Our Palliative Care Team Champions Patients' Wishes

While hospice and palliative care are often confused because they share similar goals of providing symptom relief and obtaining a better quality of life, their role in patient care is different, said Lisa Raptis, MD, Medical Director of Palliative Care at Pomona Valley Hospital Medical Center (PVHMC).

A good example is a cancer patient who is receiving chemotherapy from an oncologist while the palliative care Physician manages any discomfort. “Palliative care manages symptoms such as pain, shortness of breath, nausea, vomiting, anxiety, depression and lack of appetite while the patient continues to be followed by physicians for disease-specific treatments,” Dr. Raptis said. “Palliative care works concurrently with the patient’s other physicians with the goals of improving quality of life throughout their chronic, life-limiting disease. In contrast, hospice focuses on providing comfort management when other treatments have been proven to be more burdensome to the patient than beneficial. Hospice allows patients to die peacefully, comfortably and naturally.”

Palliative care is an interdisciplinary service provided to patients who have a chronic, life-limiting illness like congestive heart failure, kidney or liver disease, stroke, chronic obstructive pulmonary disease (COPD), dementia, cancer, respiratory failure, trauma and many other conditions. While PVHMC currently provides palliative care only while patients are in the Hospital, it works with external agencies if a patient transitioning out of the Hospital wishes to receive palliative care outside the Hospital.

“Palliative care can begin at any stage of the illness,” Dr. Raptis said. “We work collaboratively with the patient’s other treating physicians and medical team to provide the best care for the patient and support for their families.”

PVHMC’s palliative care team includes a Physician, Nurse, Social Worker, and Chaplain. The team supports the comprehensive management of physical, psychological, emotional and spiritual needs of patients and their families. “We have an extensive discussion with the patient and family about their disease, the expected disease trajectory, treatment options, and prognosis,” Dr. Raptis said. “We explore with patients what their goals are through this difficult disease process. We also have very difficult conversations about what their specific wishes would be at the end of their lives.”

“We want to optimize the quality of the patient’s life, however they define that,” said Debra Blankenship, RN, PVHMC’s Director of Utilization Management. A portion of PVHMC’s Palliative Care patients do eventually transition to end of life, she said. The Palliative Care team talks with the patient and family about what they can expect based on the facts of their individual medical condition.

“If you want to be treated with every piece of high-tech equipment we own in the Hospital, then that’s what we support,” Debra said. “But if you want to die peacefully at home, then we support that as well.”

Many times the team becomes familiar with patients because of readmissions to the Hospital. “It’s an ongoing conversation,” Dr. Raptis said. “If they want to change their treatment goals and go in a different direction, we’re there to support decisions they make along the way.”

Debra said PVHMC encourages everyone to have an advance directive, which outlines what kind of care they want to receive in the event an illness or injury renders them unable to express their wishes.

“A lot of people, especially young people, don’t think an advance directive is necessary,” Debra said. “But we see catastrophic injury and illness in people of all ages. An advance directive makes it clear what you want and don’t want and takes the decision-making burden off your loved ones.”

Palliative care services are not reimbursed by insurance. “PVHMC sponsors our half-million-dollar a year Palliative Care program so that it is available to all patients, regardless of their ability to pay,” Debra said. “Our mission supports the program because we recognize the value of it to our patients and community.” PVHMC’s Palliative Care program was the third in California to be certified by The Joint Commission. To date, there are only six certified programs in the state.