Many clinicians will likely welcome the palliative care unit for its increased support and guidance in dealing with end-of-life problems. Some providers may be reluctant to "give up" patients to palliative care teams, or to lose contact with longtime patients.
Others may feel that teams are an intrusion. Indeed, in one New York City hospital, doctors said they would view a palliative care team as a "death squad."
Successful palliative care programs are generally viewed as an adjunct to care, not as a replacement. Some new palliative care programs report that within a few months of start-up, providers have begun to refer patients regularly or call for advice and help. Many colleagues take the advice or recommendations of the palliative care teams. Northwestern Memorial Hospital Hospice/Palliative Medicine reports that in one fiscal year, its palliative consultative service received 524 total requests for consultation. Since the program's inception, the number of consultations per year has increased by approximately 10 percent each year; by 1997, the program was receiving an average of 60 consultations each month.
One leading medical center operates a palliative care consult service and an inpatient unit with a few beds scattered throughout the facility. When it first began, physicians were sometimes reluctant to refer patients. One even had to be persuaded to accept a palliative care consult for a young woman for whom a cure was impossible - and who continued to seek treatment, unaware that her prognosis was fatal. Still hoping for a cure, the woman, a single parent, had not made plans for guardianship of her daughter. When the palliative care team heard about the case, the team decided it was critical to encourage and support the oncologist in discussing the patient's prognosis with her. While the oncologist spoke to his patient, the team remained nearby, ready to help. The following day, the woman met with a team member to begin developing plans for her child, who was also present and talked about her concerns and fears.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].