Clinical Rotations
Inpatient Adult Palliative Care
Transitions LifeCare
UNC Psychosomatic Medicine and Comprehensive Cancer Support Program
Addiction Medicine
UNC Hospice
NC Children’s Hospital Supportive Care Team
Outpatient Oncology Palliative Care Clinic
UNC Inpatient Hospice Unit
Elective Opportunities
UNC Palliative Care Consult Service
The UNC Palliative Care Program provides inpatient consultations to all UNC Hospitals (UNCH) patients. UNCH is a consortium of geographically linked medical, surgical, women’s, children’s, neuropsychiatric and oncology hospitals with a total capacity of over 1,000 beds. UNCH serves both as a community hospital and a referral center for patients from all 100 North Carolina counties. UNCH serves as one of the state’s major safety net hospitals and receives annual state legislature funding for uninsured care. Annually the UNC Palliative Care Program serves over 1,000 patients.
The adult Palliative Care Consult Service serves patients with a diverse array of life-limiting diagnoses. While cancer is the most frequent diagnosis consults are completed for patients with other common life-limiting conditions, including heart, liver, lung and neurologic diseases. Patients seen by the consult service are at different stages of illness from initial diagnosis to actively dying. The consult service routinely serves individuals who are African-American and Latino (35% minority patients).
The adult inpatient Palliative Care Consult Service is staffed by board-certified Hospice & Palliative Medicine (HPM) physicians, nurse practitioners, social worker and chaplain. Fellows will participate in all team activities and receive supervision from all team members. Fellows will receive increasing patient care responsibilities evolving from direct observation by team members to independent practice with oversight from the attending physician. Teaching of fellows in palliative care competencies will occur during team rounds, at the bedside, after patient and family encounters and through review of fellows’ documentation.
Founded as Hospice of Wake County in 1979, Transitions LifeCare has been our fellowship partner since the beginning of our fellowship program in 2015. Transitions LifeCare is a non-profit, community-based hospice and palliative care provider based out of Wake County serving adult and pediatric patients throughout six counties in central NC. All fellows will complete the required 100 clinical hours of providing palliative care in long-term care facilities under the supervision of Dr. Josh Dowd. All fellows will also integrate into a home hospice team and participate in home visits and interdisciplinary team meetings under the supervision of Dr. MJ Steele. The pediatrics track fellow will also spend many weeks with Transitions Kids making pediatric home-based hospice and palliative care visits under the supervision of Dr. MJ Steele and Dr. Sophia Paraschos.
Transitions Palliative Care
Transitions Hospice Care
Transitions Kids
UNC Psychosomatic Medicine and Comprehensive Cancer Support Programs
Through inpatient and clinic visits with physicians and health professionals from other disciplines, fellows will learn about the diagnosis and treatment of psychiatric disorders and difficulties in patients with life-limiting conditions. These difficulties include depression, delirium and assessment of decision-making capacity. Particular focus will be given to addressing the psychosocial and mental health needs of patients with cancer at all stages, such as during disease-directed treatment periods, advanced disease and survivorship.
Addiction Medicine
Fellows have the opportunity to spend one week rotating with the Inpatient Addiction Medicine Consult team, observing physicians, psychologists, and peer counselors engaging in Addiction Medicine consults and supportive visits.
The goal of UNC Hospice is providing specialized care focused on comfort, compassion, and support for patients with advanced illness and their families. Hospice is for patients with serious illness who wish to prioritize comfort-focused care and quality of life over curative treatments at the end of life. Hospice focuses on providing care where the patient is (home or in a living facility).
The hospice team offer many types of support including on-call nursing care round-the-clock, guidance from medical social workers, certified nursing assistants to provide help with personal care, assistance with medications, handling medical supplies and equipment, and other things.
Hospice is a member organization of UNC Health and partner closely with UNC hospitals, clinics, and care providers to maintain continuity of care. Hospice also works closely with patients’ primary doctors to ensure patients get the high-quality, appropriate care.
NC Children’s Hospital Supportive Care Team
The Supportive Care Team provides Palliative Care consultations for children on all inpatient General Pediatrics and subspecialty services in the North Carolina Children’s Hospital which is part of UNCH. Created in 2011, the team completed approximately 200 new patient consults and 750 total patient visits last year. The team includes 4 board certified HPM physicians, a HPNA certified nurse practitioner, a child psychologist, social worker, and collaborates closely with the chaplain and child life specialists.
Fellows will participate in all team activities, including team rounds and new and follow-up consult visits. Fellows will join at least one other team member as they collaboratively complete clinical services. During this rotation fellows will learn principles of symptom management, communication skills and decision-making facilitation for children with chronic and life-threatening conditions. Fellows will consider how these principles may differ compared with adult patients based on children’s distinct needs. In addition, fellows will learn how a Palliative Care interdisciplinary team functions to serve the needs of seriously ill children and their families.
Outpatient Oncology Palliative Care Clinic
Fellows will maintain an outpatient clinic for a half day each week in the North Carolina Cancer Hospital’s Outpatient Oncology Palliative Care Clinic. Developed as an outgrowth of the inpatient Palliative Care consult service, a physician dually certified in Medical Oncology and HPM, an oncology-certified pharmacist and a nurse practitioner comprise the interdisciplinary team.
The Outpatient Oncology Palliative Care Clinic receives referrals from the inpatient Palliative Care consult service and all oncology disciplines. The clinic team provides both consults for the referring physician and longitudinal care that complements the disease-based treatments offered by the primary oncologist. Visits are scheduled in advance or occur acutely at the request of the patient’s oncologist. While acute visits primarily address patients’ unmet symptom management needs, fellows will complete comprehensive palliative care assessments with new patients that includes communication of advance care planning options and identification of available resources to complement patients’ coping and support strategies. Fellows will complete new patient consultations and follow-up visits while receiving direct or indirect supervision from Outpatient Oncology Palliative Care Clinic team members.
At the SECU Jim & Betsy Bryan Hospice Home in Pittsboro, NC, UNC Hospice provides compassionate care outside of hospital setting. This allows patients to finish out their lives with meaning and peace. Located in a beautiful wooded setting the facility houses 10 private patient rooms, each with its own private patio. The surrounding gardens are home to native birds and butterflies and families are welcome. Services include general inpatient hospice care, respite care, and residential care.
Elective Opportunities
Fellows will meet with the program director to choose their elective rotation based on their interests and career goals. With this time, they can pursue additional experiences with any of the required fellowship rotations in palliative care, hospice or psycho-oncology to deepen and intensify their skills and exposure. Other elective opportunities include the following programs:
- Anesthesiology Pain (inpatient consult service and outpatient clinic)
- Ethics (inpatient consult service)
- Global Health opportunities
- Gynecologic Oncology (outpatient clinic)
- Medicine subspecialties: Cardiology (Heart Failure), Critical Care, Geriatrics, Nephrology, Oncology (inpatient services and outpatient clinics)
- Radiation Oncology (inpatient consult service and outpatient clinic)
Each elective will enhance fellows’ developing competence in caring for patients with life-limiting conditions. The emphasis will be on learning how colleagues in different fields and care settings manage symptoms and approach the communication needs of seriously and chronically ill patients and their families.