February 11, 2000

The instinct of medical professionals to do everything possible to keep a patient alive is natural and usually admirable. But what happens when that isn't the best thing to do for the patient? How does the dying person and his or her family make such difficult decisions, especially during this emotional time?

Fortunately for many patients and families at the MGH, the Palliative Care Service is available to offer excellent comfort measures and support — regardless of their care plan — and to counsel them on end-of-life decisions.

The MGH Palliative Care Service is an interdisciplinary support program that provides comprehensive, coordinated health and wellness care to patients and families facing life-threatening or terminal illness, helping them maintain the highest possible quality of life and comfort. The team is comprised of specially trained physicians, nurses, social workers and chaplains. They offer a variety of medical and support services, including expertise in pain and symptom management; emotional, psychological and spiritual support; assistance with home care or discharge planning, insurance, finances and arranging for medical equipment; patient and family education; advanced care planning; and bereavement support.

"Most of the patients that we see are referred to us by doctors and clinicians from throughout the hospital," says J. Andrew Billings, MD, director of the Palliative Care Service. "Many of these patients have cancer, but a good number of them have advanced heart, lung or brain disease or have failing kidneys or livers. We help these patients and their families with comfort measures and psychosocial support while making sure that their wishes for care are followed."

According to Billings, the service cared for nearly 400 new patients in 1999 through formal consultations. "Addressing the needs of a seriously ill or dying patient has been one of the shortcomings in medical care in the past. Things have gotten better though, and we are very committed to wider education about our discipline to make this aspect of health care stronger," says Billings.

Unlike hospice care, which serves patients only in the last six months of life and requires that they forego life-prolonging treatments and procedures, palliative care can help patients at any phase of an illness and incorporates all diagnostic and treatment strategies. Many patients who turn to palliative care for assistance are still undergoing aggressive treatment for their disease. "Many patients say they wish they had been referred to us sooner so that they could have had extra help with comfort measures and with making earlier decisions about their care," says Billings.

"The dream is that all clinicians at the MGH become familiar with palliative care," he says. "We now offer weekly grand rounds, a program for faculty entitled 'Palliative Care — Role Models,' and rotations for nurses, medical students, fellows, social workers and chaplains in training." Billings and his staff say they hope that palliative care will be part of every clinician's training.

"It's a huge fear of many people in my peer group that if we get seriously ill, someone will stick tubes in us that we don't necessarily want," says Dan Ellis, MD, a 60-year veteran of the MGH.

Billings says that such concerns are common. "Palliative care's goal is to help meet the needs of patients, and to make sure that being terminally ill is not something patients or their families have to go through alone," he says.