Palliative Care Consult Services Focus on Comfort at Life’s End
from Clinical Update, Summer 2004

Abstract: The Palliative Care Consult Service is a multidisciplinary team that helps patients and families with the challenges of end-of-life issues and facilitates transitions to hospice or home community care.

One of Wake Forest University Baptist Medical Center’s cornerstone values is compassion, and few of its programs exemplify that more than the Palliative Care Consult Service, now finishing its first year of operation.

Palliative care is that given to patients with life-threatening conditions, addressing issues of physical comfort as well as psychosocial and spiritual concerns. It is often synonymous with end-of-life care, and that can present communication issues.

Richard C. Stephenson, M.D., medical director for the consult service, explained, “A lot of referring physicians look to the Medical Center as a place to get tertiary or quaternary care. Patients and families seeking the latest therapies may have a lot of difficulty coping when it’s clear the therapy is not working for them.

“A palliative consult service can help make the transition,” he said.

With families, Stephenson said, it sometimes involves sharing difficult statistics about survival rates, and asking, “What if this is not just her (the patient’s) acute intensive care? What if this is her end-of-life care? How would you like that to look different?

“What else would you like us to focus on? Does she want to listen to music? Can we liberalize the visiting hours? Do you want to bring in some pictures? You want her to have her favorite blanket? What is it that would bring some comfort to her if these are actually her final days?”

Patients, Stephenson said, are often more accepting than family members. “Many patients will say, ‘I’ve lived a long full life, and as long as I’m comfortable it’s OK. Everybody’s got to die.’”

Being most comfortable often means going back to the patient’s hometown, and the Palliative Care Consult Service can help make arrangements for hospice or palliative care in counties throughout North Carolina and beyond. Referring or family physicians may be notified to assist with the continuing care.

Barbara Goldsmith, R.N., nursing coordinator for the consult service, said, “We try to talk with the family early on, while the patient is still able to make the trip, and say, ‘There’s really nothing else that we can do here, would it be helpful to try to get him back closer to home?’

“Most patients would rather die in their own community, where they’re well supported, if they know that that’s what’s going to happen.”

For patients who must remain at the Medical Center, Stephenson hopes that within two years we will have a palliative care unit, with dedicated beds, a comfortable home-like environment, and a full-time staff.

William P. Moran, M.D., section head of general internal medicine, which oversees the palliative care program, said Wake Forest Baptist’s service has a strong foundation. “We are very fortunate at the Medical Center to have a nationally recognized palliative care physician such as Dr. Stephenson, and a truly dedicated nurse with unique expertise such as Ms. Goldsmith.”

Since it began in July 2003, the service has grown from a handful of patients to an average of 25 to 30 a month. The palliative care team also includes members of pastoral care, case management and social work, a palliative care fellow and many other specialty health professionals.