PITTSBURGH, September 2, 1998 — To improve the quality of life of patients when their disease is no longer responsive to curative treatments, University of Pittsburgh Medical Center has established a Comprehensive Palliative Care Service. Under the direction of Robert Arnold, M.D., associate professor of medicine, the Palliative Care Program provides comprehensive, coordinated services to terminally ill patients and their families. The service emphasizes relief from pain and other distressing symptoms, integration of physical, psychological and spiritual aspects of patient care, and development of a support system both to help patients live as actively as possible until death and to help the family cope during the patient’s illness and in bereavement.
"The focus on palliative care at University of Pittsburgh Medical Center is part of a nationwide re-evaluation of these issues," says Dr. Arnold, who is also associate director, UPMC Center for Medical Ethics, and director, section of Palliative Care in Medical Ethics, Division of General Internal Medicine. "Too often, physicians, nurses, pharmacists and social workers focus on curative treatments, leaving them ill-prepared to provide palliative care at the end of life.
"Providing palliative care requires knowledge of: the scientific basis of common symptoms found in terminally ill patients; the pharmacology of narcotics, anti-depressants and other medications; the psychology of grief and bereavement; and the ability to sensitively discuss important ethical, psycho-social and spiritual issues with patients and their families," says Dr. Arnold.
The Palliative Care Consult Service is staffed by a nurse practitioner, a physician, a pharmacist and a psychologist, all with expertise in palliative care, who work closely with primary care providers, social workers and case managers to coordinate care.
The team works with physicians to manage symptoms such as pain, delirium, fatigue, anorexia, depression, anxiety and shortness of breath. The program also provides emotional and psychological support for patients and their family members, helps discuss end-of-life issues, and develops appropriate treatments and discharge plans for terminally ill patients. It also tracks patients after discharge to ensure that families are offered bereavement services after the patient’s death.
The Palliative Care Program will extend to UPMC Shadyside this fall. Over the next two years the program is expected to expand to include an inpatient palliative care unit; an outpatient center; guidelines in palliative care for all University of Pittsburgh Medical Center institutions; educational offerings for medical students, residents and fellows; and programs for nurses, pharmacists and social workers.
The Palliative Care Program is an outgrowth of many palliative care initiatives undertaken at UPMC during the past decade. The ethics committees of UPMC Presbyterian and UPMC Shadyside have developed policies for advanced directives and "Do Not Resuscitate" measures.
The University of Pittsburgh Cancer Institute (UPCI) also has a number of initiatives to improve care at the end of life. In 1994, Dr. Rowena N. Schwartz developed the UPCI’s Cancer Pain Program to provide consistent pain management. Supportive/Palliative care was incorporated in the UPCI Oncology Disease Management effort, with guidelines released in 1997. Additionally, in 1997, UPMC developed an outpatient hospice program, Hospice of Community In-Home Services, to offer comprehensive outpatient care for terminally ill patients.
The steering committee of the Palliative Care Program includes, in addition to Dr. Arnold: Adam Brufsky, M.D., division of oncology, medical co-director of UPMC Hospice; David Pasaquale, D.O., division of geriatrics, medical co-director of UPMC Hospice; Carol DeMoss, R.N., director, UPMC Hospice; Rowena Schwartz, Pharm.D., director, UPCI Cancer Pain Service; Sally Tarbell, Ph.D., UPMC Behavioral Medicine; Beth Chaiten, M.S.W., Social Work and Co-Chair, Ethics Committee, UPMC Shadyside; and Paul Friday, Ph.D., Chief, Psychological Services, UPMC Shadyside.
Palliative Care was the subject of UPMC’s 7th Annual Current Controversies in Medical Ethics on April 27, 1998, that included the 15th annual Ira R. Messer Lecture.