Palliative Pearls

Is my patient ready for palliative care?

Do you ever find it hard to explain why you want your patient to see the Palliative Care team?  We like to use the term “Supportive Care” when explaining to people what we do.  Our team consists of a physician, a nurse practitioner, two nurses, a social worker/counselor, a medical assistant, and a team coordinator.  We help patients who are facing serious illness, by addressing physical symptoms, psychological challenges, social issues, and spiritual health.  Many of our patients interact with every person on our team during their illness, and we encourage them to bring their family or friends to their visits with us.  We try to add an extra layer of support for those who are struggling with life-limiting illness.   We often see patients with advanced heart or pulmonary disease, neurologic disorders, advanced kidney disease, and cancers.  We will explore patient’s goals of care, and complete advance directives, when needed.  We have a volunteer notary service available for helping patients complete their important documents.  We have Spanish speaking staff available for interpretation during our visits.  We work closely with the home-based palliative care teams in the county (VNA, Assisted, Central Coast).  Our team is located in the Ridley Tree Cancer Center.

We would like to use this space regularly to share stories and educate.  Do you have topics you would like to hear more about?  Have you heard from your patients about their experiences with our team?  We would like to better serve you, our colleagues, as well as our patients.  If you want more information about which patients to refer to us, please see our Referral Guidelines.

Sansum Clinic provides Palliative Care for any patient in our community, with or without a referral.  With telemedicine, we have patients stretching from Bakersfield to Oxnard.   We are available to you and your patients, by calling 805-879-0675.

Our team is motivated to align our patients’ medical care with their individual goals and preferences. One important way to do this is by initiating advance care planning discussions and having patients complete their advance care planning documents. This includes not only patients referred to palliative care, but all Sansum patients and members of our community. 

Initiating advance care planning conversations can be challenging.  It is important to approach the conversation in a motivating and exploratory way. 

How to identify which patients should complete advance directive or review their previously completed advance directive for updates? 

• Any adult age 18 years or older 
• Patients with stable, early onset, or chronic/progressive conditions
• Providers: Ask yourself the Surprise Question, “Would I be surprised if my patient was alive in a year?” (If the answer is yes, recommend referral to Palliative Care and ACP) 
• The “5 D’s” guide may help you remember to address ACP if a patient had a recent:
  • Death of family member or friend
  • Divorce
  • New diagnosis
  • Significant decline in health 
  • Reaches a new decade 
    

An advance directive is a legal form for people 18 years and older. It documents a person’s selected health care agent, and helps to determine types of medical care they would like to receive if they were very sick or injured and could not speak for themselves. A variety of legal advance directives can used including the MyCare document. *Recommended for all adults, regardless of their health status.*

A POLST is an acronym for Physician Orders for Life-Sustaining Treatment. It is a bright pink form, signed by both patient and physician, NP, or PA that has a treating relationship with the patient. The POLST transforms the patient’s wishes into medical orders, which are to be respected across the continuum of healthcare settings including the patient’s home.  The form is often placed on a patient’s refrigerator in their home to allow first responders and emergency personnel to SEE and to KNOW the patient’s wishes regarding life-supportive care, medical treatment, artificially administered nutrition including feeding tube placement and CPR. *Important to complete if patient is DNR/DNI to prevent unwanted CPR or medical care from starting* 

The advance directive and POLST forms are complementary, not meant to replace one another. 

If a patient expresses a clear desire for CPR regardless of situation, no POLST is needed. 

Dr. Meyers often asks, “Is there any medical care you would NOT want to receive?” This approach often invites questions, discussion, and can disarm those who feel they might be having care withheld from them by their providers.