NJ Hospitals Continue to Address Patient Pain With Palliative Care

Andrew Kitchenman | April 15, 2013 | Health Care
Lourdes reaches agreement with Samaritan to provide palliative care earlier in treatment cycle

Dr. Alan R. Pope, Lourdes’ chief medical officer.
Healthcare professionals are increasingly recognizing that palliative care, which focuses on reducing patient pain and improving quality of life, can be more important than curing or eliminating disease. And New Jersey hospitals are among the leaders nationally of this emerging trend.

Camden-based Lourdes Health System became the latest to increase its palliative care offerings last week, when it announced an agreement with Samaritan Healthcare & Hospice of Evesham to launch a palliative medicine program.

The expansion of palliative care into hospitals is an outgrowth of the hospice movement, a specific form of care for patients with terminal illnesses. But the Lourdes’ decision is meant to aid patients who aren’t in the last stages of life but may have a condition such as chronic pain that isn’t amenable to a cure.

Doctors who don’t specialize in palliative care “are often thinking of all of the technical aspects of a patient’s illness and perhaps they don’t spend as much time thinking about the patient’s goals as they would like to,” said Dr. Alan R. Pope, Lourdes’ chief medical officer.

Pope cited a 2010 study published in the New England Journal of Medicine that found that patients receiving palliative care lived longer at a lower cost of care.

“That might seem to be a contradiction because sometimes they weren’t choosing as aggressive care, but there’s something about having an improved quality of life that not only makes people happier but in some cases prolongs their life,” Pope said.

Palliative care only received national recognition as a medical specialty in 2006, but it’s grown steadily in the state. Of New Jersey hospitals, 80 percent offer some form of palliative care, compared with the national average of 63 percent, according to the Center to Advance Palliative Care.

“As a person gets older, they’re really focusing on how they want to be treated and how they’re going to want to be treated if they can no longer communicate,” said Don Pendley, president of the New Jersey Hospice and Palliative Care Organization, which represents 46 licensed hospices.

Pendley said Lourdes’ announcement reflects a broader trend of hospitals focusing on providing relief from pain.

While palliative care isn’t focused on care of the terminally ill, it does leaves patients better prepared for the terminal stages of their illness.

“The discussion of end-of-life issues isn’t going to be something that’s going to be done in a 15-minute doctor’s appointment,” said Pendley.

Pendley added that palliative care has always been a team-based form of healthcare, with doctors, nurses, social workers and — frequently — chaplains involved. It could provide a model for other branches of medicine as the healthcare system moves toward more coordination of care.

“Ten years, ago the concept of palliative care had almost no public recognition,” Pendley said. “I think the medical community as a whole has seen the value of more interdisciplinary care.”

Dr. Stephen Goldfine, Samaritan’s chief medical officer and a palliative care specialist, said the new program would allow patient symptoms to be managed more aggressively.

“We’re trying to move [palliative care] up in the stream of care,” Goldfine said, referring to providing the care at an earlier stage.

Goldfine said he and other Samaritan doctors will visit Lourdes patients in the hospital after their treating physician determines they will benefit from a discussion of palliative care. Lourdes and Samaritan officials said that prime candidates for palliative consultations include patients with cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s, HIV/AIDS, ALS, and multiple sclerosis.

Ultimately, Lourdes patients who have been released will receive care from Samaritan on an outpatient basis. While palliative can frequently lead to patients undergoing fewer tests and less expensive treatments, this is an outgrowth of focusing on the patient’s goals and not the goal itself, Goldfine said.

“We’re not recommending that we do nothing [to treat the illness],” he said, citing as an example a patient who didn’t want to visit the hospital frequently to have fluid drained. Goldfine recommended having a catheter inserted that allowed the patient to drain the fluid at home.

While Samaritan began offering hospice care in 1980, it only began its current in-hospital palliative care program in 2011, after a two-year pilot. It provides palliative consultations in Virtua’s hospitals. Virtua executive Dr. James Dwyer has been impressed with the results.

“It’s forced us to take a more comprehensive look at the patient’s needs,” Dwyer said.

He noted that advancements in healthcare have led to patients living longer, which can result in patients with cancer or congestive heart failure dealing with chronic conditions for a longer period of time.

“If you don’t have palliative care and hospice care, I think that’s a huge gap in the continuity of care,” Dwyer said.

Patients will “choose the quality of life they want and the treatments that are appropriate for their stage of life,” he said.