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Nurturing 101
The Kimmel Cancer Center's new palliative care program guides families through the haze of illness.

Sometimes the caregiver needs more attention than the patient.

Sometimes during a serious illness, the family caregiver needs more handholding than the patient. Such was the case of Mr. M, whose 65-year-old wife was undergoing therapy for pancreatic cancer earlier this year. 

As his wife continued to weaken, “he was pushing for her to continue therapy, looking online for different therapies, and pushing her to eat food she didn’t want,” recalls Lynn Billing, one of the nursing specialists who works at the Sidney Kimmel Cancer Center’s year-old pain and palliative care program.

“We worked with the husband, helping him to understand what he was going through, and what his wife was going through,” Billings continues. “We could see how he was suffering. It probably took several weeks with him, being very patient, but he finally said, I get it.” 

Dealing with the psychological as well as the physical, social, even spiritual aspects of severe illnesses—including those that are not terminal—is the role of an eight-member team of physicians, nurses, a pharmacist, and a social worker who staff the Harry J. Duffey Family Pain and Palliative Care Program.

Palliative care focuses on every aspect of a patient’s needs, including pain relief, depression, nausea, and appetite loss, as well as on the needs of the patient’s family. It always has been part of treatment at the center, but became a formal program in the spring of 2007.

“You can always perform palliative care better,” says Louise Knight, director of patient and family services. “We needed to have a formal program to prepare the new, rising oncologists that we train here.”

Palliative care, a rapidly growing medical discipline, practiced in about 70 percent of the nation’s larger hospitals, just received certification as a subspecialty from the American Board of Medical Specialties in late 2006.

The Kimmel Center’s formal program helps between five to 10 patients—both inpatient and outpatient—a day. Referrals come from physicians, bedside nurses, social workers, nutritionists—anyone who has regular contact with a patient or patient’s family.
Some doctor-and-nurse teams do an excellent job coordinating a patient’s care, but other medical teams are more “disease-specific” in their focus, says Andrea Cox, another nurse working for the program.

“We’re like an interdisciplinary clearing house,” says Cox. Although the team may be called upon initially for a consultation on a patient’s pain, its members can be helpful in every phase of patient care.

“We have the time to sit down and have a conversation that might take an hour or two,” says Billings.

Knight says the program has the same three-pronged approach as all of Hopkins Medicine, with emphasis on teaching, research and clinical care. “We want to grow new palliative care doctors, nurses, social workers, pharmacists—future leaders in this field.”

Research by oncologist Sydney Dy is focusing on how well caregivers are dealing with the stress of that role—and whether the palliative care team can help them handle it.

The program also has created a patient education sheet for bedside nurses to use to tell patients about the program “in a nonthreatening way,” Cox notes. Too many patients think of palliative care as being synonymous with hospice. In fact, palliative care is just as appropriate for patients with nonterminal illnesses.

“Patients come here for a cure, for hope, for treatment and a longer life—all of the things that are the antithesis of hospice,” says Cox. “We’re part of the patient’s team, and we’ll be here when they need us.”




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