Written by Melissa Bean Sterzick
Treatment for an advanced illness is a more complex scenario than treatment
for a minor illness or injury. A long-term, debilitating condition creates
more than just physical symptoms and the need for medication and surgery.
An ongoing illness or disease has to be addressed in terms of its emotional
and spiritual impacts, as well as the ways it affects a patient’s
family. This is where palliative care is applied.
Eve Makoff, MD, has been practicing palliative medicine for six years and
served as the assistant director of supportive care/oncology, working
closely with cancer patients and oncologists at Cedars-Sinai before joining
Torrance Memorial Physician Network to continue this work. At Torrance
Memorial, Dr. Makoff has integrated with the Hunt Cancer Center and is
the clinical lead of a developing palliative care team.
Palliative care is not end-of-life care. It can be administered at any
time during the course of an illness. Pediatric palliative care is also
offered. The type of care required and the goals for improving quality
of life for the patient and the patient’s family mean creating a
team of health care providers that can address a long list of needs.
Dr. Makoff says palliative care is a specialized approach to serious illness
that emphasizes quality of life, communicating about health care goals
and gathering the patient’s community. Usually a hospital or physician
will recommend palliative care if the patient or the patient’s family
are experiencing distress. Some people are beginning to self-refer for
palliative care.
“In palliative care, we provide support—both emotional support
and support for symptoms that people experience while going through any
kind of serious illness. And we also support the family and caregivers,”
Dr. Makoff says.
While the makeup of palliative teams varies, most include a physician,
nurse or nurse practitioner and a social worker. Some include a chaplain,
dietitian and pharmacist. Teams coordinate care through frequent communication
and regularly scheduled meetings.
“Ideally what we do is assess a patient’s physical, emotional
and spiritual needs and address symptoms and needs where they would benefit
from therapeutic intervention,” Dr. Makoff says.
A lot of the work the team does is bring in appropriate resources. If a
patient is experiencing more spiritual or existential distress, a hospital
chaplain can visit. Or if the patient is at home, the team will seek out
members of the patient’s spiritual community to provide support.
If the patient has specific needs in terms of language, the team will
try to help connect the patient and the patient’s family with practitioners
who speak the patient’s language.
Much of the work of palliative care is pain and symptom management. But
pain management for palliative care patients is not only a prescription;
it’s also a conversation.
“Acute pain management is a process. I will talk about how anxiety
is contributing to their pain and what they are trying to achieve that
the pain is inhibiting. It’s never just physical,” Dr. Makoff says.
“We are figuring out what is helpful. If we don’t have the
resources, we try to identify what would help,” Dr. Makoff adds.
“Aside from that, we try to see ourselves as partners with every
resource in the community. We try to include everyone as part of the larger
team.”
There are tangible benefits for everyone receiving palliative care including
those with close relationships with the patient. “There’s
lots of data to show it improves quality of life and decreases anxiety,”
Dr. Makoff says. “Caregivers have fewer mood issues, and the process
helps patients have the kind of care they want. It’s necessary to
have a team to deal with the day in and day out distress.”
Dr. Makoff and other palliative care providers discuss life goals and priorities
with patients. They translate all the information patients are receiving
from their physicians and help the patient decide how to best combine
the medical information with their needs as an individual.
“We are trained in communication. It’s about active listening
and coming into patient-family interactions without bias or any kind of
agenda just to hear their needs and guide care based on what they tell
us.” Dr. Makoff says. “If what you’re telling me is
your goal is being active and interacting with your kids and you want
to be available and engaged, then what’s the next best step?”
Dr. Makoff says palliative care recipients usually have advanced cancer,
advanced dementia, heart failure, advanced pulmonary disease, kidney failure
or neurological diseases. Advanced disease and dysfunction of major organs
are the most common health issues related to the need for palliative care.
“My career trajectory has been more toward taking care of the most
needy and frail patients,” she says. “I felt a lot of them
were dealing with trauma and more time and attention were needed on things
that were not just strictly medical.”
Some palliative care patients will move in and out of care throughout the
course of their disease. Whatever the scenario, those with serious ongoing
illnesses can benefit from treatment, applied in a holistic manner, that
addresses the many areas of their lives affected by their conditions. •
Palliative Care is Not Hospice
Dr. Eve Makoff says even though more people are taking advantage of palliative
care, many still misunderstand its purpose. People confuse palliative
care with hospice which can make them hesitant to ask for palliative care.
It’s important to make a distinction between the two for many reasons,
but the most important is hospice is end-of-life care while palliative
care can be offered at any time during the course of a disease regardless
of expected outcome. “Hospice is for the last six months of life,
and palliative care is at any time during the disease trajectory,”
Dr. Makoff says.
Palliative Care
- Administered in-clinic, at home, hospital, nursing home or extended care facility
- Care provided by a team including doctor, nurse, nurse practitioner, social
worker and in some cases pharmacist and dietitian as well
- Offered at any stage of a serious illness
- Focuses on symptom management during ongoing, disease-focused treatment
Support for family
- “It’s more about the patient being able to consider what their
priorities are, especially if they have an advanced illness, and come
up with a health care plan to achieve those goals they have set,”
Dr. Makoff says. “We are establishing their life goals and determining
if that fits with the treatment they are being offered.”
Hospice
- Administered in home or nursing home
- Care provided by family caregiver,
- hospice team
- Offered during last six months of life
- Focuses on comfort care
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Eve Makoff, MD, is head of the Torrance Memorial Physician Network Palliative
Care team. She practices at the Hunt Cancer Center at 3285 Skypark Drive
in Torrance and can be reached 310-750-3372.