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Published on November 12, 2018

Outpatient Palliative Care at UHS – A Focus on Quality of Life
 

The concept of hospice care has been around for 60 years and is a familiar term related to end-of-life discussions. A related but less well-known service called palliative care is also available to patients and families facing the symptoms and stresses of a serious illness, and can be provided in conjunction with curative treatments. (Hospice, on the other hand, is designed to provide comfort-focused care in the last six months of a person’s life after he or she has declined further curative treatments.) Examples of individuals who may benefit from palliative care include those with dementia, cancer, congestive heart failure, end-stage renal disease, or those who have had multiple emergency department visits or hospital admissions for the same reason in the past six months.
 
UHS’ interdisciplinary Palliative Medicine Team provides services to hospital patients, and at the UHS primary care offices in Endwell, Vestal and Binghamton. Said Palliative Care Program Director Kris Marks, “Patients are typically referred to the service by a primary care provider or specialist who understands the value that palliative care can bring to someone managing a serious illness.”

Philip Dzwonczyk, MD, Medical Director of Palliative Care at UHS said, "A Palliative Medicine consultation in one of our outpatient clinical settings can be very valuable as patients and their families confront the realities of a serious illness.  It often allows us to have a reasoned discussion with a patient about their treatment preferences in a calm and relatively low stress setting.  This way, we can avoid the necessity of having that discussion during a medical crisis situation." 

Multidisciplinary palliative care team members – physicians, nurse practitioners, nurses, social workers and clergy – offer a wide range of services, including symptom management for disease-related concerns, pain management, emotional support, assistance in developing advance directives or care plans, and referrals for medical equipment or hospice as it becomes appropriate. Most patients come to palliative care relatively late in their disease process, and have just one or two outpatient appointments. Said Marks, “As the community begins to better understand our services, we can get involved sooner and potentially provide more assistance. Ideally, we would see a patient at time of diagnosis so we can follow their disease process. This would allow us to provide the most help and also have conversations about the patient’s end-of-life preferences.”
 
Although a provider referral is required for palliative care, a patient or a family member can ask for it. Amy Alonzo, LMSW, Palliative Social worker said, “An easy way to understand who could benefit most from palliative care is what we call the ‘surprise’ question, as in, ‘Would you be surprised if this person died in the next year?’ If the answer is no, or the patient has expressed that he or she is tired of the amount of time spent in treatment such as chemotherapy or dialysis, palliative care can be a bridge to hospice care, enabling the person to focus more on quality versus quantity of life.”
 
Palliative care staff can help patients zero in on their goals in a way that directs their entire care plan, by offering a whole-person approach and providing education on disease progression. Said Marks, “We are a consultative service, which means we get involved and see patients and their loved ones, but we do not take over their care. We make recommendations and collaborate with other providers regarding those recommendations.” This can be invaluable to patients and families, who may be overwhelmed with technical clinical terms or information. To achieve this, patients receiving outpatient palliative care services spend a significant amount of one-on-one time with team members: Appointments usually last around an hour. And the interdisciplinary nature of the team means each provider brings a unique perspective to the patient’s situation, with different resources to recommend.
 
Choosing UHS for palliative care services means patients and family members have access to the whole UHS network of specialists and services. Maureen Daws, Ph.D, FNP, Nurse Practitioner added, “These practitioners understand the benefit palliative care brings to a patient’s well-being, and they work in conjunction with us to ensure the patient’s ‘medical story’ does not get lost between doctors and appointments. Adding palliative care to a patient’s roster of services improves his or her journey through medical issues, and can help patients and families manage the physical, emotional and spiritual effects of a serious illness.”
 
Palliative care is typically covered by insurance, and UHS offers financial assistance and payment plans for those without insurance.
 
For more information about palliative care at UHS, visit nyuhs.org.