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The Palliative Care Model at UAB Medicine



hi my name is dr. Rodney Tucker currently I'm the director of the UAB Center for palliative and supportive care here at UAB I've been a faculty member here at UAB for over 13 years and in the specialty of internal medicine and palliative and supportive care it's a pleasure for me today to share information with you about this subject and this new model of care with one of my colleagues dr. Gabrielle Roth hello my name is Gabrielle rock and I'm an assistant professor in hematology oncology as well as palliative care I also serve as the medical director for the UAB health system cancer community network when we talk about palliative care both nationally and locally with our colleagues one of the first questions is what is palliative care so we always use that as a starting point believe it or not the word palliative and the concept of palliative care was coined by a Canadian surgeon dr. Balfour mount many years ago the word palliative means to cloak and shield from the violence of illness so in our specialty of Medicine palliative care we focus on a variety of primary topics we deliver care in an interdisciplinary plan of care which means there are multiple team members that participate in the care of patients such as physicians nurses pastoral care social workers massage therapists and including many other disciplines also we focus on the patient and family as a unit of care and we focus on four domains of suffering with our patients psychological social emotional physical and spiritual so what's unique about palliative care and supportive care as we'll talk more about is that we cover the spectrum of illness for patients with advanced and life-limiting illness from the time of diagnosis really until the time of end-of-life so when thinking about the state of palliative and supportive care in the United States one import a point is that there's been a tremendous growth over the past 10 to 15 years in the emphasis of palliative care and the organization of palliative care programs within hospitals and nail with in ambulatory clinic settings since the start of the palliative care leadership center program that's coordinated through the center to advance palliative care there's been over a one hundred and twenty five percent increase in the number of hospitals in the United States who have organized palliative care programs there's been a tremendous increase in the number of younger physicians that are entering the field because they see the future in this care delivery model so I think that's an important point as we move forward and as we think about the growth and potential of palliative care and where we've been in such a short for so patients when they confer are confronted with life-limiting illness or a significant illness such as cancer heart disease dementia end-stage lung disease that starts a series of interactions in the series of care models for this patient and family so at any point from the time of diagnosis to the time of a severe hospitalization as the disease progresses patients and their referring physicians may refer to the palliative and supportive care team to add that extra layer of support for patients and families so complete assessment of symptoms that affect quality of life for patients such as pain management shortness of breath nausea and vomiting depression anxiety and anything that affects the quality of life for patients becomes the focus of the entire interdisciplinary palliative care team for example patients who have a diagnosis of a significant cancer or malignancy may benefit from the aspects of an interdisciplinary plan of care that involves referral from either the patient and family because of identified needs or from their primary oncology or treating team such as dr. ah so UAB has changed its practice model to really include palliative care as an important component in cancer care so in my practice I am often referring patients who have advanced cancer to the to palliative care services and what's really unique about UAB is the ability to provide this entire team of services including physicians psychosocial support chaplains as dr. Tucker has highlighted earlier and that really provides the best possible experience for patients going through their cancer journey here at UAB one of the primary things and what makes us more unique and as a national leader is the focus on the locations of care in which patients and families receive their treatment so palliative and supportive care may be most integral for patients in the ambulatory setting in partnership with their primary treating physician such as oncologists cardiologists etc but also when a patient has an admission to the hospital the same palliative and supportive care tuning can visit the patients can see the families for the continuity and then additionally once patients are discharged back into the community another unique aspect is that we can help with the continuity of the patient's care plan back to home involving other services such as hospice home care with the possibility of doing home visits so that makes the continuum of care and support for the patient and family all across the spectrum of their illness I think that's a really important point that that continuity really builds on the relationships between the patients and their families and the palliative care team as well as the oncology team one of the things that I think is really the future of palliative and supportive care is the extension into the community so we recognize that there is a limitation and that there aren't enough palliative care physicians to really see every advanced cancer patient so we are working together to think of more elaborate ways that we can extend services particularly into rural settings in the south because that is an unmet need that I think we have an obligation to address I agree and the future of our field is exactly that it's extension of the ideas and the concepts of patient and family-centered care matching the patient's goals with the pluses and minuses or benefits of treatment and to help our community at large all of our oncology providers our patients and families become more engaged with their treatment and decision making about their treatment options so the future is for us to continue to educate to promote the concepts that we've talked about and to continue to provide an extra layer of care as we call it for the public I think they'll always be a role for tertiary care palliative care for the most complex cases but I think one of the take-home points here is that everyone across the medical community and patients and families can really learn and benefit from the skills that palliative care brings to the care team so our future is to empower our providers and power our physician colleagues empower our patients and families to request palliative and supportive care services to expect that good symptom management discussions about goals of care good communication coordinated care is an expectation and so spreading that beyond the demak medical centers beyond UAB medicine into the community really is the core future and we're happy to partner with referring physicians medical centers all across the southeast and the nation in continuing to be a national leader in this area for the benefit of not only our local patients and families but for patients and families throughout the country who have life-limiting advanced or serious illness such as cancer

Glenn Chapman

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