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Patients and Families Consider Palliative Care

April 02, 2008
denver and the west Patients and families consider palliative care Terminal patients and their families are increasingly weighing the merits of intense medical intervention. By Katy Human The Denver Post Article Last Updated: 03/25/2008 12:35:59 AM MDT 83-year-old cancer patient Alex Silva, at Exempla St. Joseph Hospital in Denver, is visited by medical social worker Eileen Warthen on Thursday afternoon. The real art of palliative care is putting patient and family right in the center, said Dan Johnson, a Kaiser Permanente Colorado doctor and an expert on end-of-life care. (Nathan W. Armes, Special to The Denver Post)As a medical student working the late shift at a Denver hospital, Dan Johnson watched a woman come into the emergency room with emphysema so serious, she was hustled onto a breathing machine. It was her third emergency visit in as many months. "Everyone knew her already," Johnson said. As a young doctor in training, Johnson's job was just to hold the woman's hand. Still, the next day, she thanked him and told him, he said, that she was getting tired of struggling to breathe. After her family arrived and a psychological exam showed she was not depressed, she removed herself from oxygen, took some medicine to relieve her discomfort and died. "There are times when advanced medical treatments don't make sense," said Johnson, a Kaiser Permanente Colorado doctor working today as a palliative-care expert — focusing on coordinated efforts to relieve the pain, symptoms and stress of terminal illnesses. In 2006, palliative care was recognized as a subspecialty by the American Board of Medical Specialties, and today, at least eight Denver-area hospitals have palliative-care experts. About 30 percent of all hospitals and 70 percent of large hospitals nationally offer palliative care, said Diane Meier, director of the Center to Advance Palliative Care, at Mount Sinai School of Medicine in New York. Studies show that palliative care is medically and economically efficient. A Kaiser-led clinical trial in Denver, Portland and San Francisco found that palliative-care patients were more satisfied with their treatment and, over six months, spent nearly $5,000 less than "usual care" patients. There was no difference in survival rates, according to the study, which appeared this month in the Journal of Palliative Medicine. "This is one of the few examples in health care of doing well by doing good," Mount Sinai's Meier said. At Exempla St. Joseph Hospital in Denver, where Johnson practices, he collaborates with nurses, palliative_08 -- Patient Alex Silva, 83, holds the hand of palliative care specialist Dr. Kathleen McGrady, MD. (SPECIAL TO THE DENVER POST | Nathan W. Armes)chaplains and social workers to help patients and families decide when intense medical intervention makes sense and when it does not. "Our team empowers patients and family to make choices, to be able to say, 'I'm going to get off that medical gerbil wheel,' " Johnson said. Palliative care is not hospice care, Johnson said. For hospice care, most patients must be no more than six months from death, and hospice patients give up the right to pursue life-prolonging or curative treatment. In palliative care, a patient can choose another stint on a breathing machine in the intensive-care unit or elect to continue chemotherapy that may not prolong their survival, Johnson said. "The real art of palliative care is putting patient and family right in the center," he said. "It's about providing good medical care — as defined by that patient and family." Doris Miller, 87, who received care from a palliative team at St. Joseph Hospital last month, died Feb. 25. "That team was such a relief," said her daughter, Nancy Miller, 60. "I call them guardian angels. They're right there, holding your hand every step of the way." When Nancy Miller visited her parents in their Denver retirement home in February, she noticed that her mother's skin was yellow. Within days, Doris Miller was at St. Joseph, diagnosed with bile-duct cancer, which caused the jaundice. "The team, they spent half a day with us, talking. My mother had questions; my father had questions," Nancy Miller said. "We decided on no further medicine, no chemo, and that she'd stay in the hospital." In the Denver area, the University of Colorado Hospital was the first to hire palliative-care experts, starting a pilot program in 2000. In addition to helping patients, palliative care can help hospitals better regulate resources, for example, keeping intensive-care beds open for emergencies, said Jean Kutner, a gerontologist and internist at the University of Colorado Denver School of Medicine. It also helps doctors and nurses in handling emotionally difficult cases. "We're giving them skills to help prevent patients from suffering," Kutner said. More effective management is increasingly crucial for patients and hospitals, said Mount Sinai's Meier. Katy Human: 303-954-1910 or khuman@denverpost.com