Palliative care teams enhance education

Devoting time to quality-of-life issues

Physicians and nurses helping patients learn to manage disease such as heart failure often have no time to talk about patients' preferences for care; if continued interventions are consistent with their goals, and what is hampering their quality of life.

A discussion about a patient's goals and preferences can't be done in five minutes, says Steven Z. Pantilat, MD, FAAHPM, SFHM, professor of clinical medicine and director of the Palliative Care Program and Palliative Care Leadership Center at the University of California, San Francisco.

A palliative care team can fill this gap in education. Team members can take time to discuss options and gain an understanding of what is important to patients, what they value, and what kinds of outcomes and states of health are acceptable to them and which are not. Once this information is understood, the treatment can support their goals, he says.

"Gaps in education may be helping people understand goals of care and letting them know about the opportunity to document their goals and preferences for care," says Pantilat.

In addition, at University of California, San Francisco, a palliative care team assesses a broad range of symptoms that include emotional and psychological issues as well as physical. Patients who are not taking their medication successfully might not need instruction on the medication regimen but need help with depression, says Pantilat.

Members of palliative care teams have special training in communication to help determine what a patient knows about their condition, what they understand, and what they want to know, says Nathan Goldstein, MD, associate professor at the Brookdale Department of Geriatrics and Palliative Medicine, Hertzberg Palliative Care Institute, Mount Sinai Medical Center in New York City. "We figure out where patients are in their understanding and then help them move along in terms of their understanding and their education," explains Goldstein.