Palliative Care 2021

Transcript

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00:13 --> 00:15Welcome to Yale Cancer Answers with
00:15 --> 00:17your host doctor Anees Chagpar.
00:17 --> 00:19Yale Cancer Answers features the
00:19 --> 00:21latest information on cancer care by
00:21 --> 00:22welcoming oncologists and specialists
00:22 --> 00:25who are on the forefront of the
00:25 --> 00:27battle to fight cancer. This week
00:27 --> 00:29it's a conversation about palliative
00:29 --> 00:30care with Doctor Laura Morrison.
00:30 --> 00:32Doctor Morrison is an associate
00:32 --> 00:34professor of medicine and geriatrics
00:34 --> 00:36at the Yale School of Medicine,
00:36 --> 00:39where Doctor Chagpar is a
00:39 --> 00:41professor of surgical oncology.
00:41 --> 00:42Laura,
00:42 --> 00:44maybe we could start off by you
00:44 --> 00:46telling us a little bit more about
00:46 --> 00:49what exactly is palliative care.
00:49 --> 00:51I get the sense that there are
00:51 --> 00:53still some misperceptions about
00:53 --> 00:54what the term really means.
00:56 --> 00:59That's a common point.
00:59 --> 01:02It's something that a lot of
01:02 --> 01:04people still wonder about,
01:04 --> 01:07so I'm really happy to
01:07 --> 01:11give another sense of what it is.
01:11 --> 01:13Palliative care is a medical
01:13 --> 01:15subspecialty that focuses on quality
01:16 --> 01:18of life for patients with serious
01:18 --> 01:21illness of any type and their families.
01:23 --> 01:26And we also focus on relieving suffering,
01:26 --> 01:30so again, it's really about quality of life
01:30 --> 01:33and relieving suffering as much as we can.
01:33 --> 01:37This all takes place in the setting of
01:37 --> 01:39an interdisciplinary professional team.
01:39 --> 01:44And we really focus on physical symptoms.
01:44 --> 01:46Coping and the stress that patients
01:46 --> 01:49and families deal with around serious
01:49 --> 01:52illness as well as trying to streamline
01:52 --> 01:54and support good communication
01:54 --> 01:57for patients and families so they
01:57 --> 01:59get their questions answered
01:59 --> 02:01as well as possible.
02:03 --> 02:06But that sounds like a
02:06 --> 02:09combination of pain
02:09 --> 02:13medicine and psychology and
02:13 --> 02:18it's a bit of social work mixed in.
02:18 --> 02:21Tell us more about how that works and
02:21 --> 02:23how that's different from people's
02:23 --> 02:27usual doctors who also may be very
02:27 --> 02:29interested in their quality of
02:29 --> 02:33life?
02:33 --> 02:35First of all, you know,
02:35 --> 02:38we really hope that all health care
02:38 --> 02:40professionals get some training in
02:40 --> 02:43palliative care and that they provide
02:43 --> 02:46what we would call primary palliative
02:46 --> 02:48care or basic palliative care.
02:53 --> 02:57These are primary skills in addressing basic
02:57 --> 03:01pain management and providing an
03:01 --> 03:06initial level of support
03:06 --> 03:10around coping as well as some
03:10 --> 03:12nice early communication
03:12 --> 03:13support as well.
03:13 --> 03:16Palliative care goes beyond that
03:16 --> 03:19in terms of being very specialized
03:19 --> 03:22and part of that is because we
03:22 --> 03:25do have a team model of care.
03:25 --> 03:27Not all institutions are
03:27 --> 03:30equal in terms of how many
03:30 --> 03:32resource supports they are
03:32 --> 03:35able to put toward palliative care,
03:35 --> 03:39but in our setting at Smilow and across Yale,
03:41 --> 03:44we're really focused on having a robust team,
03:44 --> 03:48and for us that includes
03:48 --> 03:49social work, chaplaincy, nursing,
03:49 --> 03:52both at an RN and an advanced
03:52 --> 03:54practice nurse level.
03:54 --> 03:58We also are very fortunate to have
03:58 --> 04:00our team psychologist as well as
04:00 --> 04:03a pharmacist and art therapist,
04:03 --> 04:05so this is
04:05 --> 04:07a very broad approach,
04:07 --> 04:10and I think the special part
04:10 --> 04:13about it is that you know,
04:13 --> 04:16we acknowledge that
04:16 --> 04:19pain and other symptoms are
04:19 --> 04:22sort of a total phenomenon,
04:22 --> 04:25meaning that people can have pain
04:25 --> 04:28and anxiety and depression
04:28 --> 04:31that is in different domains,
04:31 --> 04:33meaning the spiritual,
04:33 --> 04:34the physical,
04:34 --> 04:38emotional and so are different
04:38 --> 04:41team members can play really
04:41 --> 04:44important roles in addressing symptoms
04:44 --> 04:47across this kind of spectrum
04:47 --> 04:49of suffering and really trying
04:49 --> 04:51to again improve quality of life.
04:52 --> 04:56As you think about suffering,
04:56 --> 04:58particularly of our cancer patients,
04:58 --> 05:00and many of them have symptoms.
05:00 --> 05:03Whether it's symptoms related to
05:03 --> 05:05treatment or whether it's symptoms
05:05 --> 05:07related to the cancer itself,
05:07 --> 05:10one can't help but think that the whole Covid
05:10 --> 05:13crisis kind of exacerbated that suffering,
05:13 --> 05:16especially when you put it into
05:16 --> 05:18those domains of
05:18 --> 05:20not just the physical suffering,
05:20 --> 05:22but emotional suffering.
05:22 --> 05:23Financial suffering.
05:23 --> 05:26All of the things that covid kind
05:26 --> 05:28of brought to the forefront.
05:28 --> 05:31Did you find an uptick in the need
05:31 --> 05:34for palliative care during the crisis?
05:36 --> 05:38You know, I think you're absolutely right.
05:38 --> 05:41Covid sent us something that we were
05:41 --> 05:45really challenged by
05:45 --> 05:48especially initially figuring out
05:48 --> 05:53how we could best support both our
05:53 --> 05:57colleagues and our patients and families.
05:57 --> 06:00I think the need shifted.
06:00 --> 06:03I think at first we weren't sure because
06:03 --> 06:06of just the exposure issues and how
06:06 --> 06:10to still be as helpful as possible,
06:10 --> 06:13but I think what really happened
06:13 --> 06:16was of course, as we all know,
06:16 --> 06:19in the earlier surge there was such
06:19 --> 06:23a concern about how sick people were,
06:23 --> 06:26and of course unfortunately a lot of
06:26 --> 06:30people were sick enough that they were
06:30 --> 06:33in a place where they were not
06:33 --> 06:36able to get better and were dying.
06:36 --> 06:40And so for us in particular,
06:40 --> 06:43we were really brought in for
06:43 --> 06:44physical symptom management,
06:44 --> 06:48especially around shortness of breath.
06:48 --> 06:51Which is where we saw COVID
06:51 --> 06:54hit us all very hard.
06:54 --> 06:57So managing shortness of breath for
06:57 --> 06:59people that were really suffering
06:59 --> 07:03with that and trying to improve their
07:03 --> 07:05day-to-day and in cases where people
07:05 --> 07:08were sick enough that they were dying,
07:08 --> 07:11we were really pulled in to
07:13 --> 07:16be present with them as much as possible,
07:16 --> 07:19but to really be involved in
07:19 --> 07:21reaching out to their families.
07:21 --> 07:24Trying to help our medical
07:24 --> 07:27colleagues in the ICU's with
07:27 --> 07:29spending extra time
07:29 --> 07:32being available to families,
07:32 --> 07:36especially and to really try to help there.
07:36 --> 07:41Be some contact before someone died.
07:41 --> 07:43So that was challenging
07:43 --> 07:45in a different way for sure.
07:45 --> 07:47And fortunately I think,
07:47 --> 07:50now that we've gotten on top
07:50 --> 07:53of Covid and learned so much,
07:53 --> 07:55and people are really
07:55 --> 07:57doing a lot better now,
07:57 --> 08:00certainly not as many people are dying,
08:00 --> 08:03but we still have those roles
08:03 --> 08:04currently trying to
08:04 --> 08:08still be present to have these
08:08 --> 08:10harder discussions and prepare patients
08:10 --> 08:13and families for what can happen.
08:13 --> 08:17I actually just took care of a patient a
08:17 --> 08:21week ago who was in her 90s and
08:21 --> 08:24dealing with covid and in isolation.
08:24 --> 08:27And was actually in a mode where
08:27 --> 08:30the patient and daughter were
08:30 --> 08:33accepting that she might not live
08:33 --> 08:36through this covid episode for her,
08:36 --> 08:40but in fact she has been able to
08:40 --> 08:43be stable and come through that
08:43 --> 08:46and actually come out of sort
08:46 --> 08:48of a comfort focused time.
08:48 --> 08:52And now we're focusing on how
08:52 --> 08:54to think about supporting her
08:54 --> 08:57the best we can for her to
08:57 --> 08:59ultimately try to recover.
08:59 --> 09:02So things are a little different now.
09:03 --> 09:05I can imagine that,
09:05 --> 09:08particularly during the covid crisis and
09:08 --> 09:11and even now for patients in isolation,
09:11 --> 09:14that comfort and that support
09:14 --> 09:15and that communication,
09:15 --> 09:17particularly with the family,
09:17 --> 09:19must be really difficult.
09:19 --> 09:21I mean, how do you
09:21 --> 09:24do that when both
09:24 --> 09:27the family wants to be with
09:27 --> 09:29their loved ones who are facing
09:29 --> 09:33a potentially terminal crisis,
09:33 --> 09:38and patients themselves are suffering.
09:38 --> 09:41And dealing with more than
09:41 --> 09:44the usual because not only do they
09:44 --> 09:46have their physical symptoms,
09:46 --> 09:48but also the emotional isolation.
09:50 --> 09:53How do you kind of bridge that and
09:53 --> 09:56be with with the patient and
09:56 --> 10:00be there for the family as well?
10:02 --> 10:06It's such a privileged place to be.
10:06 --> 10:08It's awfully difficult as well,
10:08 --> 10:12but I think all of us on the team,
10:12 --> 10:15whether it's one of our chaplains
10:15 --> 10:18or one of our social workers, our nurses,
10:18 --> 10:22I think all of us just try to bring
10:22 --> 10:25110% of our presence
10:25 --> 10:30to open up conversations to just try to give
10:30 --> 10:34people the space and opportunity to express
10:34 --> 10:36the deepest part of what's
10:36 --> 10:39weighing on them and what they are
10:39 --> 10:41most worried about and
10:41 --> 10:44to acknowledge the sadness.
10:44 --> 10:46The heaviness of the situation.
10:46 --> 10:49Sometimes we're able to be
10:49 --> 10:53in person with the patient.
10:53 --> 10:56Occasionally, if someone really is
10:56 --> 10:59seemingly in a place where they
10:59 --> 11:03may be dying in the next hours,
11:03 --> 11:06family may be able to visit
11:06 --> 11:10briefly and we try to be present
11:10 --> 11:13for those opportunities and to
11:13 --> 11:15advocate for them when possible.
11:15 --> 11:18We've also had the opportunity, obviously,
11:18 --> 11:23to use technology and have families
11:23 --> 11:26through FaceTime or through Zoom.
11:26 --> 11:29and be able to
11:29 --> 11:31see their loved one.
11:31 --> 11:33Sometimes that person can respond
11:33 --> 11:36and sometimes they can't.
11:38 --> 11:42I think we try to always make it as
11:42 --> 11:45personalized a situation as possible.
11:45 --> 11:47Sometimes there's music that is meaningful
11:47 --> 11:50to the patient or family members.
11:51 --> 11:56Last week I had a patient who
11:56 --> 11:59was dying and the family was able to
12:00 --> 12:04let us know that that person really
12:04 --> 12:06enjoyed jazz music and we were
12:06 --> 12:09able to have that present and you
12:09 --> 12:12know it seemed to be part of the
12:12 --> 12:16quality that we could add to
12:16 --> 12:20a sad situation for sure.
12:20 --> 12:24I think earlier
12:24 --> 12:28when we had more people who
12:28 --> 12:31seemed to be facing death,
12:32 --> 12:34we had a lot more technology
12:34 --> 12:36and a lot more Zoom meetings,
12:36 --> 12:39we would have occasionally a family who
12:39 --> 12:42would get connected from around the world
12:42 --> 12:46and Zoom together
12:46 --> 12:49and sometimes they would stay on for
12:49 --> 12:5212 or 24 hours with their loved one.
12:52 --> 12:56Until they passed away.
12:58 --> 13:01It's such a time to
13:01 --> 13:03reflect on what matters to people
13:03 --> 13:07and to try to help families be able
13:07 --> 13:10to focus in on how much time we
13:10 --> 13:13think we may have and
13:13 --> 13:15what is possible to try to make
13:15 --> 13:18things you know a little more
13:18 --> 13:19meaningful to everybody.
13:20 --> 13:22Yeah, it's so important,
13:22 --> 13:25particularly at the end of life,
13:29 --> 13:32and the suffering that the families go through
13:32 --> 13:36doesn't end when their loved ones pass.
13:36 --> 13:39In fact, sometimes is just starting
13:39 --> 13:43to surge their own grief over the loss.
13:43 --> 13:46What about palliative care for them?
13:46 --> 13:48Does your role continue?
13:48 --> 13:50Or how does that work?
13:51 --> 13:53Yes, thank you for asking that
13:53 --> 13:55question because it's so important
13:55 --> 13:58to acknowledge
13:58 --> 14:00that there's so much more
14:00 --> 14:03to the journey for family members,
14:03 --> 14:06especially, even after someone dies.
14:06 --> 14:09So we're very fortunate within our
14:09 --> 14:11Hospital system and
14:11 --> 14:14Smilow that within our palliative
14:14 --> 14:17care program we do have a bereavement
14:17 --> 14:20service that's been really a critical part
14:20 --> 14:23of what we do for a number of years now.
14:26 --> 14:28We have two
14:28 --> 14:31full time social workers,
14:31 --> 14:34bereavement specialists, who work
14:34 --> 14:37within our program and so when we
14:37 --> 14:40do have a death on our service,
14:40 --> 14:44we let our bereavement coordinators
14:44 --> 14:47and specialists know about that particular
14:47 --> 14:51family and then they are able to follow up.
14:51 --> 14:56We have a number of really wonderful
14:56 --> 14:57support group opportunities
14:57 --> 15:01as well as the option for
15:01 --> 15:03a referral for more formalized
15:03 --> 15:05counseling or psychotherapy as well
15:05 --> 15:07within our community,
15:07 --> 15:10but I think the really important
15:10 --> 15:14first step is just to make sure
15:14 --> 15:17that we do have that follow through
15:17 --> 15:20to be able to check on families
15:20 --> 15:23and to really check in with them
15:23 --> 15:25specifically weeks after to just
15:25 --> 15:28see how they're coping.
15:28 --> 15:29and to acknowledge
15:29 --> 15:32all the normal parts of
15:32 --> 15:34grief and the bereavement process.
15:34 --> 15:37So that's absolutely critical to
15:37 --> 15:40our community and something that I
15:40 --> 15:43think is unique that we are able
15:43 --> 15:46to provide in that regard.
15:46 --> 15:49Great, we're going to take a
15:49 --> 15:51short break for a medical minute.
15:51 --> 15:53Please stay tuned to learn more
15:53 --> 15:54information about palliative care
15:54 --> 15:56with my guest Dr. Laura Morrison.
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16:48 --> 16:52You're listening to Connecticut Public Radio.
16:52 --> 16:53Welcome
16:53 --> 16:55back to Yale Cancer Answers.
16:55 --> 16:57This is doctor Anees Chagpar
16:57 --> 16:59and I'm joined tonight by
16:59 --> 17:01my guest doctor Laura Morrison.
17:01 --> 17:03We're talking about palliative
17:03 --> 17:05care and Laura,
17:05 --> 17:08before the break we were talking a lot
17:08 --> 17:11about how palliative care has a role
17:11 --> 17:13in supporting patients and families,
17:13 --> 17:14particularly at
17:14 --> 17:17the time of of death and when
17:17 --> 17:19patients are really suffering.
17:19 --> 17:22But I think one of the misconceptions
17:22 --> 17:24is this whole idea
17:24 --> 17:26of palliative care versus
17:26 --> 17:29Hospice versus death panels.
17:29 --> 17:33Can you clarify where palliative
17:33 --> 17:37care sits in this whole spectrum?
17:39 --> 17:40Yes, absolutely.
17:40 --> 17:42It's an important distinction,
17:42 --> 17:46so palliative care again is for any patient
17:46 --> 17:50with a serious illness in their family.
17:50 --> 17:52That's a pretty broad group,
17:52 --> 17:58but not everyone is referred to us so
17:58 --> 18:01theoretically, anyone with a serious
18:01 --> 18:04illness could request palliative
18:04 --> 18:08care through their physician
18:08 --> 18:12so palliative care can be involved
18:12 --> 18:15for that extra attention
18:15 --> 18:17to really improving quality of
18:17 --> 18:19life and relieving suffering.
18:19 --> 18:22That's part of many people's experience
18:22 --> 18:25with serious illness and so with
18:25 --> 18:28palliative care we
18:28 --> 18:30coexist and Co manage our
18:30 --> 18:33patients together with their
18:33 --> 18:35specialists and physicians
18:35 --> 18:37and primary care doctors.
18:37 --> 18:39So for Smilow patients,
18:39 --> 18:42that means that we're
18:42 --> 18:44often Co managing with the
18:44 --> 18:47oncologist or the hematologist.
18:47 --> 18:52Hospice is a separate entity.
18:52 --> 18:54Hospice is an opportunity
18:54 --> 18:56for patients and families
18:56 --> 18:59when a patient is coming to a time
18:59 --> 19:02in their illness where their life is
19:02 --> 19:05likely going to be limited in time.
19:05 --> 19:10And so if someone has six months or
19:10 --> 19:14less in their disease course, they
19:15 --> 19:18may become eligible for Hospice and
19:18 --> 19:22that happens in conjunction with
19:22 --> 19:25making decisions usually to
19:25 --> 19:28steer away from more therapies
19:28 --> 19:30that would prolong life,
19:30 --> 19:33and so it's a time when people
19:33 --> 19:36are really focused on comfort and
19:36 --> 19:39really having as their primary aim
19:39 --> 19:43the quality of life and comfort,
19:43 --> 19:46and potentially no longer pursuing
19:46 --> 19:49curative or life prolonging therapy and so
19:49 --> 19:52Hospice is a time when usually people
19:52 --> 19:56are not as involved with their
19:56 --> 19:59oncologist or hematologist anymore.
20:00 --> 20:02And really palliative care
20:02 --> 20:05can enter at any time and stay with
20:05 --> 20:08people even if they are able to be cured.
20:08 --> 20:12Or just have a long period of
20:12 --> 20:14time in their illness
20:14 --> 20:18course, and so I think that
20:18 --> 20:19that's really important,
20:19 --> 20:22because palliative care then does not
20:22 --> 20:27mean that there is any sense that your
20:27 --> 20:30life expectancy is somewhat limited.
20:30 --> 20:34It simply means that you have some suffering,
20:34 --> 20:37whether that is physical suffering,
20:37 --> 20:39emotional suffering, spiritual suffering,
20:39 --> 20:44or other needs in terms
20:44 --> 20:47of communication or spiritual
20:47 --> 20:51needs that could use the services of
20:51 --> 20:54a dedicated interdisciplinary team?
20:54 --> 20:56Is that right?
20:56 --> 21:00That's absolutely right, yes.
21:00 --> 21:03I think it often starts just
21:03 --> 21:06with acknowledging what a change it
21:06 --> 21:09is for people to be diagnosed with a
21:09 --> 21:12serious illness and how stressful that is,
21:12 --> 21:15and simply the stresses of being in
21:15 --> 21:18the hospital and not being in your
21:18 --> 21:21own realm of control in the same way.
21:21 --> 21:23So it really starts at that very basic
21:23 --> 21:26human level of just acknowledging that
21:26 --> 21:28things are really changing for somebody.
21:28 --> 21:32And as you pointed out, we do have that.
21:35 --> 21:38And it may be that one member of
21:38 --> 21:41our team is a little more relevant
21:41 --> 21:44at one time or another,
21:44 --> 21:48but we do have the full team to draw upon.
21:48 --> 21:51So for instance, we have some patients,
21:51 --> 21:53many patients in active treatment,
21:53 --> 21:56and sometimes our real goal is just to
21:56 --> 21:59get them through their active treatment
21:59 --> 22:03in the best supported way possible.
22:03 --> 22:05And that may mean that they're
22:05 --> 22:08coming to an art therapy group.
22:08 --> 22:10You know, while they're getting
22:10 --> 22:12treatment for their breast cancer
22:13 --> 22:15or their acute myeloid leukemia.
22:15 --> 22:18Maybe at a later time they're
22:18 --> 22:20coming into our clinic when they
22:20 --> 22:23come in to see their hematologist,
22:23 --> 22:25because we're helping them with
22:25 --> 22:26pain or their fatigue.
22:26 --> 22:29So we do have an inpatient,
22:29 --> 22:31and an outpatient presence as well.
22:32 --> 22:36I think that that's so important,
22:36 --> 22:38particularly now during covid when
22:38 --> 22:42you know the real thrust was to try
22:42 --> 22:45to manage patients in an outpatient
22:45 --> 22:47setting as much as possible.
22:47 --> 22:50So for patients who are not in hospital,
22:50 --> 22:54who may be at home,
22:54 --> 22:58tell us more about how the outpatient
22:58 --> 23:00palliative care services work.
23:00 --> 23:02It seemed from our earlier
23:02 --> 23:05discussion that the inpatient
23:05 --> 23:08service was
23:08 --> 23:09this multidisciplinary service
23:09 --> 23:12integrated with the managing team,
23:12 --> 23:14the oncologist, and together
23:14 --> 23:16managing patients in the hospital.
23:16 --> 23:21But for patients who are at home, how do you do that?
23:24 --> 23:28Is tha by virtual visits.
23:28 --> 23:30How does that really manifest?
23:32 --> 23:35We have a really vibrant palliative
23:35 --> 23:39care clinic that is located in New
23:39 --> 23:43Haven within Smilow, so people come
23:43 --> 23:49into the 4th or 8th floor usually.
23:49 --> 23:52And then we also have one of our
23:52 --> 23:54colleagues see patients as well
23:54 --> 23:57at a number of the care centers
23:57 --> 24:00around New Haven in North
24:00 --> 24:03Haven and Guilford and Trumbull.
24:03 --> 24:05Torrington, so there's
24:05 --> 24:08a fairly good access to our services.
24:08 --> 24:10As you're pointing out,
24:10 --> 24:12the Covid situation has altered our
24:12 --> 24:15practice patterns there as well,
24:15 --> 24:17and we've come
24:17 --> 24:19in and out of virtual
24:19 --> 24:22and in person visits a couple of
24:22 --> 24:24different times with the surges.
24:24 --> 24:26But you know, eventually,
24:26 --> 24:28obviously we hope to be
24:28 --> 24:30back to mostly in person,
24:30 --> 24:32but I think we all acknowledge
24:32 --> 24:35that virtual visits are going to
24:35 --> 24:37carry forward with us.
24:37 --> 24:39At the moment,
24:39 --> 24:41the majority of our clinic
24:41 --> 24:44visits are virtual at this time,
24:44 --> 24:47but you know you schedule an
24:47 --> 24:50appointment with us just like
24:50 --> 24:53you do with any other clinic
24:53 --> 24:55if they are in person,
24:55 --> 24:57then we often try to pair them
24:57 --> 25:00up with someone's oncology or
25:00 --> 25:02hematology visit so that people
25:02 --> 25:04aren't making multiple trips,
25:04 --> 25:07so we really do try to be wary
25:07 --> 25:10of those extra burden
25:10 --> 25:12issues for patients and families.
25:14 --> 25:17So when you pull up caring
25:17 --> 25:19and alleviation of suffering,
25:19 --> 25:22whether that's pain or fatigue or
25:22 --> 25:25nausea or any number of symptoms,
25:25 --> 25:28physical, emotional or otherwise,
25:28 --> 25:31some patients may be at
25:31 --> 25:34home and suffering that way.
25:34 --> 25:37Is there such a thing as
25:37 --> 25:38home palliative care?
25:38 --> 25:40Where people can
25:40 --> 25:43deliver therapies at home?
25:44 --> 25:48Yes, so it follows a model that is
25:48 --> 25:51similar to home nursing services that
25:51 --> 25:55we typically get through Medicare
25:55 --> 26:00or private insurance so people can have
26:00 --> 26:03what is called home palliative care.
26:03 --> 26:06It's typically through the
26:06 --> 26:09same kind of agency
26:09 --> 26:13that regular home nurse would be set up,
26:13 --> 26:17but these are specialized groups within that,
26:17 --> 26:20so a number of our local organizations
26:20 --> 26:22in the community around Connecticut
26:22 --> 26:26have home palliative care services,
26:26 --> 26:30and what that looks like for patients
26:30 --> 26:35and families is really at the most a
26:35 --> 26:39daily visit for an hour or two perhaps.
26:39 --> 26:42They can also include physical and
26:42 --> 26:44occupational therapy services within that,
26:44 --> 26:46but the nursing component
26:46 --> 26:47often isn't even everyday.
26:47 --> 26:51It's sort of based on what the need of
26:51 --> 26:55the patient is as far as the frequency.
26:55 --> 26:57But these are typically nurses
26:57 --> 27:01who may have had a prior
27:01 --> 27:05opportunity to do some Hospice work.
27:05 --> 27:09Or may have a particular interest or training
27:09 --> 27:12in more on the palliative care side,
27:12 --> 27:14and those skill sets are quite
27:14 --> 27:17similar and they bring a more
27:17 --> 27:19holistic approach to really assessing
27:19 --> 27:22and trying to manage symptoms.
27:22 --> 27:24The management part is still
27:24 --> 27:27handled by a physician
27:27 --> 27:29who is
27:29 --> 27:32covering and supporting that Nurse.
27:36 --> 27:39Offering that kind of nursing service
27:39 --> 27:43would exist on its own for some patients
27:43 --> 27:46that might then later transition into
27:46 --> 27:49a Hospice type of approach as well.
27:51 --> 27:53And so you mentioned insurance briefly,
27:53 --> 27:56but expand on that a little bit more in
27:56 --> 27:59terms of palliative care you had said,
27:59 --> 28:01anyone who has a serious
28:01 --> 28:04illness can request palliative care,
28:04 --> 28:06but I'm sure many of our
28:06 --> 28:07listeners might be thinking,
28:07 --> 28:10it sounds like this is yet another cost
28:10 --> 28:12with a specialized interdisciplinary team.
28:12 --> 28:14Whether it's in the inpatient or
28:14 --> 28:17the outpatient or the home setting,
28:17 --> 28:19is that yet another medical bill
28:19 --> 28:22that's going to add to the financial
28:22 --> 28:23suffering that people have?
28:23 --> 28:25Are these services generally
28:25 --> 28:26covered by insurance?
28:28 --> 28:30Thankfully, yes.
28:30 --> 28:33Palliative care is considered
28:33 --> 28:35a medical subspecialty,
28:35 --> 28:38just as infectious disease,
28:38 --> 28:42cardiology, neurology. So
28:42 --> 28:45that part of the financial picture is
28:45 --> 28:48really handled in a billing fashion
28:48 --> 28:51just like any other subspecialty.
28:51 --> 28:54Even similar to oncology or hematology.
28:55 --> 28:57For the most part that would be
28:57 --> 29:00covered by a private insurance
29:00 --> 29:03as well as Medicare and Medicaid.
29:03 --> 29:06Doctor Laura Morrison is an associate
29:06 --> 29:08professor of medicine and geriatrics
29:08 --> 29:10at the Yale School of Medicine.
29:10 --> 29:11If you have questions,
29:11 --> 29:13the address is canceranswers@yale.edu
29:13 --> 29:15and past editions of the program
29:15 --> 29:17are available in audio and written
29:17 --> 29:18form at yalecancercenter.org.
29:18 --> 29:21We hope you'll join us next week to
29:21 --> 29:23learn more about the fight against
29:23 --> 29:26cancer here on Connecticut Public Radio.

Information

Palliative Care 2021 with guest Dr. Laura Morrison February 7, 2021 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095