Alliance Community Hospital adds palliative care team to help patients deal with chronic illnesses
By Shannon Harsh, The Review, Published January 21, 2013
Among Alliance Community Hospital's accomplishments during 2012 was the addition of a palliative care team to give extra help to patients dealing with serious and chronic illness. After a two-year process of investigation and research and intensive training at Mt. Carmel in Columbus, a five-member team was created that began implementing its services in October.
The team includes medical director Dr. Debra Lehrer, Dr. Ferdinand Cortese and nurse practitioner Cathy Fluharty, who oversee consultations at the hospital and work to set up family conferences. Lehrer said they try to make sure that every patient has a good understanding of their disease process, answer any and all questions that the patient and family have and coordinate with other doctors seeing the patient.
"We try to make sure that everybody's on the same page and that we have a good direction and we try to oversee the plan of care so that everybody's pulling in the same direction for the patient. That's one of the main things that we do is to try to help direct so that we're all aiming for the same goal," Lehrer said.
According to Lehrer, palliative care focuses on education, symptom management and establishment of a plan of care. She said that while hospice, which is part of palliative care, focuses on terminal cases, palliative care can be considered for any patient that has a chronic, ongoing illness, such as chronic obstructive pulmonary disease, congestive heart failure or dementia.
Lehrer called palliative care an "extra layer of service" for patients. "It doesn't mean to supplant anybody else, it's just an extra layer of service, an extra layer of help for the patient and the family," she said. "In palliative care, I tend to think of instead of 'hurry up and do something,' it's 'let's slow down and take some time here.' In palliative care, we have the time to sit down with the patient and the family to do education, to do explanation of the sometimes many different diseases that are ongoing in the patient and to go over each one to talk about what it means."
Rather than just focusing on the acute problem and reason for a hospital stay, she said palliative care is also about what is going to happen down the road to prepare the patient and the family. This includes how the patient wants their illness treated as it progresses and becomes life-threatening.
"What I very much don't like to see are patients that haven't had the education, haven't had the time to think about things, haven't had that time to prepare, haven't had that time to come to terms," Lehrer said. "Their family is clueless to what's going on. They come in in a rush to the emergency room and get put on life support. We're up in the ICU, it's a sob festival and no one knows what's going on because no one's taken the time. Then it is just horrific for the patient, for the family, for the caregivers, for all of us, it's gut-wrenching, and it doesn't need to be that way."
Lehrer said the hope is that they can provide education early on so that people can make the right decisions for them so that they can have the ending they want. "Here in the U.S., death is something that we fight at all costs. Nobody ever wants to face that," she said. "We're all going to come to that one day. It's part of the natural cycle -- the circle of life -- and it would be better if we came to terms with it before that day. It would be better if we, as caregivers, could help the patients and family be able to do that, and that's what palliative care's about, and that's why I'm so excited to be a part of this team."
Amy J. Antonacci, vice president of Patient Care Services, stressed the importance of informed choice. She said patients often don't understand their disease process and aren't prepared for the difficult decisions their families may have to make at the end. She said having a doctor sit down and go over the process their disease will take can help the patient and family understand and be able to make decisions ahead of time.
"Our goal and intention is to really educate our community so that they understand not just about palliative care, but about advanced directives and living wills because we want people to have informed choice," Antonacci said. "That's what's most important. Regardless of what your decision is on your treatment or plan of care, we want the patient to understand it and be a part of that. And it gets so confusing nowadays with the lingo and multiple physicians and providers they see. They get lost sometimes, but if they understand their choices, it makes it so much easier for them."
Lehrer said they have plans to continue to grow the palliative care services, including soon adding a sixth member to the team, a chaplain to work in palliative care and hospice. She said they also hope to be set up soon so that they can go out and do follow-ups in the nursing homes once patients are discharged from the hospital. Eventually, they want to be able to make home visits when patients are discharged back to their homes. Antonacci added that down the road, they want to have a dedicated bed space for palliative and hospice care somewhere on the ACH campus.
For now, the team continues to do its best to educate patients and help them make thoughtful choices about their health care. "I think it's making a difference," Lehrer said. "I think it's making a difference in their care, and I think it makes a difference for the family."