January 11, 2008

Palliative care team offers range of support options

Featured Image

The Palliative Care Consult Service includes (front row, from left) Sumi Misra, M.D., Mohana Karlekar, M.D., and Jill Nelson, R.N., (back row, from left) Gina Turner, R.N., Kelly Sopko, M.D., and Melinda Bailes, L.C.S.W. (photo by Neil Brake)

Palliative care team offers range of support options

Now in its third year of operation, Vanderbilt University Hospital's Palliative Care Consult Service is comprised of palliative care specialists Mohana Karlekar, M.D., Sumi Misra, M.D., M.P.H., and Kelly Sopko, M.D.; advanced practice nurses Jill Nelson, R.N., and Gina Turner, R.N.; and Social Worker Melinda Bailes, L.C.S.W.

Karlekar, medical director of VUMC's Palliative Care Program, recently answered questions about the program.

What is palliative care?

Palliative care is a new specialty in medicine that focuses on patients who are facing life-threatening illness or injury, at any stage in the continuum of disease. It is not just for the patient who is about to die.

One of the biggest challenges our team faces is the misperception that palliative care is synonymous with hospice and only for patients diagnosed with cancer. We work with patients from every major specialty within medicine, and often the best value comes when we're involved earlier rather than later. There's a regrettable common misperception that palliative care begins only after curative treatment is discontinued, but part of our expertise concerns helping patients in coping with illness and addressing disabling symptoms. We believe that if the person is in a better place emotionally and physically, he is more likely to tolerate his treatment.

We recently worked with a 40-year-old patient with a new diagnosis of leukemia. She was extremely anxious, worried she might succumb to her leukemia. She had been unable to talk about her fears with anyone. Her children were afraid to visit with her. Our team counseled her on methods to better cope with her illness and communicate with her children. The end result was more enjoyable visits with her family and a lot less anxiety.

We're increasingly involved in helping patients and families cope with a recent diagnosis. We can aid the patient's understanding of what's going on medically and can help establish goals of care. It's better to discuss things earlier, rather than later, in a time of crisis.

What can trigger a palliative care consultation?

Typically teams will call us for assistance in symptom management, developing goals of care, taking care of the dying patient and setting up hospice. Also, long hospital admissions, or cases where individuals have had multiple admissions in a short period of time, are triggers for consults — patterns commonly seen in the elderly or those with chronic disease. Patients with chronic diseases such as dementia, chronic obstructive lung disease or congestive heart failure are progressive and carry with them significant symptom burden and mortality.

We see a lot of patients with young children in the picture. A number of findings indicate an increased risk of psychiatric disease in the children of patients who are dying of cancer. There are effective ways to communicate information surrounding death and dying. Our service can help with that.

Describe interdisciplinary aspects of the Palliative Care Consult Service.

To my knowledge, our team is one of the few in the Nashville area with a physician team leader and a consultation volume this robust. We view the patient and family as the unit of care. Because the needs are multidimensional, our team delivers a diverse systemic range of support options to best suit a patient and family's distinct needs.

What do other academic medical centers typically have in terms of palliative care services?

Palliative care is still in its infancy. Around the nation, capabilities are uneven and education is suboptimal. There's a push by the Association of Graduate Medical Education to provide expanded palliative care education.

Under Sumi Misra, M.D., Vanderbilt in July will launch a year-long palliative care fellowship, with two physician-trainee slots sponsored by the Veterans Administration. VUMC is also attracting increased funding for palliative care research.

Physicians can use WizOrder to request a palliative care consultation at VUH. For patients at the VA Medical Center, access Computerized Patient Record System (CPRS).

The Pediatric Advanced Comfort Team is a separate palliative care service for patients of Monroe Carell Jr. Children's Hospital at Vanderbilt. Reach them at pager 936-PACT (7228). q