News and Information
Featured Stories
Palliative Care Program Offers Patients Hope for Quality-of-Life
The Yale-New Haven Hospital Adult Palliative Care Service has been providing comprehensive interdisciplinary care to patients and their families since October 2007. The service, directed by Lawrence Solomon, MD, focuses on symptom management and quality of life issues for adult patients with serious chronic progressive or terminal illnesses. Dr. Solomon is also Associate Professor of Medicine and the former director of the Adult Sickle Cell Service at Yale. Much of his clinical research is focused on palliative care.
Pain Rating Scale
“An important distinction needs to be made between hospice care and palliative care. Palliative care is available to patients at any stage of their illness and helps to improve and maintain the quality of their lives at the same time that other treatments are being used to control or possibly cure their underlying disease. If treatment of the illness is no longer effective, palliative care continues to focus on maintaining patient comfort and meeting the needs of patients and their families,” said Dr. Solomon.
Leslie Blatt, APRN, is the Clinical Coordinator of the service. She and Dr. Solomon initially consult with patients together and then Leslie handles the follow-up care. They commented that because physicians and nurses have limited time during regular appointments to spend discussing symptom management with their patients, their main objective with the Palliative Care Service is providing the time needed to discuss these issues.
Traditionally, palliative care has focused mainly on cancer patients, but Dr. Solomon and Leslie care for patients with many kinds of chronic progressive diseases, including heart disease, lung disease, and neurologic illnesses, to name a few. The program is centered on the patient and their family, and deals with physical issues such as pain, fatigue, and nausea; and also with psychosocial issues like depression, disruption of family life, and financial concerns.
The program has seen more than 700 patients so far and the referral rate continues to increase. They have recently started an outpatient clinic as well, where they see 4-8 patients a week. Any physician caring for a patient with a potentially life-threatening illness can initiate a consult. The consultation includes a comprehensive review of medical records, a detailed medical history, a physical examination, and a discussion of the symptoms, goals, values, social interests, and spiritual needs of the patient and his/her family. Ongoing evaluation and follow-care is then provided as needed.
“We take time to listen to the patient and help them sort through all of the information they have received and, based on this assessment, come up with a plan of care. The plan of care is constructed using a multidisciplinary approach that involves a psychologist, a social worker, pastoral services, and other related fields,” Leslie said. They also coordinate family meetings 2-3 times a week that include the multidisciplinary team. Leslie explained that the key to successful palliative care is communication between all specialists involved.
Although the program is not limited to cancer patients, the program operates under Yale Cancer Center, which provides financial support and management assistance. The Palliative Care Program will also practice in the new Smilow Cancer Hospital at Yale-New Haven.
“It’s not the disease, it’s the individual that is the focus of care. Ours is a very individualized approach and is based on the needs of each individual patient and his/her family,” said Dr. Solomon. “There is an enormous need for this type of program but palliative care is often under-utilized because both patients and physicians tend to think of it solely as ‘end-of-life’ care instead of ‘quality-of-life’ care.”
Future goals of the program include hiring more faculty to expand the services; providing education to clinicians, students and the community at large; starting a fellowship program so that more physicians are trained in the field of palliative care; and improving services through critical, non-invasive observational research.
Covering a large scope of care, the YNHH Adult Palliative Care Service provides an individualized, multidisciplinary approach to patient care that is needed by patients with serious, chronic progressive illnesses that interfere with their daily lives. It is offered not only as last resort end-of-life care, but as quality-of-life care for patients with both physical and psychosocial needs at any stage in their illness.