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Understanding Palliative and Supportive Care · Talking FACS

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  Welcome to Talking FACS, and thank you for tuning in to Cancer Conversations
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  on Talking FACS, a podcast collaboration between the University of Kentucky
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  Markey Cancer Center and the UK Martin-Gatton College of Agriculture,
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  Food, and Environment's Cooperative Extension Service.
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  We will share with you the latest developments in cancer prevention,
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  diagnosis, treatment, and research from the experts at Markey Cancer Center,
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  Kentucky's only National Cancer Institute -designated Comprehensive Cancer Center.
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  Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello, and welcome to Cancer Conversations on Talking FACS.
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  We are a partnership project between the University of Kentucky Markey Cancer
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  Center and the University of Kentucky Cooperative Extension Service.
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  I am Mindy McCulley, Extension Specialist for Instructional Support with Family
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  and Consumer Sciences at the Martin-Gatton College of Agriculture, Food, and Environment.
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  My guest today is Dr. Katrina Nichols, an Assistant Professor in the Department
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  of Internal Medicine, the Division of Palliative and Supportive Care.
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  Welcome, Dr. Nichols.
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  Hi, thanks for having me today. We are going to talk about palliative and supportive
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  care in relation to a lot of chronic diseases, but especially in relation to cancer.
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  And so my first question to you is what is palliative care?
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  Yeah, it's a common question of what is palliative care.
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  And the answer is actually not straightforward because I have two answers for
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  you. First of all, palliative care is an approach.
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  It's an approach to taking care of people who are living actually with serious illness.
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  It can be like having multiple chronic illnesses that cumulatively together
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  put someone at high risk of needing to go to the hospital frequently,
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  have procedures done frequently, having some risk of death, which is very scary.
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  And so looking at the approach to care, looking at them in their life outside
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  of healthcare, looking at them in the social concept, how they're coping with
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  it, as well as physical symptoms.
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  And then palliative care also is a sub-specialty. It's like a medical sub-specialty,
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  just like there's cardiology, oncology.
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  These are healthcare professionals who have additional training on top of general
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  medical training to deliver this care.
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  And so as a sub-specialty, we are trained in really advanced pain and symptom
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  management and understanding all of the points of distress that our patients
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  and the people who care for them go through when they're living with serious illness.
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  It sounds to me that it requires almost a whole team kind of to provide this
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  type of care. Would that be accurate?
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  Exactly. Exactly. Ideal palliative care is a full, all-hands-on-deck team approach.
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  And so in our palliative care clinic, and not every single palliative care service
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  or clinic has a full team,
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  but for example, in our clinic, we have a specialized training in our pharmacist,
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  in our nurse, in our social worker,
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  in our chaplain, and then with our nurse practitioners and physicians on our team.
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  But that could also include pulling in, say, like physical therapists or speech
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  therapists who are familiar with working with patients, especially at the Markey
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  Cancer Center, who have needs related to their treatments,
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  you know, such as like having a tracheotomy and speech deficits or having neuropathy
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  and fatigue related to cancer treatments.
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  So it really is like the team could be quite big or it could be small,
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  depending on what the patient needs.
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  I love that everybody kind of has to work together because it seems to me that
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  it would give some comfort not only to the patient, but also to those caregivers,
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  the people who are working to make sure that the patient is supported and cared
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  for, even when they aren't maybe in the hospital.
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  Yeah, exactly. Exactly. And, you know, and knowing the teams can be very large
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  and then that can be for a lot of people comfort.
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  But honestly, it also can be overwhelming, like trying to keep up with so many team members.
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  But just knowing that people are available, resources are available,
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  people with special training are available to support someone with whatever
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  they feel is most urgent and pressing at the time.
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  Dr. Nichols, can you explain how palliative care is different from hospice care?
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  That comes up very frequently.
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  Because we have, as palliative care clinicians, we have the same training and focus as hospice.
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  And actually, for physicians, our fellowship training encompasses hospice and
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  palliative care in that year of additional training.
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  Because they're both focused on quality of life and improving symptoms and dealing
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  with patients who have a high level of stress and they are worried about their prognosis.
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  But I would say palliative care is broader and hospice care,
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  at least in the United States, is very specific because it's a bundle,
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  you know, like insurance bundle for that entire team-based approach,
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  including medications and equipment to the home and all of those things.
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  But it's very specific to that insurance bundle.
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  So it's very specific to having a limited prognosis a month's live.
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  But in palliative care, it's that overall approach.
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  So anyone living with life-changing illness, you know, in the hospital,
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  we see it commonly like just in the trauma ICU.
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  And many people live and survive, but it's a very stressful time.
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  But it's there to provide that extra layer of support while the other specialists
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  are focused on helping their body and health improve.
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  I mean, using all of those skills and training so that they know how to improve
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  the patient's It's survival and function and health, and the palliative care
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  team helps support how they're coping through it, how they're receiving the information,
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  and then if they have unmanaged symptoms, to help with that as well.
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  What are some of the things that a patient and their caregivers can expect when
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  they're going through palliative care and maybe graduating out of palliative care?
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  Right, right. At least here in the Markey Cancer Center,
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  what we'll see, and for us where we are right now in our growth,
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  although any patient with a serious illness would benefit from palliative care,
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  where we are right now with the size of our division is we're focused right
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  now only on seeing patients with advanced stage cancers.
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  But so if someone is diagnosed and they know they're going to have an intensive
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  treatment plan and their oncologist identifies that they could benefit and be
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  receptive to go into another clinic appointment, then they'll meet our whole team.
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  So it's a physician and pharmacist helping, looking at the medications that
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  would help with all of the chemo-related side effects or surgery side effects
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  or radiation side effects to help that be more manageable.
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  Meet with a social worker to consider what are some resources within the cancer
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  center that can help them, even if it's dietary, if it's gas cards or staying at the Hope Lodge.
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  And then also, you know, some mental health assessments, you know,
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  do we have recurrent major depression and we need to get connected again with
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  a psychiatrist, for example.
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  And we also have spiritual support. And that doesn't have to be religious-based
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  by any means, but just making sense of some thoughts that people will have now
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  that they're looking at their life differently of, I'm pretty sick and I don't
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  know what this could mean.
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  And we all know we're not living forever, but it's quite different when you
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  start thinking about your own limitations.
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  So coming with that whole team approach and then seeing just clinic visits like
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  you would other clinic visits and knowing that you have a team that's working
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  with your cancer center team as well, your oncologists to provide the best care,
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  improve the quality of life until however often and for however long that it's helpful to the patient.
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  We have lots of listeners who are out in the state.
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  So if they aren't local to Lexington, how would they go about finding if they
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  can access palliative care resources where they are?
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  Yeah. So I would recommend first starting with the healthcare teams that you have.
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  I know that there are several palliative care approach services out in this,
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  but they may not be called palliative care.
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  I would say primary care offices are usually most familiar, I found at least,
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  with what resources are available.
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  Larger hospital systems might know and have and house yourselves palliative care services.
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  And that can look differently wherever you are. Here at University of Kentucky,
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  of course, it's the university, so it's staffed robustly.
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  But at other smaller or community hospitals, it may be that it's a palliative
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  care nurse-led to help with coaching through these are the services that you
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  would need and just having conversations and
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  guiding patients and families,
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  but asking for, you can say palliative care, and as we mentioned before,
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  so that they know that they're not asking for hospice care,
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  just because sometimes people confuse those terms, saying, you know,
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  I just need more support.
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  What supportive services are there to help me navigate all of this?
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  So it might sound like a supportive service, it might be a care navigation service.
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  And then they can help pull in what a team would look like.
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  Like, who are the pain management specialists in the area?
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  Who are the mental health providers in the area?
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  Or maybe it's that I need case management and resources, and maybe there's an
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  elder care service or American Cancer Society-supported service or something like that.
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  Well, before we wrap up, are there any last thoughts that we need to share?
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  I guess just to say there's such a benefit for having palliative care in that
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  approach, and unfortunately, just not enough services, so maybe...
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  I would say, you know, if anyone is familiar with your local healthcare community,
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  being an advocate for palliative care and bringing that approach into your area
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  can really help the quality of life of so many people.
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  Having people who understand it, having people who have lived it through it
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  themselves and supporting others, that can't be underestimated.
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  And I'll share with you, Mindy, some websites that people can,
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  you know, check it out for themselves. ourselves as well.
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  Well, definitely. And we will get those linked in the show notes.
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  And so listeners can find those and access them.
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  Thank you so much for your time, Dr. Nichols. I know that I have learned a lot
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  through this conversation and I know that our listeners will as well.
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  Thank you for having me. If you are just tuning in, you're listening to Cancer
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  Conversations on Talking Fox, and you can find us wherever you listen to your favorite podcast.
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  Thank you for listening to Cancer Conversations on Talking Facts.
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  please message us on the UK Markey Cancer Center Facebook page at facebook.com
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  Music.