American Society of Regional Anesthesia and Pain Medicine February 2015 - (Page 20)
Palliative Care and Pain Medicine-Beyond Intrathecal Pumps
and Opioids
with expertise in these domains and a focus on interdisciplinary
collaborative care, can help provide an extra layer of support to
these patients and families as well as the clinicians caring for them
in both the inpatient and outpatient setting.
Halena M. Gazelka, MD
Anesthesiology, Pain Medicine,
and Palliative Medicine
Jacob J. Strand, MD
General Internal Medicine and
Palliative Medicine
Mayo Clinic
Rochester, Minnesota
Section Editors: Andrea Nicol, MD, and Kevin Vorenkamp, MD
"
W
hat is palliative care?" is one of the more common
questions we hear when introducing ourselves on our
inpatient hospital consult service. Patients, nursing staff,
and fellow clinicians are often unsure about our role in patient care
or associate our presence with end-of-life care.
As a relatively new specialty, and one that grew out of the
hospice movement, it is understandable that people would ask
such questions. With the ever-increasing complexity of care for
patients with serious illnesses
and the growing evidence
for introducing palliative
care early in the course of
a patient's care, palliative
care providers are strongly
positioned to help educate
providers from all specialties
about the benefits of early
collaboration.
The provision of palliative care is rapidly becoming mainstream,
with palliative care consultative services available in more than
60% of United States hospitals with greater than 50 beds and an
even higher penetration (>85%) in hospitals with more than 300
beds.1 Palliative care teams help care for patients with a widevariety of serious illnesses, such as cancer, congestive heart
failure, chronic obstructive pulmonary disease, end-stage renal
disease, neurodegenerative disorders, and critically ill patients in
a variety of intensive care unit (ICU) settings. As the evidence for
earlier palliative care integration has increased, more programs are
developing and staffing outpatient palliative care clinics to meet the
needs of patients with a serious illness in a variety of care settings.
THE CASE FOR PALLIATIVE CARE
Palliative care teams focus on treating symptoms of a serious
illness, including pain, dyspnea, fatigue, constipation, nausea,
anorexia, insomnia, and depressed or anxious mood. Palliative
care clinicians engage in complex communication interactions
surrounding medical decision-making and look to help delineate
a patient's goals, preferences, and values. This approach to care,
done in collaboration with referring clinicians, seeks to both
improve a patient's quality of life and help align a patient's care
with those values, working to provide the right form of care, at the
right time, in the right care setting.
As palliative care has grown as a
specialty, so too has the evidence
for its involvement earlier in the
course of a patient's serious
illness. Early palliative care
involvement has been shown to
significantly reduce symptom
burden such as dyspnea, anxiety,
depression, and pain for a variety
of patients with serious illness from cancer to heart failure to chronic
obstructive pulmonary disease.2 Importantly, palliative care services
have been shown to improve overall patient well-being and quality
of life, reduce caregiver burnout, increase satisfaction with care, as
well as reduce ER visits, hospitalizations, ICU and hospital length of
stay, all without increasing mortality.3 In fact, we now have a number
of well-designed clinical trials revealing that early palliative care
involvement in patients with metastatic cancer may actually impart a
survival advantage compared to standard care.4,5
"Palliative care providers are
strongly positioned to help educate
providers from all specialties about
the benefits of early collaboration."
Palliative care is specialized medical care for patients with serious
illnesses. Our mission is to provide relief from the symptoms of
serious illness while assisting patients and families with support
in achieving their goals for medical care. Particular importance is
placed on improving and achieving quality of life.
Basic symptom management, prognostication, and clarifying
treatment goals are inherent to the practice of nearly every medical
specialty. However, the situations of patients suffering serious
medical illnesses are often complex, fraught with difficult to
manage symptoms, communication challenges, and a need to align
treatment decisions with appropriate goals of care. Palliative care,
20
2
PALLIATIVE CARE COLLABORATION WITH PAIN MEDICINE
SPECIALISTS
The effective management of complex pain in patients with
American Society of Regional Anesthesia and Pain Medicine
2015
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2015
In Memoriam : Alon Palm Winnie, M.D., ASRA Founding Father
President’s Message
Editorial
40th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
Resident and Fellow Events at the 2015 Spring Meeting
How We Do It: Managing an Acute and Perioperative Pain Medicine (APPM) Service at the University of Florida
Ketamine—an Old Drug with New Tricks
Optimal Postcesarean Delivery Pain Management
Palliative Care and Pain Medicine—Beyond Intrathecal Pumps and Opioids
Scientist Spotlight—Dr. Guy Weinberg, Trailblazer in Patient Safety
American Society of Regional Anesthesia and Pain Medicine February 2015
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