Maine gets a B for hospital comfort care

Erin Fredrichs | BDN
Posted Oct. 04, 2011, at 5:38 p.m.
Last modified Oct. 05, 2011, at 12:07 p.m.

BANGOR, Maine — Many people are unfamiliar with the term “palliative care,” but a new national report suggests that it is becoming an essential component of the U.S. health care system and that more and more Americans soon will come to appreciate the services it provides.

In a study released Wednesday, Maine scores a B grade for the number of hospitals that provide the comforting and supportive measures available though palliative care.

The emerging medical specialty aims to relieve symptoms such as pain, nausea and anxiety while improving quality of life for patients and their families who are living with a serious or terminal condition. Unlike hospice services, which only can be provided for the projected final six months of a patient’s life, and then only if the patient agrees to forgo aggressive interventions, palliative care is appropriate at any stage of a serious illness and can be provided along with curative treatment.

“This is not just for the end of life. Once the diagnosis of any terminal condition is made, we can get involved, ” said Dr. James Van Kirk, medical director for palliative services at Eastern Maine Medical Center in Bangor. “We work with a whole lot of people who are getting very aggressive therapies. Our job is to try and help them get through it.”

For patients undergoing cancer treatment, for example, the palliative care team helps ensure that pain and nausea are well controlled.

“No one wants to live in pain, or die in pain,” Van Kirk said. In addition, the team, including physicians, nurses, chaplains, social workers and volunteers, also helps family members and caregivers understand the often confusing progression of a loved one’s illness. And when the time comes to consider giving up aggressive medical therapies, risky surgeries and other traumatic procedures, palliative care providers can help make the medical and emotional transition to “comfort-only measures” easier.

Many patients and families, Van Kirk said, find great relief in taking a less stressful road through illness.

“Many people still think the doctor is God and if the doctor suggests [a treatment] they’ll do it,” said Nadine Tasker, nursing director of the palliative care program. “We’re a support layer. We tell them it’s OK to say no and die with dignity.”

The team also helps hospitalized patients and families create a comfortable environment that includes music, photographs and visits from beloved pets. Out of the hospital, the team provides care in patient homes, nursing homes and other settings.

The new report, “America’s care of serious illness: a state-by-state report card on access to palliative care in our nation’s hospitals,” finds that 20 of Maine’s 39 acute-care hospitals offer palliative care services. Those hospitals range in size from the state’s largest facilities in Portland and Bangor down to some of the smallest 25-bed community hospitals. Across the nation, 50 states scored a B grade. Seven states — Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Vermont and Washington — received an A. Delaware and Mississippi received an F. Overall, the United States scored a B.

Authors of the survey, conducted for the Center to Advance Palliative Care, said the nation as a whole has made progress in providing palliative care to patients who want it. But still, the report notes, more must be done. As Americans age and live longer, there will be more demand placed on the health care system to treat symptoms associated with aging, including heart disease, lung disease and diabetes.

“Patients followed by palliative care teams are less likely to die in the hospital, are likely to spend fewer days in the ICU, have better pain management and higher satisfaction with their health care,” according to Dr. Sean Morrison, the study’s lead author. In addition, he said, by supporting patients who decide against aggressive medical treatment for terminal conditions, palliative care providers save money for patients, families and the health care system.

The report calls for national strategies to expand the availability of palliative care, including work force development, more research to establish effective approaches and reimbursement reform to enable hospitals of all sizes to better support palliative care teams.

The full report can be read online here.

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