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Palliative Care and Hospice, Understanding the Difference


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 be achieved.

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 here.

Categories: Health, Q&A