Palliative Care

Palliative care is a team-based medical specialty that helps patients who have a serious illness in the relief of their pain, symptoms, suffering and stress. The goal is to prevent and ease suffering and to offer patients and their families the best possible quality of life. It is useful at any stage of an illness and for patients of any age.

Palliative care can be provided at the same time as curative treatments.

The Palliative Care team works closely with all hospital disciplines to ensure that all the needs of the patients and families are met. These disciplines include:

• Case Management/SocialWork
• Nursing
• Patient Advocates
• Speech and Swallow Services
• Rehabilitation specialists
• Pastoral Care
• Primary Care Physicians
• Psychiatry
• Surgery
• Ethics Committee
• Cancer Care Committee
• Wound care program
• Pharmacy
• Medical Specialists (e.g. Cardiology, Pulmonary Critical Care, Oncology, Infectious Disease, etc.)

Currently, palliative care at NYP Queens is a service available to hospitalized patients.

New York State has passed recent laws related to palliative care:

Palliative Care Information Act (PCIA)

Effective February 9, 2011, New York State passed a law called the Palliative Care Information Act, which requires physicians and nurse practitioners to offer terminally-ill patients information and counseling concerning palliative care and end-of-life care options. The law is intended to ensure that patients and their families are fully informed of the options available to them when they are faced with a terminal illness or condition, so they are empowered to make choices consistent with their goals of care, wishes and beliefs and to optimize their quality of life. Even though this law focuses on patients with terminal illness, palliative care is actually much broader and can be accessed by patients with any serious illness, regardless of their prognosis.

Palliative Care Access Act: Palliative Care Requirements for Hospitals, Nursing Homes, Home Care and Assisted Living Residences (Enhanced and Special Needs)

Effective April 1, 2011, New York State passed the Palliative Care Access Act (PCAA). The "PCAA" builds upon the "PCIA" in the following ways:

1. It applies directly to health care facilities, home care agencies, and assisted living residences, as well as individual practitioners;
2. It applies to patients/residents with "advanced life limiting conditions or illnesses who might benefit from palliative care" and not just those who are terminally ill;
3. It requires, not only an offer of information and counseling, but also that the covered health care provider or residence "facilitate access to appropriate palliative care consultation and services, including associated pain management consultations and services."

Palliative Care May Be Appropriate In a Variety of Illnesses

Palliative care may be appropriate in the setting of a variety of illnesses, including but not limited to:

• advanced dementia or Alzheimer's Disease
• advanced neurological illnesses such as Parkinson's Disease and ALS
• advanced kidney, liver, lung or heart disease and stroke

The Role of Palliative Care in the Treatment of Cancer

In September 2010, the New England Journal of Medicine published an important study entitled Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. The study enrolled 151 patients and randomized the patients to one of two subsets: 1) standard oncologic care, or 2) standard oncologic care + early palliative care. The study found that among patients with metastatic non-small cell lung cancer, early palliative care led to significant improvements in symptoms, quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival (about two months longer).

In September 2011, the Commission on Cancer (CoC) released a new manual of program standards, Cancer Program Standards 2012: Ensuring Patient-Centered Care. This includes a new standard for palliative care (Standard 2.5). As the premier source for setting accreditation standards for cancer centers, the explicit inclusion of a robust palliative care standard represents an important step towards the recognition that all cancer patients and families have equal access to palliative care throughout the continuum of the cancer experience.

The Palliative Care Program at NYP Queens works closely with our Cancer Center and its specialty physicians and staff to provide high quality palliative care to patients living with cancer and their families.

Palliative Care Initiatives at NYP Queens

Interdisciplinary Pain Performance Improvement Project

This is a unit based project to improve pain management experiences for cancer patients. Controlling patients' pain is everyone's responsibility. Multiple disciplines meet together every week to review and attack pain problems so that patients' pain is better controlled and their quality of life is improved. These disciplines include nursing, palliative care, geriatrics fellows, pharmacists, and nursing education.