A Palliative Care Physician Offers Advice For Patients And Families Who Are Confronting Serious Illness
If you or a loved one has a serious illness like COVID-19, it’s important to control symptoms and, when appropriate, create a plan for end-of- life care. Marianne Holler, MSW, DO, FAAHPM, a palliative care physician at Community Medical Center (CMC) and Chief Medical Officer of VNA Health Group, explains the benefits of palliative care.
What is palliative care?
The goal is to support patients and families coping with advanced, life- limiting illnesses. Some people confuse palliative care with hospice care. Hospice refers to palliative care in the last six months of life. With palliative care, we discuss the effects an illness is having on a patient’s quality of life and his or her family. We also talk about his or her goals. If we can control symptoms, we can keep patients out of the hospital and help them live their best life.
What’s the best time to start the conversation?
A patient or family member should, ideally, begin discussing palliative care when he or she is diagnosed with an illness. If the conversation is started too late, it becomes a discussion about hospice care. The benefit of starting the conversation earlier is that patients and their families can determine what’s an acceptable quality of life. For instance, how does a patient feel about being in the Intensive Care Unit (ICU) or on life support? What level of pain is acceptable? Palliative care physicians usually have these conversations with patients and families in person. Due to the pandemic, meetings are being conducted virtually.
How can you talk about palliative care with a loved one?
Patients are taught that if they have a certain diagnosis, they should pursue a particular treatment. But what is the goal? Will a medical intervention rob you of your quality of life or help you? I always tell patients, “Your goal is to live as long as you can, but if things don’t go as you hope, there has to be a road map.” Ask your loved one: “Do you have a living will? Have you appointed a health care proxy?”
What are practitioner orders and how do they differ from advance directives?
If you or a loved one is seriously ill, you should have Practitioner Orders for Life-Sustaining Treatment (POLST), a form that specifies the treatment a patient wants for his or her medical condition. It’s signed by a physician and can be enforced in the absence of a family member. An advance directive, on the other hand, is a legal document that outlines the treatments a patient wants if he or she becomes ill. The patient also designates a person to make health care decisions for him or her if he or she is unable to do so. The document must be included in the medical record.