Dr. Rebecca Brown, CaroMont Palliative Care Provider,
Makes the Distinction between
Palliative Care and Hospice
Learning that you have a serious illness is a challenging time and many
are left to endure chronic symptoms and suffering as a result. Understandably,
many are also left with questions and uncertainty about their future and
faced with important decisions regarding their health and quality of life.
Fortunately, for individuals who may find themselves in this situation,
there is hope. You have options to help make your life—and those
around you—much easier with palliative medicine.
CaroMont Health sat down with Rebecca Brown, MD, palliative care physician
at CaroMont Regional Medical Center, and Richard Lahm, Director of Gaston
Hospice, to understand palliative and hospice care and the ways the health
system can help patients make more use of these services.
People often confuse hospice and palliative but in fact, the two can be
separated into two different services. Can you explain the difference?
The distinction comes down to timing. Palliative medicine is care that
relieves suffering and improves quality of life for people of any age
and at any stage in a serious illness whether that illness is curable,
chronic or life-threatening.
Generally, when we talk about palliative care, it’s in the context
of serious illness such as chronic bronchitis, advanced heart disease,
progressive pulmonary disorders, HIV/AIDS, cancer, etc. Patients with
chronic illness need help to have a better quality of life, but it doesn’t
necessarily mean they are at the end of life.
Though very similar, hospice is palliative care without curative intent;
the patient no longer has curative options or has chosen not to pursue
treatment for personal reasons, or in some cases, the treatment risks
or side effects outweigh the benefits. Hospice is a subset of palliative
care, for end of life when the provider thinks the patient may have a
prognosis of six months of life or less.
What does it mean when you say palliative care?
Palliative care, or comfort care, has been around for centuries. We’ve
all received palliative medicine. I frequently use the example of strep
throat when I’m explaining what I do to patients. When you have
strep throat it can feel like your throat is on fire, so you go to the
doctor. You tell the doctor your throat hurts. The doctor performs a throat
swab and confirms that you have strep throat. You are prescribed an antibiotic
and instructed to take an antibiotic for the next 14 days. Your doctor
also tells you to gargle with salt water and take Tylenol. The antibiotic
treats the infection, but initially does nothing to ease your symptoms.
The salt water and Tylenol do nothing about the infection, but they’re
going to soothe your symptoms and make you feel better in the short-term.
The goal of the practice of Palliative Care is to help people with serious
illnesses feel better. It prevents or treats symptoms and side effects
of disease and treatment.tional, social, practical, and spiritual problems
that come with illness, and hopefully an improved quality of life can
What can a person expect when receiving palliative care?
When I meet with my patients and their families, I tell them to think
of me as their health advocate— someone who is in their corner and
someone who is going to be focused on their quality, goals and understanding
of their health situation. I am here to help them establish their goals
and determine what they need in order to better manage their symptoms
and achieve a better quality of life. Needs and treatment, and therefore
goals, are going to vary depending on the patient’s desires. For
some, it may be that they want to be able to sleep at night versus someone
else who wants to be able to work in the garage. These are two different
types of goals.
Palliative care means I also advocate for the patient and family to help
them understand their illness and exactly what’s going on with their
health. Healthcare can be very complex with a lot of information to retain.
While some patients and families are more medically-savvy than others,
I like to make sure each patient and their family understands what to
expect by spending extra time with them in the hospital. Working with
primary care doctors and other specialists, I help coordinate care. Additionally,
we are strong advocates for patient voice and patient Advanced Directives
(Living Wills and HCPOAs), which provide a strong legal patient voice
for certain extreme treatments. Basically, we advocate for everyone—the
patient, family, and clinical team. Illness is not fun, but it is my goal
to make my patients as comfortable as possible.
Who provides palliative care?
Palliative care can be available in a number of places including hospitals,
outpatient clinics, long-term-care facilities, hospices or home. My role
is primarily within the hospital, but Gaston Hospice offers palliative
care in the community. When a provider recognizes that a patient’s
symptoms need to be better managed, senses that the patient or family
may not understand their disease process or hasn’t defined end of
life goals, they will put in a consult for me to meet with the patient
and/or family and discuss any or all of the above.
Working collaboratively with primary care providers and other specialists,
Gaston Palliative Services, a division of Gaston Hospice, provides outpatient
palliative care for patients who are experiencing pain, stress and other
symptoms due to a serious illness. The hope with palliative therapy in
the outpatient setting is that primary care providers will begin to recognize
these advanced diseases and symptoms that would benefit from management
beyond what they can treat in the office. Palliative Nurse Practitioners
are able to check on patients in their home and report back to the primary
care doctor about their status. This systematic approach, focusing care
and assistance both in the hospital and outside of it, aims to provide
optimal quality for each person’s situation.
What are the different types of treatments you might provide?
Palliative therapies are all spectrums of care that focus on pain and
symptom control, communication and care coordination, and emotional support
for the patient and family/caregiver. Our focus is on chronic disease
states that are going to worsen over time, and that time frame can be
many years. The goal with palliative therapy is to try and slow the progression
of a disease as much as possible and in time, that will in part help ease
symptoms and make a patient more comfortable. Unfortunately, because many
of these illnesses are inevitably going to progress, patients may have
flares of symptoms from time to time. It’s in these situations when
a palliative care provider is there to offer additional support.
How long can one receive palliative care?
As long as a patient needs care and as long as they’re having symptoms
that need to be managed, we’re going to stay involved. Let’s
say through symptom management, a patient’s symptoms stabilize or
resolve, a palliative care provider may suggest to the patient careful
monitoring of their symptoms and overall health, and might step back.
How do palliative, hospice and primary care work together?
For patients who have been diagnosed with a chronic disease and life-limiting
illness, it is important that their transition from the hospital and back
home is seamless. Palliative care in the outpatient setting becomes the
primary care provider’s support team by working with patients in
their environment, and not necessarily in the doctor’s office or
hospital setting. After a patient is discharged from the hospital, our
Palliative Care Team works with the patient’s doctor to discuss
outpatient palliative care. Some physician practices offer outpatient
palliative therapy for patients who have not been in the hospital. It’s
important to talk to your doctor about palliative care options that are
available to you.
Having worked with providers in both palliative and hospice care for a
number of years, Richard Lahm, Director of Gaston Hospice, sees coordination
of care unfold through these different disciplines. He explains that “if
and when palliative care patients do become hospice appropriate, they
typically receive longer hospice services. This usually translates into
better experiences because with more time, hospice teams can provide more
services for the patient and their families. A lot of people think that
hospice care is only for those who are days away from death, but we encourage
people to think of it differently—hospice care is about understanding
where a person is in their life and making those final days, months and
weeks as comfortable and dignified as possible. Palliative care and hospice
share the commonality of both being focused on making a patient’s
quality of life the best it can be.”
About Dr. Brown
Why did you choose the medical profession?
I chose medicine as a teenager. I felt called to do something with my
life that was going to help people. My heart of hearts is in family practice,
which is my background. But from the beginning, I practiced in a very
palliative way. I listened to my patients and tried to come up with a
plan of care that was practical. I can read the guidelines and tell them
what to do, but I wanted to find out where they are in their health journey
and find out what their goals are, which change over time. Eventually,
this led me to a career in palliative care that allows me to sit down
and help patients understand what’s going on with their health and
advocate for them. It’s a big honor. It’s humbling, particularly
the hospice end of it.
How has your philosophy of care impacted how you work with patients?
I think the ability to do what I do well starts with me not talking but
instead listening. I’m also very thorough in my review and assessment
of all my cases. When I go into a patient’s room, I make it a point
to tell them that I’ve been looking at their chart and that extensive
collaboration has been taking place between the different doctors to make
sure they receive excellent care. Without hesitation, I am able to tell
them that no stone has been left unturned.
Because palliative care requires that I have a broad understanding of health,
I believe my family practice background provided me with this foundation
and set the stage for my current role. A fundamental part of my training
in primary care that I keep with me is to never forget why the patient
is there for assistance. They may not come in and say, “I’m
having a heart attack.” Instead, they may say, “I’m
having chest pain,” “abdominal pain,” or some issue
with something that’s uncomfortable. Physicians should diagnose
and treat the disease, but should not forget the reason why a patient
is really there, which is their chief complaint. I am in a unique position
to help a patient feel less pain and suffering and make more effective
decisions about treatment, options and choices.
Rebecca Brown, MD joined CaroMont Health and Gaston Palliative Services
in July 2016. She attended the Medical University of South Carolina in
Charleston, SC and completed her residency at Palmetto Health Richland
Trauma Center in Columbia, SC. She is Board Certified by the American
Board of Family Medicine. While caring for her patients is her passion,
she also enjoys several hobbies including: crafting, cooking and beading,
and is involved with her church. She and her husband have two teenage boys.
To learn more about Gaston Palliative Services and Dr. Brown, click