Palliative care moves beyond hospital setting

Palliative care, no longer restricted to the terminally ill, is making strides across multiple care settings.

Last week, Cleveland Clinic celebrated the 25th anniversary of its palliative medicine program. As the first program of its kind, according to Cleveland Jewish News, the palliative program works on cancer symptom control, case management, inpatient consultation services, outpatient clinics, family education, referral services, home care, hospice and bereavement services--but not isolated to the hospital setting.

"The idea is there is a menu of services available so no matter whether the patient was home, in the outpatient clinic or in the hospital there was an ability to look after them wherever they are," program director Declan Walsh said. "In the setting of a complicated illness, people move from hospital to home (and) from home to outpatient clinic and so it's very important to provide continuity of care between those different areas."

The program has 100 caregivers, made up mostly of nurses but also includes 12 attending staff physicians and three research fellows. Cleveland Clinic plans to recruit several new doctors in the next couple of years to expand the program across the entire health system, according to Walsh.

The availability of palliative care services may be a reaction to patient demand. According a California HealthCare Foundation survey, 70 percent of Californians said they would like to die at home, although most deaths occur at hospitals or nursing homes.

"Patients shouldn't have to be hospitalized to get this kind of care," Judy Citko, executive director of the Coalition for Compassionate Care of California, told California Healthline. "So whether you're getting care from a clinic, a nursing home, whatever setting you might be in, or just living in your home and seeing your primary care doctor, that you can always have access to palliative care," she said.

"We are getting more and more involved with patients who are coming to the hospital to pursue complex, curative care," Parag Bharadwaj, medical director of palliative care services at Cedars-Sinai Medical Center in Los Angeles, told California Healthline. Cedars, one of the busiest palliative care programs in the country with up to 40 patients a day, also targets heart failure and bone marrow transplant patients, for instance.

"I think where we've been very successful here is getting involved early on in a patient's care," Bharadwaj said. "So that makes it a lot easier to handle those very difficult conversations and situations with the patients, and also with the staff, because we always have a very clear plan of care up front."

Hospital palliative care has more than doubled at a 138 percent increase in the past decade, according to the Center to Advance Palliative Care.

For more information:
- listen to the California Healthline audio report and read the transcript (.pdf)
- read the Cleveland Jewish News article