While there may be uncertainty among health care providers and the general public about what palliative care is, there is no confusion about where Palliative Care is headed on this campus, it is full steam ahead. The Palliative Care Program on the Anschutz Medical Campus has seen tremendous growth over the last decade, including a number of prestigious national grants and The Joint Commission’s Gold Seal of Approval.
So what is “palliative care”? Jeanie Youngwerth, MD, Assistant Professor in the Department of Medicine and Director of Palliative Care at the University of Colorado Hospital (UCH) describes it this way, “Palliative care is specialized medical care for people with serious illnesses. It is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a patient's other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.”
The mission of the University of Colorado Palliative Care Program is to improve quality of life for patients and families by providing exceptional clinical services while advancing the field of palliative medicine through a commitment to education and research.
Palliative Care is delivered through an interdisciplinary team. They determine what the patient’s and family’s wishes are for pain management, treatment and comfort as well as what is needed to enhance quality of life. Palliative care embraces not only the clinical, but the spiritual and psychological needs of a patient and their family. Porter Storey, MD, FACP, FAAHPM, Executive VP of the American Academy of Hospice and Palliative Medicine describes the palliative care team as “the patient’s advocate.”
What has caused the rapid growth of palliative care both nationally and on the Anschutz campus? It is often attributed to a growing population with serious advanced illness as well as evidence for the contributions of palliative care to enhancing value in health care by providing higher quality care at lower cost. A number of national organizations now endorse provision of palliative care concurrently with disease-focused treatments. Here at the Anschutz Campus leaders, like Jean Kutner, MD, MSPH, head of the Internal Medicine Division, have focused their efforts on growing palliative care both locally and nationally. In 2010, the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) awarded the University of Colorado and Duke University $7.1 million to create the Palliative Care Research Cooperative Group (PCRC), the first research cooperative in the United States focused specifically on advancing the science of palliative and end‐of-life research through rigorous, multi-site, evidence-based research. The mission of the PCRC is to develop scientifically-based methods that lead to meaningful evidence for improving quality of life of patients with advanced and/or potentially life-limiting illnesses, and their caregivers including family members and providers of care. In 2013, the PCRC was awarded an additional $10 million to expand its capacity (www.palliativecareresearch.org). Dr. Kutner is Co-Chair of the PCRC, along with Dr. Amy Abernethy (Duke).
In 2013, the LIVESTRONG Foundation awarded the UCH program $10,000 to assist them working toward The Joint Commission advanced certification in palliative care. The Joint Commission accredits and certifies health care organizations across the United States. Certification from The Joint Commission symbolizes quality and indicates that the inpatient palliative care program is able to demonstrate exceptional patient/family care. The process to prepare for the evaluation visit is both time consuming and arduous. However the staff felt it was both positive and enlightening. Jeanie Youngwerth, MD describes some of the benefits, “Working toward certification has enabled us to examine the care we are providing to see how we might need to improve that with quality initiatives. It allows us to standardize aspects of quality care and help us to see how we can disseminate that throughout the hospital, even to patients we never see.” In November 2013, the UCH Palliative Care program hosted an onsite review with Joint Commission members. They were evaluated on compliance with Joint Commission palliative care-specific standards, clinical practice guidelines and performance measures. The UCH Palliative Care Service was awarded the Gold Seal of Approval immediately following the site visit, one of only 49 palliative care centers in the US to receive this gold standard.
Currently, the UCH Palliative Care Consult Service is staffed by six physicians who are board-certified in Hospice and Palliative Medicine, 2 advanced practice nurses, a chaplain and a social worker.
While the University of Colorado Palliative Care program continues to grow and receive honors, the demand for more palliative care physicians and nurses is also growing. Unfortunately demand is not keeping up with the needs in the field. In order to meet the needs of all patients with serious advanced illness and their families, the University of Colorado Palliative Care Program is focusing both on training specialists in hospice and palliative medicine as well as enhancing the capacity of all health care providers to address the basic palliative care needs of their patients. Board Certification in Hospice and Palliative Medicine requires special training; access to fellowship training programs is limited. The programs require funds to support training costs, including fellow stipends and faculty time. Dr. Youngwerth, who, along with Dr. David Nowels in the Department of Family Medicine, oversees the palliative care fellowship program for physicians on the Anschutz campus, is actively working on incorporating palliative care requirements into the medical curriculum. Currently, family practice and internal medicine training at the CU Medical School includes basic palliative care training. Through expanding clinical programs, education and research, Dr. Kutner’s wish is that in the near future, all people with serious illness and their families will have access to high quality, evidence-based palliative care across all settings. The University of Colorado Palliative Care Program in leading the way in achieving this goal.