WASHINGTONIn an ideal world, palliative care would be integrated into therapeutic care from the time of cancer diagnosisnot limited to hospice or end-of-life care. An interdisciplinary palliative care team would regularly assess each patient's needs, not only for pain and symptom relief but also for psychosocial and spiritual needs. Their activities and recommendations would be closely coordinated with clinicians on the curative team.
This is no pipe dream, according to Ann Berger, MD, chief of the Pain and Palliative Care Service (PPCS) at NIH's Clinical Center, where she is working to turn this vision into reality. The NIH Clinical Center is a clinical research hospital, and all patients participate in clinical research studies.
Speaking at the World Cancer Congress, convened by the International Union Against Cancer (UICC), Dr. Berger described the philosophy and methods that are enabling NIH to integrate palliative care into the treatment of cancer patients and those with other diseases on therapeutic research protocols (abstract 6-2).
"Palliative care is optimized when initiated at the time of diagnosis and comprehensively utilized throughout the disease," Dr. Berger said. "We're there the whole way through."At NIH, the PPCS is addressing those needs through a core team consisting of a chief physician, a palliative care advanced practice nurse, a nurse practitioner, a nurse thanatologist, and an administrative coordinator. Designated liaisons in Clinical Center departments also work with the PPCS.
The Quality-of-Life Team
A key tool for the PPCS team is going on rounds with the curative team. "Clinical presence at the bedside is paramount," Dr. Berger said. One challenge at the outset was the perception that the start of palliative care equals the end of hope for cure or long-term remission. Changing terminology helped. "We call ourselves the quality-of-life team," Dr. Berger said. "That's acceptable to patients."
A second critical step is daily follow-up visits to anchor symptom management in the research protocol. And a third is documentation in a consult format, providing a rationale for interventions.