Issue link: https://viewer.e-digitaledition.com/i/704061
certification, which includes an additional one year fellowship in hospice and palliative care. Additional specialists on the palliative care team may include a nurse practitioner, social worker and a chaplain. In hospice, however, patients and families have the benefit of a very robust, multidisciplined team of caregivers who surround the patient and his or her family. They not only have a physician, they have a nurse, social worker, grief counselor, chaplain, hospice aide and they even have our dedicated volunteers providing a whole array of wonderful services. Q What are some misconceptions you have to face when delivering this kind of care? Franchitto: There is a perception that hospice is only for those in their very last days of life. In fact, hospice is available to patients in their last six months of life. Hospice was intended to support a patient and his or her family so that a patient's final months of life would be comfortable, peaceful and filled with dignity. Another challenge associated with hospice is overcoming our death-denying, death-defying society, in which discussions about end-of-life and hospice are just not part of our language. Thankfully that's changing now, and there is much greater acceptance and conversation regarding care at the end of life. Q Can you talk about the importance of advanced health- care planning conversations between patients, family members and providers? Franchitto: The bookends of life are important times in the life of a family and, while I think we've always grasped the wonderful, magical days when a new baby enters a family, it's been a challenge for families to think about how best to provide care in a dignified way, given our very complex healthcare system. Advance planning is a gift that family members can give to one another, particularly as it relates to having open communication and meaningful conversations about one's end-of-life care wishes. Q How can healthcare policy help physicians promote some of these conversations? Fra nchitto: Conversations bet ween physicia ns a nd their patients rega rding serious illness a nd ca re a re impor ta nt, a nd t hey have to be t houg ht f u l. These conversations a re of ten leng thy a nd may occur over severa l v isits. A lig ning reimbursement systems to incor porate t hese impor ta nt conversations into the patient/physicia n visit will be critica l from a hea lth policy perspective. Q How do you determine when to change from medical inter ventions to a focus on quality of life? Franchitto: Our hea lthca re system is built on curing a nd hea ling patients. Tra nsitioning from cure to comfor t is not ea sy. That is why t he specia lt y of hospice a nd pa l liative medicine has become a critica l component of the hea lthca re system over the past 10 yea rs. There is great oppor tunity for pa lliative ca re physicia ns to work with prima r y ca re physi- cians and other subspecia lists — geriatricians, cardiologists, pulmonologists, oncologists — for the benef it of patients a nd fa mily members. Q Hasn't HopeHealth been a pioneer in the training of physicians so they're better equipped to discuss end- of-life issues? Franchitto: We a re the major teaching a ff iliate for hospice a nd pa lliative medicine at the Wa rren A lper t Medica l School at Brow n Un iversit y. We tra i n ever y medica l st udent i n hospice a nd pa l liative medicine a long w ith the residents a nd t he fel lows in our pa l liative prog ra m. Ten yea rs a go, there was no forma l tra ining for physicia ns in hospice a nd pa lliative medicine. Q W h a t w o u l d y o u l i k e p h y s i c i a n s t o k n o w a b o u t HopeHealth and Hope Hospice? Franchitto: Hope Hospice is here to help physicia ns ca re for t hei r ser iously i l l pat ient s. A s t he la rgest nonprof it hospice a nd pa lliative ca re orga nization in New Engla nd, physicians have access to a hospice program with signif icant breadth a nd depth, a nd a broad a rray of prog ra ms for their patients a nd fa mi lies. Hope Hospice wa s founded by our communit y, thus we feel a g reat sense of obligation to g ive back to the community a high-qua lity hospice a nd pa lliative ca re orga nization. ■ M D N E W S .C O M /// M D N E W S S O U T H O F B O S T O N ■ 2 016 1 9