Kristen Kerkhove, RN, remembers her family’s devastation when her father was diagnosed with the aggressive brain cancer that led to his death just four months later.
Experiencing her father’s illness and loss when she was 10 years old strongly influenced Kerkhove’s decision to become a nurse specializing in palliative care. Palliative care is a medical specialty that focuses on improving quality of life through pain and symptom management as well as psychosocial interventions for individuals facing serious illness or injury.
Kerkhove, who has worked on the Vanderbilt University Medical Center Palliative Care Team for nearly a year, said her career choice came full circle recently when she helped arrange services to support a critically ill patient and his family. She immediately connected with his 10-year-old daughter standing at his bedside.
“She asked me very bluntly, ‘When is my daddy going to die?’” Kerkhove said. “Nothing can ever fully prepare you for something like that, but I feel passionate now about being a resource and advocate for people going through what can be the worst time in their lives. I think back on when my father was dying, and I wonder what it might have been like if he had received some of those resources. And what if we, as kids, had better resources to help us deal with losing a parent at such a young age.”
Kerkhove was among more than 80 attendees at a Palliative Care Conference in Nashville recently led by faculty members of the Palliative Care programs at VUMC and the Nashville VA Medical Center, and VUMC Center for Biomedical Ethics. She attended in part to strengthen her skills in having difficult conversations, such as supporting patients as they complete an advance care directive to document their wishes regarding medical care.
This is the second year the VUMC group has organized a Palliative Care Conference, and attendees included physicians, nurse practitioners, staff nurses, medical interpreters, patient affairs staff, social workers, medical residents and medical facility administrators. A diverse range of medical specialties was represented including trauma, oncology, internal medicine, geriatrics, intensive care specialists, complex care medical providers and hospice workers.
Research published in leading medical journals provides clear evidence that palliative care can result in fewer trips to the emergency room, fewer hospital admissions and readmissions, decreased medical costs, improved quality of life and even prolonged survival for the terminally ill. Unfortunately, palliative care is often misunderstood by both the general public and by medical professionals to be limited to end-of-life or hospice care.
Palliative care is a relatively young field of practice, but according to the Center to Advance Palliative Care (CAPC), an organization dedicated to increasing the number and quality of palliative care programs in the United States, over the past decade the number of hospital-based palliative care programs in this country has more than tripled.
In 2018, the Tennessee Palliative Care and Quality of Life Advisory Council was created by the Tennessee General Assembly, and Mohana Karlekar, MD, medical director of VUMC’s Palliative Care Program, serves as council chair. The group’s mission is to assess the status of palliative care, including barriers to care, in Tennessee, and to provide recommendations regarding palliative care to the governor and the General Assembly.
In September, the council, in collaboration with the Tennessee Hospital Education and Research Foundation and the Tennessee Center for Patient Safety, is hosting a regional conference focused on palliative care. The keynote speaker is Diane Meier, MD, CAPC director and foundation of one of the first institutional palliative care practices in the United States, the Hertzberg Palliative Care Institute at the Icahn School of Medicine.
Karlekar, Maie El-Sourady, MD, and Sumi Misra, MD, MPH, co-directed the recent local conference, and they agree both medical providers and patients are increasingly understanding and accepting palliative care as an important component of holistic medical care.
“There is a generation of older physicians and medical providers that was never formally educated on palliative care because it didn’t exist as a field when they were training,” said Misra. “Now, we have medical students who are becoming young practicing physicians and nursing students who are becoming nurses who embrace palliative care as normal or ‘business as usual’ and incorporating palliative care into the services they provide to patients. These young health care providers will change the practice of medicine.”
“I would definitely encourage all medical providers, no matter what their role or specialty, to learn more about palliative care, not only as it relates to the patients they care for, but also as it applies to their own personal lives,” Karlekar said.