Raising Awareness About Palliative Care

Palliative care department members, pictured left to right, include: Tom Crane, MD; Margaret Marquez, MD; Lynette Whitman, manager, Long Term Care/Palliative Care, Marin-Sonoma; Gina Osbeck, LCSW; Paul Clagett, RN; and Dale Webb, MDiv, chaplain. Not pictured are: Karen Leider, MD; and Patricia Riley, RN, service director for Long Term Care/Palliative Care, San Francisco, Marin-Sonoma.

Palliative care (sometimes also known as comfort care, supportive care or symptom management) aims to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of the disease, side effects sometimes caused by treatment of the disease, psychological and social problems related to the disease.

When Kaiser Santa Rosa's palliative care department was created in 2005, Tom Crane, MD, was a team of one. Two years later, increased awareness about the value of palliative care, both within Kaiser Permanente and externally, has expanded the palliative care team to eight members—with room to grow.

Every palliative care patient is assigned a core team of caregivers (physician, nurse, social worker, and chaplain) to address care from multiple perspectives.

"Our mission is to enhance the quality of life for patients living with serious, advanced illness by aligning treatment choices with their personal values," said palliative care Nurse Coordinator Paul Clagett, RN, who joined the department in May. "This requires advanced care planning that takes each patient's needs and desires into consideration. We address the full spectrum of issues involved, including symptom management, emotional and spiritual support, and facilitating discussions about values, goals, and treatment options."

Working with terminally and chronically ill patients isn't necessarily easier than following traditional care plans, but it can be more rewarding. "Once someone is diagnosed, the system tends to move so quickly," said palliative care Social Services Coordinator Gina Osbeck, LCSW. "Palliative care allows us to slow things down and extend a deeper level of care, compassion, and respect for each patient's individualism. Palliative care team members are in this to help patients and their families in a more all encompassing and in-depth manner."

The results are win-win for Kaiser Permanente's patients and systems. "Along with the many patient benefits, palliative care positively affects utilization management," said Alan Ross, newly appointed Continuum administrator for Kaiser Permanente Marin-Sonoma. "For example, engaging Kaiser Santa Rosa's palliative care team results in fewer hospital admissions and Emergency Department visits, allowing resources to be redirected where necessary. By developing treatment plans, in a non crisis mode, that enhance patients' quality of life, we make the best use of Kaiser Permanente's medical services and best meet the needs and desires of our members."

Currently, the palliative care department provides inpatient services and assists physicians who are uncomfortable with end-of-life discussions. In the future, team members envision broader horizons, such as assisting Kaiser Santa Rosa staff dealing with serious illness in their lives and extending palliative care's outpatient services.

"There is a really big need for us in the outpatient setting," said Osbeck. "Many people prefer not to die in a hospital, but they are unaware of other choices available to them. Palliative care is all about helping patients to maintain their quality of life and to understand there are options beyond just giving up."

The palliative care team's focus is patient driven. "Palliative care decisions aren't based on what we think," said Osbeck. "For example, when patients elect to keep fighting and treating their illnesses we remain supportive and respectful of their values."