On Tuesday evening, May 10, Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, welcomed everyone to a virtual lecture on palliative care. The lecture was hosted, as always, by Congregation Etz Chaim. Dr. Breite noted that the idea of palliative care was never taught when he was in medical school, and Dr. Cynthia Pan, Director of Palliative Care at NewYork-Presbyterian Hospital Queens, also shared that this term was not taught when she attended medical school. So, it is a fairly new idea.
Dr. Cynthia Pan shared that it’s not so easy to talk about this subject. She introduced Dr. Kelly Thomson, who is a resident in palliative care at NewYork-Presbyterian Hospital and who also shared information during this lecture.
Dr. Thomson shared that hospice is under the larger category of palliative care, and hospice is for patients with a diagnosis that they have only six months or less to live. Palliative care, on the other hand, is for anyone living with a serious illness. It provides pain management and specialized medical care with a team of specialists.
Dr. Pan shared that there is a lot of stress when there is a serious illness, and the palliative team works to provide an extra layer of support for the patient and the patient’s family. The goal is to improve quality of life and to help with pain management and to reduce suffering. The focus is on relief of symptoms and to provide help to reduce stress for the patient and the family. It is good to have palliative care become involved as early as possible. It is for any age or stage of illness. She stressed that, “along with curative treatment, the goal is to improve quality of life.”
She shared statistics that show how the population in America and the world has an increasingly larger percentage of people over 65. Life expectancy is into the 70s and 80s. Cause of death in earlier times used to be pneumonia or infections while now it is more chronic illnesses like heart disease and cancer. Some 95 percent of hospitals in the United States offer palliative care. There are some homebased agencies. It is harder to procure this care outside of the hospital.
Dr. Pan then detailed how hospice is different from palliative care. Hospice focuses on comfort, reducing suffering, and reducing stress of the illness, and the focus is also on the patient and the family. It can be done in a nursing home, hospital, or in the patient’s home. She shared that Medicare provides 13 months of bereavement care support for the family.
Patients on hospice who were interviewed shared that they want pain controlled, to avoid prolonging dying, to achieve a sense of control to relieve burden on the family, and to strengthen relationships with loved ones. Dr. Pan noted how, during 9/11, when people on the plane knew they were going down, the first thing they did was call their family to say good-bye.
Family members of patients on hospice who were interviewed shared that they want the wishes of their loved-one honored, they want to be included in the decision process, practical help for caring for patient, to be listened to, and to be remembered and contacted after the patient dies.
Palliative care can help family have conversations with the patient to find out what the patient wants in terms of health directives.
A study showed that patients with terminal illness who had palliative care lived longer lives than those who did not have it. Dr. Pan explained that she believes this is because they had a support system treating their pain and symptoms.
Dr. Thomson then spoke about advanced dementia and decision-making in this situation. People lose memory and functioning and it’s a progressive disease. Eventually, they lose the ability to swallow or to walk. In the end stage, they cannot interact with their family. So it’s important to talk with the person before, to find out what he or she would want in the future in terms of care.
Dr. Pan said it used to be an automatic thing to give a person with dementia a feeding tube, but today palliative care experts find that it is more effective psychologically to provide care with hand-feeding.
She stressed the importance of have advanced directives and appointing a health-care proxy agent. “Talking about it makes you prepared.” Palliative care provides the opportunity for advance directives. She then spoke about resuscitation preferences.
She shared that most insurance plans, including Medicare and Medicaid, provide full or partial coverage for palliative care. A social worker from the palliative care team can help with payment options. The team partners with the primary care doctor so both that doctor and the family benefit. The palliative care team holds family meetings and meets with the patient, as well, to discuss options based on what they want and to make recommendations. Under New York State Law, a person with serious illness must be provided with palliative care. It is harder to obtain palliative care on an outpatient basis.
Rabbi Charles Rudansky, who has worked in hospice since 1993, added his thoughts, and he praised to Dr. Pan and Dr. Thomson for this informative lecture.