In grave moments come insights about life choices

News Archive

In grave moments come insights about life choices

Palliative caregivers help patients with a potentially fatal injury or illness to live with intention and address “what ifs”
Brian Donohue

Medical advances today keep patients alive through diseases and traumas that a generation ago meant certain death. Such progress enables people with life-threatening illnesses to more fully consider not only “How will I die?” but also “How will I live?”

Clare McLean
Dr. Jane Becker talks with a patient in the outpatient palliative care clinic at Harborview Medical Center.
Dr. Jane Becker talks with a patient

The thought can seem emancipating or onerous, depending on the health conditions involved, a person’s outlook and myriad other considerations of daily life. At UW Medicine, palliative care specialists help patients and families acknowledge mortality and then explore living with intention.
Recognition of palliative care’s value to medicine has grown appreciably: in 2000, 25 percent of hospitals had such a program; today it’s 66 percent. Yet the general public and many clinicians hear “palliative” and think “end of life” – a too-narrow conclusion.
“End of life is a big piece, but palliative care is appropriate for any seriously ill patient whose future is uncertain. They may recover from that illness or injury and their palliative care needs dissolve,” said Dr. Randy Curtis, section head for Pulmonary and Critical Care Medicine at Harborview Medical Center and director of UW Medicine’s new Palliative Care Center of Excellence. 
Physicians who refer patients to UW Medicine for care of a serious illness might get a call from a palliative care provider who has been asked to see their patient. These calls bring to light practical information for both parties.
“Primary physicians have longevity with the patient. They give us any number of insights: The daughter is the decision-maker, or the patient is a fighter and has unrealistic expectations, or the patient is undergoing all these treatments so he can go home and take care of his wife, who has Alzheimer’s,” said Dr. Stuart Farber, the new center’s clinical operations chair and a UW professor of family medicine. “Patients don’t always share this context.

Clare McLean
Dr. Randy Curtis (blue shirt) leads a team through patient rounds in the Intensive Care Unit at Harborview Medical Center. He is director of the UW Palliative Care Center of Excellence.
Palliative care specialist Randy Curtis leads a team through patient rounds.

“We might share, for example, that the patient wants to go home with hospice, and ask, ‘Are you willing to be the hospice physician, or do you know a good resource nearby?’ We want to collaborate on giving the patient the best transition back to the community.”
Palliative care clinicians often can bring calm and clarity to people in grave and unfamiliar circumstances. They face family members’ wide-eyed grief and, sometimes, outpourings of long-held regrets and misgivings. These specialists present plainspoken realities of conditions, treatments and outcomes. They ask patients to identify life priorities and remind them: You have choices.
“As our society ages and our technological care gets better, we have the ability to prolong life, but it isn’t clear whether we should. There's no blood test or X-ray that tells you,” Farber said.

Beyond the inpatient program, an outpatient counterpart combines palliative and primary care for terminally ill people in King and southern Snohomish counties.

Clare McLean
A patient hugs Dr. Darrell Owens after his monthly house call to provide primary and palliative care.
Palliative care patient hugs Dr. Darrell Owens.

 “It’s a model that’s not duplicated anywhere else in the country,” said its director, Dr. Darrell Owens. “Our current census is just over 300, and more than half are seen via house calls. We receive physician referrals and self-referrals, too, from people who are housebound. [Watch related video.]
“We treat a number of cancer patients who are not established with a primary care provider. In seeing them, we may manage their high blood pressure as well as their pain associated with cancer as well as helping them with medical decision-making,” Owens said.
Palliative care is hardly new to UW Medicine; rather, the “center” designation involves more tightly integrating pockets of excellence in clinical care, teaching and research, and improving UW Medicine’s role as a resource for regional providers who want to develop or improve palliative care at their sites.