Palliative Care Conversations

Special note: This information on models of palliative care was adapted from material provided by the Center to Advance Palliative Care. Adopted by George Hankins Hull Spiritual Care Coordinator LRGHealthcare Solo Practitioner Model Consultative service with Doctor (MD) or advanced nurse practitioner (ANP) provides initial assessment and communication with attending physician, nursing, and patient support staff. May or may not write patient orders. MD or ANP refers patients to needed services (e.g. social work, chaplain, dietitian, pharmacist, care manager, rehab therapist, pain management, alternative therapist or volunteer), discusses needs in patient conference, and communicates with clinicians. Assists patient and family with advance directives and plans for future. Service Model MD or ANP receives referrals from attending physician, hospital staff, patient, or family. All units in hospital deliver palliative care as part of their stated mission. MD or ANP develops protocols for

Palliative care is life affirming and regards dying as a natural part of the human experience. The goal of palliative care is to achieve the best possible quality of life through: the relief of suffering control of symptoms the restoration of functional capacity while taking into account personal, cultural, religious values, beliefs, and practices of the individual patient and family concerned. Interdisciplinary Approach: Palliative care requires an interdisciplinary approach calling upon the expertise of, medical staff, nursing staff, care managers, social workers, chaplains and volunteers who in cooperation with family members and friends provide patient care. Smooth Transitions between Hospital and Community Services: Palliative care encompasses the full array institutional and community resources such as hospital, hospice, home care, long-term care, and adult day care to ensure a smooth transition between institutional settings and community services. Five Principles of Palliative

Discussion: Sometime ago a New England newspaper, the Worcester Telegram & Gazette, carried a story entitled "Various Pathways Lead to a Good Death." in which a retired former chief of surgery, Dr. H. Brownell, spoke of his concern that too many patients die what he called ‘a bad death.’ In the article Brownell spoke about seeing patients, including his own, die in an intensive care unit with tubes poked into their chests, their bellies and just about every orifice of their bodies. He further commented about patients resuscitated with so much fluid that their faces were unrecognizable, arms black and blue from needles and blood sticks, in severe pain and unable to communicate—and with very little hope of survival. "No one," he commented, "should have to die like this." Janet L. Abrahm, M.D., F.A.C.P., at the University of Pennsylvania School of Medicine, Philadelphia, encourages physicians to broaden their concept of care for patients who are terminal