Page 26 - Delaware Medical Journal - April 2017
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Palliative Care: How It Can Help You Care for Your Patients
Tracy Tull, RN, MSN, CHPCA
Palliative care helps patients with advanced illness as they continue to receive active, disease-modifying
care and treatment. Through home visits by a nurse practitioner and social worker, Delaware Palliative provides assistance with the physical and psychosocial burdens of a serious illness. Care in the program is initiated via a consultation and prescription from the patient’s primary care physician. In collaboration with the primary provider, the palliative care team works with the patient and caregiver to identify goals of care related to symptom management and end-of-life care decisions.
Palliative care differs from hospice care in
• Palliative care is provided alongside curative treatment regimens.
• A terminal prognosis is not required; palliative care is appropriate and life-limiting illness.
• Palliative care can be provided together with other post-acute care options, i.e., home health services and rehabilitation.
To help reduce the most burdensome and costly consequences of serious illness, decreasing visits to the emergency department and preventing hospitalizations is a primary objective of the program. The Delaware Palliative team provides early intervention for
symptom exacerbations, answers questions, and monitors adherence to medication regimens. The team further aligns and engages community resources to optimize the ability of patients to stay in their preferred living environments more safely. Collaboration and communication with the patient’s primary care physician assures the patient’s needs and changing condition are well known
Delaware Palliative uses a holistic approach to care of the patient and his or her family members with the goal of maximizing physical, emotional, and psychosocial comfort. The care team consists of nurse practitioners and social workers, all with highly developed expertise in symptom management and end-of-life goals of care conversations. An extensive history and physical are conducted during the initial visit, and, without exception, a compassionate discussion centered around end of life wishes is initiated.
Having “the talk” can be a very time- consuming task for medical providers, and having that discussion in a medical impersonal. Having the conversation
at home with loved ones present is the more ideal situation. Two quality of care outcome measures Delaware Palliative is proud of: 100 percent of patients have a goals of care discussion during
patients in the program have expressed their wishes for end of life treatment verbally and in writing using both Advance Health Care Directives and DMOST forms.
No one is led to choose comfort care over curative treatment, or hospice care over palliative services. “My goal as a Delaware Palliative Nurse Practitioner is to empower patients and their families to seek the information they need to make informed decisions. We are able
to collaborate with their providers to ensure that we are promoting informed decision making, and focusing on the patient’s greatest needs. By doing so,
we are able to effectively manage their disease process, with a focus on quality of life and choice.”
— Nicole Hunter, MSN, APRN, PCCN
Frequency of visits and goals of care are patient driven. The care team responds to the urgency of the requests and needs. A nurse practitioner and social worker schedule visits or telephone check-ins weekly, monthly, or as needed. Palliative patients are sometimes still quite active and mobile; they are not required to be homebound as with the home health regulations. When, due to disease progression, the patient and/or family need more care and services, the team provides information and assists in the exploration of the options and resources, working with the collaborating physician to obtain the needed orders and referrals.
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Del Med J | April 2017 | Vol. 89 | No. 4
