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Northeast Florida Medicine
Vol. 67, No. 1 2016
13
Guest Editorial
What is palliative care? Which patients need it most?
Who provides it? What is the status of palliative care in
Northeast Florida?
Palliative care is specialized medical care for serious
illness, with a focus on quality of life, relief of distressing
symptoms and shared communication toward realistic goals.
This holistic care for
patients and families
is provided by a core
teamof palliative social
workers, chaplains and
physicians. Palliative
medicine is a mainstay
now at many academic
centers, which publish
mounting evidence of
its benefits for patients,
families, hospitals and
our health care system.
In 1973, surgical
oncologist Dr. Balfour
Mount coined the term
“palliative care” to distinguish it from hospice care. While
not constrained by the Medicare Hospice Benefit, palliative
care is better viewed as a separate but complementary spe-
cialty to hospice. Palliative consultants often work side by
side with other specialists during an acute hospitalization.
The interdisciplinary palliative care team addresses not
only physical pain and symptoms, but also psychosocial
and spiritual issues that often magnify distress. Aggressive-
ly addressing these symptoms of suffering can then allow
important “goals of care conversations,” during which pa-
tients confirm their understanding of the medical opinion
and voice and document their preferences for care. These
conversations are best seen as a process, with preparedness
plans (advance directives) ultimately becoming physician
orders. And with improved symptoms, patients are better
able to comply with treatment plans.
Patients expect their physicians to listen to their concerns,
address symptoms and provide their medical opinion. This
triad becomes increasingly important as an illness progresses,
and when attempts to cure or even manage a disease become
increasingly burdensome. We physicians foresee predictable
outcomes but often struggle to share these with our patients.
In our complex medical system both real and hoped-for
medical breakthroughs often lead to unrealistic expectations,
universal frustration and distress.The identified need for im-
proved symptommanagement and communication exceeds
the current availability of palliative care specialists. However,
skills in palliative care are available to all practitioners.
After completing my fellowship in Hospice and Palliative
Medicine in 2007, I was honored to sit for the inaugural
board exam, after no fewer than 10 medical specialty boards
supported the official recognition of the specialty. By 2015, in
U.S. hospitals with more than 50 beds, 72 percent had some
type of palliative care program. Here in Northeast Florida,
nine hospitals have board-certified palliative physician-led
consultation services, and outpatient palliative services are
growing in their availability.
The articles in this issue, written by my local colleagues,
complement the nationwidemove to provide “generalist-level
palliative care” training, while growing the number and
quality of palliative care specialists. We are fortunate to
have two Hospice and Palliative Medicine fellowships in
Jacksonville, at the University of Florida College of Medi-
cine – Jacksonville and Mayo Clinic Florida.
Dr. Andrea Sharp’s article highlights palliative care in the
often urgent and high-pressure atmosphere of the emergency
department, where distressing symptoms need appropriate
management, and best disposition is essential.
Drs. Corey Hobbs, Jamie Cesaretti, Mitchell Terk and
Michael Olson bring to the forefront the use of advanced
technology to provide quality of life, noting that symptom
management has long been amajor goal of radiation therapy.
Jamie Buller, our local coordinator for the Honoring
Choices® Florida community-wide advance care planning
collaborative, provides a wonderful overview of perhaps
the most patient-centered event in health care history, with
Jacksonville at the forefront.
Dr. Neel Karnani’s article permits us to accompany him
during a critically important procedure in palliative care:
that of compassionately removing life support. The “double
effect” confirms the clear intention of providing excellent
care when the goal is to protect our patient from technology
that is no longer helpful.
Drs. Robert Shannon, AlvaRoche’-Green andKristin Scott
have provided an encompassing series of case reviews that
highlight how effective a palliative approach can be in chal-
lenging situations, and review core concepts of our specialty.
Finally, palliative chaplain David Morrell brings his ex-
perienced perspective to the often-underappreciated area of
spiritual distress and offers support resources.
The rapid growth of palliative care highlights the need to
improve quality of life in our complex health care system.
Our patients with serious and advanced illnesses will greatly
benefit fromphysicians who embrace palliative care and refer
early when it is needed.
I hope this issue of Northeast Florida Medicine will
find itself at the top of your reading list and be a frequent
reference. I am honored to be your guest editor and to join
authorswhobring such awealthof experience, knowledge and
expertise to the discussion. We should all be proud that our
region has this degree of resources in palliative care – experts
who can provide the best care possible for our patients.
v
Andrew P. Daigle, MD
Guest Editor
Palliative Care in Northeast Florida