Mixed bag in isle palliative care


POSTED: Thursday, November 13, 2008

Despite a C grade for access to palliative care in hospitals, Hawaii leads the nation in several areas of care for seriously ill or dying patients, those in the field say.

America as a whole also drew a C grade for palliative care to hospital patients in a recent national study by the Center to Advance Palliative Care.

Palliative care is aimed at relieving pain and providing psychosocial and spiritual support to improve quality of life for patients with critical or advanced illness and their families.

“;Bottom line, the whole nation is fairly mediocre,”; says Dr. Daniel Fischberg, professor of geriatric medicine at the University of Hawaii's John A. Burns School of Medicine and medical director of pain and palliative care at the Queen's Medical Center.

  Except for Maui, neighbor-island hospitals do not have palliative programs, which affected the state's grade, he said. But programs have doubled in Hawaii since the survey was done based on 2006 data, he said.

Queen's and Kaiser Medical Center were the first with palliative programs. Others now are at Straub Clinic & Hospital, Hawaii Medical Center-East, Kapiolani Medical Center for Women & Children and Maui Memorial Hospital, Fischberg said. Kona hospital's hospice administrator also has palliative expertise, he said.

“;Buried in this study, Hawaii leads the nation in the number of hospital palliative medical specialists (per capita),”; Fischberg said. Hawaii also is advanced in terms of palliative training and experience at the medical school, he said.

Dr. Patricia Blanchette developed a palliative medical care division as part of the medical school's geriatric program, which is a model for the nation, he said. Every graduate has training and experience in palliative medicine, Fischberg said.

  Most people want to die in their own bed, “;but unfortunately, most people in America and Hawaii die in a hospital,”; he said. “;Palliative care needs to be improved.”;

Rachael Wong, executive director of Kokua Mau, a partnership of more than 250 individuals and organizations to improve end-of-life care, said the C grade was disappointing because with 28 doctors ”;we have the highest per-capita rate of palliative physicians.”; There were none in 2004 when the HMSA Foundation provided a grant to develop palliative-care capacity, she said.

  Palliative care, approved a few years ago as a board-certified medical subspecialty, is not just for those nearing the end of life, Wong noted, but for anyone with a chronic illness or injuries from an accident.

“;It's addressing not just the physical, but psychosocial and spiritual needs, of an individual and the whole family, and not just with the doctor, but the whole interdisciplinary team - the nurse, social worker, chaplain and therapist - to improve quality of life,”; Wong said.

“;We talk abut relieving suffering at the end of life, but we can't talk about a more critical area than pediatrics where the child and family suffer every bit as much,”; Fischberg said.

  He said Queen's received 100 percent ranking for its palliative program, which has a team of seven doctors, nurses and a social worker and is adding another physician and advance-practice nurse.

“;This is a high-quality way of caring for people with serious illness,”; he said.

Despite challenges at small rural hospitals that are already stressed, he urges administrators to recognize the “;win-win”; value of palliative programs because outcomes are better and patients and families are happier.

“;We want to design a system so we know when our time comes, we would be comfortable receiving the kind of competent, compassionate care everyone is entitled to as a human right,”; he added.