Dr. Manouchka Joseph, a pallative care specialist, visits a patient, Ginger Carol Watson, in her room at Phoebe Putney Memorial Hospital. Pallative care specialists are called in for cases in which pain relief or symptom management may be needed, and is most commonly used for hospice patients.
ALBANY — While it is something most commonly used for hospice patients, palliative care is something that can be brought in at any time.
That's something many patients don't learn until they have to use it.
Palliative care is a subspecialty that deals with patients with advanced or serious illness who may need symptom treatment or pain relief. In addition, physicians in this field also work closely with family members to ensure they understand the situation their loved one is in and involve them in the patient care process.
The ultimate result is a better quality of life.
"Initially, it was used to take care of those at end-of-life, but it has evolved to the point that palliative care can be used for ongoing treatment," said Dr. Manouchka Joseph, a palliative care specialist at Phoebe Putney Memorial Hospital. "We follow patients through it.
"At the end stage, we play a primary role in symptom control."
The process involves daily family meetings to update loved ones on a patient's status, specifically to discuss what progress has been made. Wishes of family members are also discussed, including family and patient values in terms of end-of-life care.
"We go over options as to whether to continue treatment or start comfort care," Joseph said.
Palliative care is a step that could occur at any time. However, since referrals generally come in late, it is primarily used for patients in hospice.
By that time, they are not expected to survive more than six months.
"Most people are afraid of the word 'hospice' because they think it comes a week or even a couple of days before death, but it can be used earlier," Joseph said.
"Palliative care can come in at any time. At the point in which treatment is not working, we focus on symptom management."
Social workers as well as spiritual care are also involved in the overall palliative care package, Joseph said.
"Our philosophy is on quality of life rather than quantity of life," she said. "When someone has a certain disease, most of the time, their quality of life is altered. We see patients as a whole. They feel better, and quality of life is improved.
"They live better because there is a decrease in anxiety and depression. In some cases, they live longer."
The spiritual care aspect on its own provides a holistic approach to palliative treatment.
"When you are doing end-of-life care, you can't (go without) spiritual care," Joseph said.
It's something that can be especially helpful in situations when everyone involved, including the patient as well as family members, are stressed over their circumstances.
"When dealing with serious illness, there is stress," Joseph said. "That is why we explain what is going on, get on the same page and focus on the patient."
While palliative treatment can be used at any time, usually what would get Joseph involved in a patient's care is if his or her physician feels it is the right time to go down that route.
"For example, it may be a patient in the ICU (intensive care unit) on life support doing poorly, and families need support to discuss options if treatment is not working," Joseph said. "They can ask for a palliative care consult.
"Or it could be about a family member with dementia and there are questions about tube feeding, or questions about treatment. They can call for a consult."
They can also be brought in for cases in which there are legal documents expressing a patient's wishes such as a DNR, or "Do Not Resuscitate" order, or an advanced directive — or when there is an order to discontinue life support.
It can range from end-stage cancer to advanced heart or respiratory disease, from advanced dementia to massive strokes or multiple sclerosis.
Generally, a primary care physician gives the authorization for a palliative care specialist to step in. At that point, family members can be given a good idea of what to expect near the end.
"We can give you a pretty good idea of the life expectancy," Joseph said.
The services of palliative care can provide comfort not only for the patient, but for the families in the long run.
"Families have been very appreciative of it," Joseph said. "When I get involved I see that people are relieved, and they see it (palliative care) was very much needed.
"It also provides a very different view on hospice, and families feel involved in care rather than standing by the care of a loved one."
Overall, it has a positive impact on the emotional toll advanced illness can take.
"The doctor gets into the social impact of disease and offers a shoulder (to cry on), or an ear," Joseph said. "Families are emotional, and we are here to listen and provide support."
Since this is a service most often used with hospice, palliative care has the potential to play an even more vital role in treating patients in the coming years.
"Our population is aging, and now we have a very major part of our patient population impacted by multiple chronic illnesses," Joseph said. "At that point, their care becomes more complicated.
"We don't look at one disease at a time. We look at the patient as a whole. We are able to help families with treatment options and let them know what will be beneficial and will not be beneficial.