American Society of Regional Anesthesia and Pain Medicine February 2015 - (Page 20)

Palliative Care and Pain Medicine-Beyond Intrathecal Pumps and Opioids with expertise in these domains and a focus on interdisciplinary collaborative care, can help provide an extra layer of support to these patients and families as well as the clinicians caring for them in both the inpatient and outpatient setting. Halena M. Gazelka, MD Anesthesiology, Pain Medicine, and Palliative Medicine Jacob J. Strand, MD General Internal Medicine and Palliative Medicine Mayo Clinic Rochester, Minnesota Section Editors: Andrea Nicol, MD, and Kevin Vorenkamp, MD " W hat is palliative care?" is one of the more common questions we hear when introducing ourselves on our inpatient hospital consult service. Patients, nursing staff, and fellow clinicians are often unsure about our role in patient care or associate our presence with end-of-life care. As a relatively new specialty, and one that grew out of the hospice movement, it is understandable that people would ask such questions. With the ever-increasing complexity of care for patients with serious illnesses and the growing evidence for introducing palliative care early in the course of a patient's care, palliative care providers are strongly positioned to help educate providers from all specialties about the benefits of early collaboration. The provision of palliative care is rapidly becoming mainstream, with palliative care consultative services available in more than 60% of United States hospitals with greater than 50 beds and an even higher penetration (>85%) in hospitals with more than 300 beds.1 Palliative care teams help care for patients with a widevariety of serious illnesses, such as cancer, congestive heart failure, chronic obstructive pulmonary disease, end-stage renal disease, neurodegenerative disorders, and critically ill patients in a variety of intensive care unit (ICU) settings. As the evidence for earlier palliative care integration has increased, more programs are developing and staffing outpatient palliative care clinics to meet the needs of patients with a serious illness in a variety of care settings. THE CASE FOR PALLIATIVE CARE Palliative care teams focus on treating symptoms of a serious illness, including pain, dyspnea, fatigue, constipation, nausea, anorexia, insomnia, and depressed or anxious mood. Palliative care clinicians engage in complex communication interactions surrounding medical decision-making and look to help delineate a patient's goals, preferences, and values. This approach to care, done in collaboration with referring clinicians, seeks to both improve a patient's quality of life and help align a patient's care with those values, working to provide the right form of care, at the right time, in the right care setting. As palliative care has grown as a specialty, so too has the evidence for its involvement earlier in the course of a patient's serious illness. Early palliative care involvement has been shown to significantly reduce symptom burden such as dyspnea, anxiety, depression, and pain for a variety of patients with serious illness from cancer to heart failure to chronic obstructive pulmonary disease.2 Importantly, palliative care services have been shown to improve overall patient well-being and quality of life, reduce caregiver burnout, increase satisfaction with care, as well as reduce ER visits, hospitalizations, ICU and hospital length of stay, all without increasing mortality.3 In fact, we now have a number of well-designed clinical trials revealing that early palliative care involvement in patients with metastatic cancer may actually impart a survival advantage compared to standard care.4,5 "Palliative care providers are strongly positioned to help educate providers from all specialties about the benefits of early collaboration." Palliative care is specialized medical care for patients with serious illnesses. Our mission is to provide relief from the symptoms of serious illness while assisting patients and families with support in achieving their goals for medical care. Particular importance is placed on improving and achieving quality of life. Basic symptom management, prognostication, and clarifying treatment goals are inherent to the practice of nearly every medical specialty. However, the situations of patients suffering serious medical illnesses are often complex, fraught with difficult to manage symptoms, communication challenges, and a need to align treatment decisions with appropriate goals of care. Palliative care, 20 2 PALLIATIVE CARE COLLABORATION WITH PAIN MEDICINE SPECIALISTS The effective management of complex pain in patients with American Society of Regional Anesthesia and Pain Medicine 2015

Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2015

In Memoriam : Alon Palm Winnie, M.D., ASRA Founding Father
President’s Message
40th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
Resident and Fellow Events at the 2015 Spring Meeting
How We Do It: Managing an Acute and Perioperative Pain Medicine (APPM) Service at the University of Florida
Ketamine—an Old Drug with New Tricks
Optimal Postcesarean Delivery Pain Management
Palliative Care and Pain Medicine—Beyond Intrathecal Pumps and Opioids
Scientist Spotlight—Dr. Guy Weinberg, Trailblazer in Patient Safety

American Society of Regional Anesthesia and Pain Medicine February 2015