MDNews - Greater Boston

the interdisciplinary palliative care team at Good samaritan Medical Center (L–r): amanda voysey, Patient advocate; dr. Clarkin; dr. Carty; Caroline Morse, nurse practitioner; Bonnie Jefferson, rn; Jolene dooley, social worker; and Gerry Paciello, director of spiritual Care Palliative care teams treat pain and other debilitating symptoms. They also facilitate ongoing communication with patients and their families about patients' personal healthcare goals. These conversations often help patients navigate difficult end-of-life decisions and provide valuable assistance with advance care planning documents, as well as bereavement support for loved ones after a patient has passed away. Teams also provide recommendations and caregiver support and can coordinate care with specialists. The number of inpatient and outpatient programs across the country has grown considerably in recent years, as has the very definition of what palliative care means. "Palliative care has matured during the last two decades," Dr. Carty says. "Many physicians are learning the value palliative care consultations can bring to them and their patients, which has led to significant increases in consult volume, larger numbers of inpatient programs and, finally, the growth of some ambulatory/outpatient programs." Palliative care teams are being brought into ICU settings to help with decisions regarding artificial life support measures or the identification of a healthcare proxy and the creation of advance directives. The Good Samaritan Palliative Care Program takes an interdisciplinary approach to patient care, which both Dr. Carty and Dr. Clarkin are keen to distinguish from a multidisciplinary approach. In a multidisciplinary setting, the skills and experience of caregivers from different disciplines are put to use, but each discipline looks at the patient from its own point of view. The interdisciplinary approach seeks to integrate the different disciplines into a unified consulting group. "The multidisciplinary approach can sometimes lead to a lack of communication," explains Dr. Clarkin. "Medicine can be highly fragmented, and the great benefit of an interdisciplinary approach is that it requires continual communication between all members of the team." The best palliative care programs have a high-functioning, interdisciplinary team wherein all members respect and value each other's expertise and opinions. The team can include the patient's primary care physician, as well as specialists, palliative care physicians, nurses or nurse practitioners, and social workers. Other members can include pharmacists, interventional pain specialists, advanced practice professionals, psychiatrists, massage therapists, nutritionists and members of the rehabilitation services team. Pastoral care can also be an important additional function. This interdisciplinary team has combined skills and experience in communication, symptom management, psychosocial and spiritual assessment, hospice care, transitions in care, and discharge planning — issues that too often go unaddressed as patients move between various caregivers and providers. "In my previous position as a hospitalist attending physician in a tertiary medical center, I saw many patients with life-limiting illnesses bounce mdnewS.com ■ MD News Greater Boston |7

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