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When faced with a grim prognosis or a chronic debilitating illness, Mississippi patients may benefit from an emerging practice aimed at helping them live free from pain and stress while still seeking curative care.

Hospitals around the state are introducing palliative care programs as a complement to time-limited hospice programs, which already provide for end-of-life care. Among the challenges for these multidisciplinary teams as they start out is simply explaining their mission to the medical community around them.

“This is an effort to improve the quality of life for individuals with a life-limiting illness,” said Rhonda Saunders, RN, who leads the palliative care program at North Mississippi Medical Center (NMMC) in Tupelo.

Since the hospital launched the program in 2006, Saunders and her team have worked with patients to address their needs in such areas as symptom management, advanced directives and spiritual care.

“With palliative care, many times patients make the choice to continue with aggressive treatment like radiation or even chemo,” Saunders said. “But our service helps them have a better understanding of the disease process, of the goals they want to set and the future they face, so they can be making those decisions along the way.”

While Saunders considers the program a work in progress, it’s already seen marked growth. The team saw 225 patients in their first year, and has already seen more than 260 in the first two quarters of 2007.

With Saunders serving as coordinator, the team is based in the acute-care unit and includes hospital staff in nursing, case management, outcomes management, pharmacy, pastoral care and respiratory therapy. A home-care hospice liaison also works closely with the team as patients often transition from one program to the other.

Cancer patients make up a portion of that number, but the biggest groups they’ve served so far have been stroke patients and others with neurological problems, as well as those suffering from respiratory illnesses like congestive heart failure and emphysema, and those fighting major infections.

With a host of different program models to choose from — nurse-driven or physician-driven, separate in-patient unit or not — NMMC’s own program is continuing to feel its way forward. Among Saunders’ dreams is eventually adding a physician to lead the team and boost the program’s standing among referring fellow physicians.

“We have some excellent champion physicians who use us and call quite often,” Saunders said. “But with some, it’s either ‘out of sight, out of mind’ or ‘I can handle that.”

Still others think to call for a consultation later rather than sooner in the course of a patient’s hospital stay. But when the palliative care team is called within five days after a patient’s admission, the average length of stay is only 6.1 days — compared to 19 days when the team was consulted later.

Since the team’s service is not reimbursable, its fiscal value to the hospital comes in terms of cost savings as it helps families set goals for care. That support allows them to look toward earlier discharge for the patient, whether it’s to a nursing home, hospice center or home-based care.

At St. Dominic-Jackson Memorial Hospital, it was a collaborative process involving many staff members over several years that launched its palliative care program this past April.

Hospital staff researched the service by visiting programs at the Mount Carmel Palliative Care Leadership Center in Ohio and Our Lady of Lourdes Regional Medical Center in Lafayette, La. With those models in mind, they surveyed physicians of various disciplines as well as oncology nurses, to see whether they felt a need for the kind of support a palliative care program would provide.

“We found that, indeed, you had some physician groups who just didn’t feel as comfortable with managing pain while others struggled with breaking bad news to patients,” said Nancy Aycock, RN, an oncology nurse who serves as the program’s coordinator.

Envisioned as a support to both physicians and nurses as well as patients, the program has been well received in its first few months. When a doctor gives the order, Aycock is the first among her team to make contact with a patient, explain the program and listen to his or her needs.

“The wonderful thing is that in this position, I’m able to be at their bedside as long as they need me to be,” she said. “As a bedside nurse, you want to treat their emotional needs and all the things they’re dealing with, but there’s just so little time. So I tell our nurses and physicians, ‘Let me be an extension of you and let us complement your care.’”

In bringing in the palliative care team, Aycock alerts St. Dominic’s pastoral care department of each new consult so that chaplains can give extra attention to patients as they face hard decisions or take in bad news.

“There are times when they cannot see every patient in the hospital — but they make a point to see these,” Aycock said.

Likewise, the program’s social worker adds to her regular assessment the particular issues palliative care patients are facing. In addition to suggesting consults for occupational or physical therapy, Aycock and her team work with an advisory board of physicians who provide support to the program.

While some mature palliative care programs grow into adding a certified physician and even a separate palliative care unit, Aycock says St. Dominic’s fledgling consultation service has simply aimed to start small with a focus on oncology and grow as more needs arise.

“I think one of the biggest pieces is realizing that no matter at what stage the patient and their family are, they’re going to have suffering that we need to identify,” she said. “When we can see people even as early as their diagnosis of a life-threatening illness, we can address their physical, emotional and spiritual suffering and increase their quality of life.”

PHOTO CUTLINE: North Mississippi Medical Center’s multidisciplinary Palliative Care Team includes (from left) Judy Ellis, RN; Rachelle Carter, Pharm.D.; Linda Roof, RN; Yolanda Shackleford, MSW; Rhonda Saunders, RN; and Jeannine Peters, Pharm.D. Other team members are James Richardson, Pastoral Care; Cheryl Edgeworth, RN; Penne Warren, RT; and Pam Hodges, RN.



September 2007

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