer to it. We might not be able to prolong life, but we can improve quality of life for the time they have.