UAB Synopsis, Vol. 24, No. 1, January 17, 2005
UAB Expands its Center for Palliative Care
"Americans are clear about end-of-life priorities. Research shows they want control in decision making, home-based emotional and spiritual support, and effective pain management."
Rodney Tucker, MD, UAB Palliative
Care Clinical Program
The Latin root for palliation, palliare, signifies to shield or to cloak. "Palliative care is a collaboration of professionals aimed at shielding and protecting patients from the violence of advanced disease, especially at the end of life," Christine Ritchie, MD, MSPH, director of UAB's Center for Palliative Care (CPC), says.
Emphasizing the need for substantial improvements in end-of-life care in the United States, Rodney Tucker, MD, medical director of the CPC Clinical Program, offers a case study. "Recently, a patient with kidney and lung disease, coupled with early dementia, came to us. Three months ago, he went through bypass surgery, with major complications, and was in such pain from surgical complications he did not want to live. No further curative treatment was possible.
"His final wish was to be at home, but he could not manage the pain on an outpatient basis. We initiated continuous aggressive pain therapy that allowed him to live comfortably and peacefully where he desired."
Choices
In the United States, the field of palliative care has developed out of the recognition that acute care experiences often do not adequately address symptom management or fully identify patients' wishes regarding treatment. The goal of palliative care is to promote quality of life in advanced illness and respect for patients' wishes regarding their care.
Many palliative care principles emanate from the collective hospice experience. With a broader application of hospice concepts, palliative care applies to patients with a significant burden of illness, but who are much earlier in the disease trajectory. This care can be integrated with curative or life-prolonging treatments, while hospice is explicitly noncurative.
"Many people think palliative care is what you do when there are no other options," says Dr. Ritchie, who was recruited from the University of Louisville to direct UAB"s CPC. "Palliative care addresses end of life care and prevents and relieves suffering through earlier assessment and treatment of pain and help for other physical, psychosocial, and spiritual issues."
Advance planning is an important focus of palliative care. Like hospice, palliative care integrates the psychological and spiritual aspects of patient care and recognizes the importance of the family in the patient's treatment plan.
UAB Center moves to Geriatrics
Imbuing these principles, the CPC — founded in 2000 and now a component of UAB's Division of Geriatrics and Gerontology — has provided interdisciplinary support for patients with significant illness, including cancer. In fall 2004, the clinic moved to its new home at the William C. & Margaret Spain McDonald Clinic, 1521 11th Avenue S. Here, physicians and staff have more room to provide a full range of services to meet local patients' nutritional, psychosocial, functional, and spiritual needs.
The Palliative Care Clinic, held on Wednesdays and Fridays, is accessible to any patient with a chronic, life-limiting illness, including cancer, heart failure, emphysema, Alzheimer disease, AIDS, and Parkinson disease. The Supportive Care Clinic sees primarily cancer patients.
"We support patients through the multitude of problems encountered during and after treatment," Dr. Tucker says. Assistance is provided for control of symptoms, such as pain, fatigue, and nausea, as well as attention to emotional and spiritual support, food and nutrition counseling, and preservation of quality of life and dignity.
A time to grow
CPC faculty include Amos Bailey, MD (medical director of the Birmingham Veterans Affairs Palliative Care Clinical Program), Elizabeth Kvale, MD, Carol Griffin, MD, Charlotte Williams, and Cindy Baker. They offer fellows, residents, and medical and nursing students training in a fundamental palliative care skill — communication.
They also offer education in ethical issues at end of life, psychosocial considerations, and symptom management. Special areas of focus include ethical decision-making, spirituality, and interface with cultural norms. Training stresses a team approach. Research is integrated with clinical care, and studies aimed at symptom control for seriously ill patients and caregiver support are a major focus.
"Prior studies evaluating end-of-life care showed that, as a health-care system, we have a long way to go to improve quality of life in patients with advanced illness," Dr. Ritchie continues. "Improvements are best achieved by identifying concerns important to individual patients, communicating patients' concerns to the treating medical team, and working collaboratively with the team until all concerns are addressed."
The CPC was designed to promote palliative care not only at UAB and local affiliated programs but also throughout the regional medical community. It works with community hospices for service outreach and partners with community networks. "It is important for patients to know there are many things we can do to help," Dr. Tucker concludes. "Much of our work is the ministry of presence. We are here to help alleviate suffering." For more information, call 975-8190.