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Program takes new approach to palliative care by Heather Woolwine Public Relations Along with a new year, January brought another change to MUSC and the Hollings Cancer Center—namely, a new way to view and treat patients with life-limiting diseases. Conscious of an increasing older adult population and, subsequently, of those that will suffer from life-limiting or terminal illnesses, MUSC began its Supportive and Palliative Care Program. Representing the Supportive and Palliative Care Program Team Task Force from left are: Winnie Hennessy, R.N., clinical nurse specialist; Dr. Frank Brescia, professor of medicine; Casey Liddy, business manager; and Mary Wilbur, R.N., care manager. Designed as an interdisciplinary team approach to support patients with life-limiting or terminal diseases who exhibit complex physical, psychological, social, and spiritual problems, the program’s main goal is to alleviate suffering and improve the quality of life for patients and their families. MUSC’s program plans to operate 24/7, with formal consultations from 8 a.m. to 5 p.m. for adults and pediatrics. Winnie Hennessy, R.N., clinical nurse specialist, steers most of the consultations. For her, the program’s core principles realize her dream job. “I attended my first palliative care conference in San Diego in 1991,” she said. “With all of the years I spent in ICUs, I felt that this approach got it right where the patients were concerned. It made the ICUs seem less number-and machine-oriented and more about helping those who are suffering in so many ways.” Also helping to run the program are Pat Cawley, M.D., hospitalist program director, Frank Brescia, M.D., the palliative care program’s medical director, and Jerome Kurent, M.D., medical education leadership. The palliative program is meant to operate like consultation-style service. “This program is designed for patients who suffer from illnesses like AIDS, heart failure, COPD, and stroke,” said Colleen Corish, R.N., Oncology and Medical Surgical Services clinical director. “And this program needs physician buy-in for it to work. Fortunately, we’ve achieved that.” Corish mentioned that, historically, physicians have a difficult time releasing some of the control they exert over a patient’s care. “Physicians ‘fix’ the problems affecting their patients,” she said. “And they will use every treatment or means necessary to save those patients. But sometimes nothing works, and the patient and family must be prepared to deal with a more supportive or palliative approach. We look at this program as a partnership with physicians, nurses and the rest of the health care team to help alleviate the suffering these people go through when facing life-limiting disease.” National data supports MUSC’s move into the palliative care field and recognizes the numerous benefits associated with these types of programs, like more effective treatments for patients; increased quality of life; decreased caregiver burden; increased patient and family satisfaction; increased staff satisfaction and retention; increased capacity within the hospital (decreased length of stays); compliance with JCAHO standards; and decreased costs (less unwanted or inappropriate testing/procedures). In fact, Hennessy and her colleagues predict cost containment of approximately $100,000 in hospital savings for the first year of MUSC’s program. Linked with the MUSC Hospitalist Program, the Supportive and Palliative Care Program plans to offer educational opportunities to students, faculty, and staff through grand rounds, lecture series, mentorships, and a palliative care fellowship. Hennessy described some of the barriers that in the past have rendered health care professionals less equipped to deal with patients who suffer from life-limiting diseases. They include: clinicians’ lack of knowledge of ethics, laws and standards in relation to those patients, decreased awareness of the patients’ specifics problems, decreased understanding of their needs concerning chronic pain and symptom management, little funding for palliative care research, lack of standardized guidelines in hospitals, and suboptimal communication among the physician, nurses, other health care providers, the patient, and family caregivers. “It is important to introduce palliative care programs into hospitals, not only to alleviate suffering,” Hennessy said, “but because the public wants this type of care. Eighty to 90 percent of the population wants to die at home, but 75 percent of the population dies in the hospital or a nursing home.” However, Hennessy cautioned that palliative care programs are not substitutes for hospice care. “Think of it this way,” she said. “From the point of diagnosis, a patient has a variety of treatment options available and little palliative care involvement, but as time goes on and those options diminish, palliative care participation increases. About the six-month mark prior to the possibility of death, and once every option has been exhausted, hospice can step in to prepare the patient and family for the dying process and bereavement.” With hopes to re-establish and further develop hospice collaboration and to move MUSC into the forefront of palliative care, Hennessy and her colleagues have ambitious goals for the program's next three years. “We hope to obtain an inpatient unit with 12 beds, develop a strong curriculum, preceptorship, and fellowship, expand our research opportunities, and exceed cost containment projections,” she said. “But above all, we hope to better serve and alleviate the suffering, in all aspects, that our life-limiting disease patients endure.” For more information, contact Hennessy at 876-1121. MUSC Supportive and Palliative Care Program Team Task Force Winnie Hennessy, R.N., Elena Bell, John Heffner, M.D., Colleen Corish, R.N., Alice Boylan, M.D., Rachel Herbert, Casey Liddy, Lynne Brown, Jerome Kurent, M.D., Marilyn Schaffner, R.N., Cindy Carter, Ph.D., Kristi Lentz, Pharm.D., Frank Brescia, M.D., Pat Cawley, M.D., Rick Smith, M.D., Marci Tumbleston, Charlie Tupper, R.N., Sally Webb, M.D., and Mary Wilbur, R.N. Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.