Fall 2013
Ask the expert: Palliative care

Q&A about palliative care with Mariel Harris, MD, JD, chief of Palliative Care, Bridgeport Hospital

What is palliative care?
A:
Palliative care is the medical specialty focusing on preventing or easing pain, stress and suffering during an illness. It is holistic in its approach, in that it addresses the entire person. So, we deal with the physical, emotional and spiritual needs of patients and their families.

How is palliative care coordinated with a patient’s doctor?
A:
Palliative care collaborates with the primary care physician to help patients and families coordinate treatment for an illness, with the goal of achieving the best possible quality of life. Care is usually by referral. Palliative care is beneficial at any stage of an illness, starting from diagnosis. It complements treatments focused on curing a patient and it is appropriate when a cure is not possible. This applies not only to cancer treatment, but also many other illnesses, such as cardiac and pulmonary disease, dementia and other neurologic diseases, arthritis, diabetes and serious infections, as well as injuries.

Where can palliative care be provided?
A:
It can be provided at home, in an outpatient setting, an urgent care or emergency department, nursing facility or hospital. In hospitals and many nursing facilities, there are teams comprised of physicians, nurses, chaplains or other spiritual care practitioners, social workers, therapists, pharmacists and nutritionists.

How is palliative care provided at Bridgeport Hospital?
A:
Our Palliative Care Consult Service team consists of five physicians certified in both palliative care and geriatrics, and two advanced practice nurses, one certified in hospice and palliative medicine, and one certified in oncology. We also have a chaplain for spiritual support.We work with hospital social workers and care coordinators, and help plan care after a patient is discharged from the hospital, whenever appropriate.

In essence, we join the patient’s primary medical team whenever we are consulted for a hospitalized patient. We tailor our consultative role to the requests of the referring team and the needs of each individual patient and family. In the future, we will expand our service to provide pain and symptom management to patients previously cared for at the hospital.

How is palliative care different from hospice care?
A:
Hospice is a specialized form of palliative care for patients in the terminal phase of their illness. Patients may enroll as an insurance benefit when their principal goal is comfort. Palliative care and hospice are alike in that both can be delivered at a variety of sites, ranging from home to hospital, depending on the patients’ and families’ care needs and preferences.

What are the benefits of palliative care?
A:
They include:

  • Managing symptoms, including pain, shortness of breath, nausea and vomiting, fatigue and weakness, loss of appetite, anxiety and insomnia.
  • Help with medical decisions, ensuring decisions are ethical and shared between the patient/family and medical team. This can reduce emergency visits, procedures and hospital admissions.
  • Providing patients with someone to listen and help choose reachable goals.
  • Coordinating palliative care with other services and connecting the patient with services such as spiritual care, rehabilitation, dietary counseling or hospice.
  • Improving communication among family members and between the patient/family and medical team.
  • Educating hospital staff, patients and family members about the patient’s treatment plan to ensure a patient’s comfort.