Curative vs. palliative care: Hospital blends the two

Program doesn’t require terminal diagnosis

The University of Maryland Medical Center is helping to blur the line between curative care and palliative care. Taking a page out of hospice’s book by implementing an interdisciplinary team, staff are able to provide both palliative care and life-saving care at the same time regardless of whether the patient is terminally ill.

The hospital-wide palliative/supportive care program is designed to help patients and their families deal with chronic or terminal illnesses or life-altering injuries. Since a three-month pilot project started in March 2001, more than 200 patients have been referred to the program. The program was fully implemented in February.

Hospital officials say the program is the first in the region that is hospital-wide and the only one funded entirely through the hospital’s operating budget, rather than foundation monies.

"We deal with people who have life-threatening, life-altering illnesses or injuries, but not necessarily a terminal diagnosis," says Jean Tucker Mann, MSW, the director of Social Work, Palliative Care and Patient Advocacy at the University of Maryland Medical Center, explaining a key difference between palliative care and hospice care.

Like hospice, though, the hospital employs a team that encompasses the patient’s needs. The hospital’s palliative care team comprises a physician, who serves as medical director, as well as a full-time social worker, chaplain, and nurse. The medical center also plans to expand the team to include a pediatric nurse to work with children and their families.

The team provides a range of support services, including pain management, counseling, and spiritual guidance. In the case of a Baltimore woman with advanced cancer, the team’s social worker helped to arrange for someone to care for her three grandchildren who lived with her in the event of her death so she could stop worrying about their future and focus on her own treatment.

"Patients referred for hospice care are expected to live six months or less. Some of our patients are able to go home, but the illness itself has altered the patient’s life forever. They could live a week or up to five years or more," says Tucker Mann.

"We are committed to extending the medical, psychosocial, and spiritual support that is characteristic of hospice care to a broader group of individuals in need," says Stephen C. Schimpff, MD, the chief executive officer of the medical center. "This includes any patient, their family, or loved ones who are trying to deal with life-altering illness. It is clear to us that quality-of-life issues are as important as medical ones to patients and families facing life-threatening and terminal illnesses. Our palliative/supportive care team promotes comfort and dignity for patients and their loved ones, and provides emotional as well as spiritual support."

Referrals to the palliative care program are made by nurses, physicians, case managers, social workers, chaplains, and others within the medical system. Palliative care is not provided unless everybody involved approves the referral, including the attending physician, the patient, and the family.

Cancer, respiratory or cardiac ailments, brain surgery, and transplant procedures were among the conditions suffered by the more than 200 patients who have used the service. Others were injured in automobile accidents. Most had terminal conditions.

"Many patients are at a crossroads in their lives," says the Rev. Kathleen E. Corbett, RN, M.Div. "They are either very sick and going to get better, or they’re very sick and not going to get better. We try to deal with all of their medical and emotional needs."

The program does not completely cut hospice out, although referral may come much later than expected. An team nurse described the case of a 61-year-old man who was slowly dying of multiple organ failure. The team arranged for the man’s family to take him home, although he was still on a ventilator. There, surrounded by family members and in familiar surroundings, he died the next day. "We were able to give him this quiet, peaceful time in his own home," says Janet Ward, RN, the team’s nurse.

The team works closely with the Visiting Nurse Association of Maryland, which is affiliated with the University of Maryland Medical System and provides palliative and hospice care services when a patient goes home or into a nursing home.