Palliative care is specialized medical care to promote comfort and quality of life for people with serious illness – whatever the diagnosis or life expectancy – and to ensure that treatment aligns with patient goals and values. Palliative care is on the rise in the US and here at UNC. The Division of Geriatric Medicine extends congratulations to Division faculty members Laura C. Hanson, MD, MPH, and Gary Winzelberg, MD, MPH, on Palliative Care Program expansion in the Department of Medicine.
Hanson was recently named Director of the Department’s Palliative Care Program, with Winzelberg as Associate Director. Together they will lead an expanding interdisciplinary program of palliative care services, teaching, and research that will reach every subspecialty in the Department.
According to the Center to Advance Palliative Care, the rise in palliative care among health care providers and at hospitals has been steady over the past 16 years. In 2000, less than a quarter of US hospitals had a palliative care program, compared with three-quarters in 2016. Clinical palliative care services began at UNC Medical Center in 2001 with funding from UNC Hospitals and support from the Divisions of Geriatric Medicine and Hematology-Oncology.
“Both Geriatric Medicine and Palliative Care are grounded in an approach that prioritizes the patient’s goals and preferences, addresses physical needs along with psychological and social needs, and involves families and caregivers in a process that seeks to improve quality of life, no matter the patient’s prognosis,” says Chief of Geriatric Medicine and Center for Aging and Health Director Jan Busby-Whitehead, MD. “Palliative care needs of older patients can be different from those of younger patients, but we share the goals of reducing burdensome interventions and hospitalizations at the end of life, while increasing the quality of end-of-life care.”
Dr. Hanson describes the additional layer of patient care and family support that palliative care provides.
“Palliative Care starts with good medicine – we must understand the pathophysiology, diagnoses, and treatment options for patients facing serious illness. But palliative care clinicians add careful assessment of the patient and family caregiver experience of illness – what is causing suffering and distress? What values and goals do they want to guide their medical treatment choices? What allows the patient and family to experience quality of life while living with serious illness? From that assessment, we make recommendations to the primary team about ways the patient may become more comfortable, or live better in spite of a serious or incurable disease.”
As to the discipline’s expanded role in medicine, Hanson says: “Without question we are seeing increased interest in palliative medicine and nursing. We currently train medical students and nurse practitioner students; we also routinely support rotations for Internal Medicine residents, and for Fellows in Geriatric Medicine and Oncology. Each year we train three Fellows in Hospice and Palliative Medicine, and we hope to expand opportunities for this specialty fellowship in the next few years.”