Pet Peace of Mind

Keeping hospice patients and their beloved pets together.

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If you’re a pet owner, you know that a dog, cat or other ‘furry friend’ can truly become a part of your family, a part of your world.

So it’s no surprise that those diagnosed with a debilitating or terminal illness sometimes worry more about their four-legged friends than themselves. What happens if they can no longer care for their pets? Where will those animals live once their owners are gone?   Pet Peace of Mind is a nationwide program that helps hospice patients like Donna Sarner keep their pets near them during their end of life journey.  The program also helps place the pet after the patient dies.

Here is Donna’s story as told by Kristine Murtz, Volunteer Services Manager and Pet Peace of Mind Program Coordinator at Cornerstone Hospice:

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In particular, Pet Peace of Mind demonstrates the holistic approach that is at the heart of hospice . The emotional connection that people have with their pets is one to be respected and nurtured.

Donna Sarner is 68 years old and lives in a small, rural town in Central Florida. She was diagnosed with adenocarcinoma of unknown origin, a cancer which causes her a great deal of pain throughout her back, abdomen and legs.  She has no caregiver, no nearby family, and limited financial resources. Despite the challenges, Donna maintains a positive yet realistic attitude and wants to enjoy the time she has left with her dogs as well as the cats, vultures, raccoons and bears she feeds outside.

Donna was admitted to Cornerstone Hospice services in October of 2015 and is supported by a dedicated team who go beyond the call of duty.  The many programs we offer are about helping patients and families feel like things are going to be “ok”.

In particular, Pet Peace of Mind demonstrates the holistic approach that is at the heart of hospice . The emotional connection that people have with their pets is one to be respected and nurtured.

Donna has taken better care of her pets—including the buzzards outside—than she has herself. She wants to have her dogs with her as long as possible, “until the very end.”

Donna’s Social Worker, Renee, had to wait several months before approaching advance directives and funeral plans with Donna, but PPoM visit opened the door to this by discussing how her “babies” will be cared for when she no longer can.

Donna spoke with pride about each of her dogs: Ozzie, a 6-year old Australian Shepherd/St. Bernard mix (I know, right?!); Roxy, a 5-year old Chow mix; Bertie, a 4 year-old Catahoula mix; and her beloved old guy “Highknee,” who is a 15-year old poodle mix. He’s only about ‘knee-high’, hence the name. Along with caring for the dogs, our program arranged to have the stray cats she feeds spayed, neutered, and vaccinated. We haven’t really considered what the buzzards might need!

Pet Peace of Mind volunteer Karen Sanders transported each of the dogs to one of our partner veterinarians to get them vaccinated and any necessary medications; she continues to deliver dog and cat food to Donna. We’re providing little Highknee with some medication for his congestive heart failure, and I’ve promised Donna I would personally care for him after she cannot. She also understands that it may not be realistic to have the three large dogs with her until the end, and we are already looking for loving homes for Ozzie, Roxy, and Bertie.

See the flyers below to learn about each dog.

Learn more about Pet Peace of Mind by visiting their website.

Bertie

 

Ozzie

 

Roxy
Complete Article HERE!

Veterans serving Veteran patients create a healing connection

By elyzabethanne

Vietnam War Veteran John Eilers
Pictured with Vietnam War Veteran John Eilers are, from left, Marine Corps 1st Sgt. Jimmy Richard, Marine Corps Veteran Nicole Richard and Army Sgt. Daiana Wininger.

Nicole Richard is kind of in awe.

Well, as she is a former Marine Corps Staff Sergeant, maybe it is more appropriate to say shock and awe.

To provide a bit of background, Richard has a certain niche when it comes to volunteering. “Kids and the elderly, to me, are really close to God,” Richard said.

As a single woman serving in the Marine Corps in Okinawa, she would sign up through the chaplain to serve in the community. It was something she did throughout her 11-year military career, working with the elderly and school children overseas in Japan, Thailand and Korea. She left military service in 2012.

In 2015, she called Diane Sancilio, the Director of Volunteer Services at Hospice of the Chesapeake, to find a way to serve seniors. When Sancilio learned she was talking with a Marine Corps Veteran, she told her about the Veteran-to-Veteran volunteer program that pairs volunteers with military experience with hospice patients who also served. After her spiel, Sancilio heard nothing on the other end of the phone. She even had to ask if Richard was still on the line.

“I was in shock about this because I didn’t even know it existed,” Richard said. She couldn’t believe that there was an opportunity for her to not only care for elderly hospice patients – but also fellow Veterans. It was kismet.

The 33-year-old mother of three from Annapolis threw herself into volunteering. She has done much of her work performing Reiki therapy at the Inpatient Care Center in Pasadena. And though she has served many patients who aren’t Veterans, she said when she works with those who have served, they feel an instant connection, “We all hold those same values, even the families,” she said. “A lot of time, these Veterans, at the end of their life, all they need to transition is to share their story, and for us to give them that welcome home that they didn’t get. They have sacrificed so much.”

The Vet-to-Vet program is part of the We Honor Veterans Program, a collaboration of the National Hospice and Palliative Care Organization and Department of Veterans Affairs. Program partners like Hospice of the Chesapeake use resources and education provided by the NHPCO and the VA to help Veteran Volunteers care for Veteran patients and their families. With more than 25 percent of Hospice of the Chesapeake patients having served in the military the need for Patient Care Volunteers who also are Veterans is growing.

Many Veteran Volunteers take it to the next level of volunteer after performing an Honor Salute for a Veteran patient. The brief but moving ceremony takes place in the patient’s home or at his or her bedside. It demonstrates a tremendous respect for the patient while also serving as an intimate moment for all involved. Richard tells of her first Honor Salute. The patient’s daughter said he had become sullen and unresponsive, and she didn’t think he would talk. Upon learning the patient was a fellow Marine, she asked her husband to join them. Marine Corps 1st Sgt. Jimmy Richard is still in active duty, assigned to Marine Barracks Washington, D.C.

The minute he saw the Richards in their uniforms, the patient perked up.

“He talked so much. We used our terminology – oorah, semper fidelis — and he was smiling, telling us about his unit, where he served, and what he’s done,” Nicole said.

Before leaving, Jimmy removed the pin from his cover and gave it to the man. There were tears all around.

The moment cemented the purpose of having the program Nicole. “He wouldn’t talk to others, but he was open to talking to us because we understand, the terminology, the values — honor, courage and commitment” she said.

She said the families will sometimes roll their eyes as a patient starts telling “another” war story. “But (Veterans) get it. It heals us, too. We have our own mental and physical wounds. Just listening to somebody else kind of helps heal us, too.”

Nicole is still a bit in awe.

“I am still digesting this is here. And I am excited to be learning more. I thought it was amazing to volunteer at the Veterans Day event,” she said, adding that the Veterans she helped at the ceremony, which included an opportunity for Veterans to talk about their service, shared her surprise.

“They are in shock about it, too,” she said. “They are thinking, ‘they shared my story, they understand, they honor me’.”

Complete Article HERE!

Doctors should be trained in art of ‘diagnosing death’

By LIZZY BUCHAN

Diagnosing death
‘Diagnosing death’ would prevent unnecessary distress at the end of life.

Doctors need to be trained in the art of “diagnosing” death to prevent unnecessary distress at the end of life, an expert has claimed.

Dr Erna Haraldsdottir, a senior lecturer at Queen Margaret’s University, in Musselburgh, called for a shake-up of thinking on medical intervention for the dying after watching her elderly father-in-law die in hospital.

The 84-year-old had been diagnosed with dementia five years beforehand and his family watched his gradual decline until he was admitted to hospital. Although he was elderly and very frail, doctors attempted to discharge him at one point and tried to resuscitate him as a “do not resuscitate” note had not been arranged.

Doctors were also reluctant to issue a death certificate as they were unsure of his cause of death.

Writing in the European Journal of Palliative Care, Dr Haraldsdottir said doctors need to change their mindsets over when patients need medical intervention and try to “diagnose” death.

Dr Haraldsdottir, who also leads a pioneering research programme at St Columba’s Hospice in Edinburgh, said: “In my own experience, our family believed my father-in-law had a good death, however what was noticeable was the staff’s lack of insight into the situation and understanding of what was happening.

“This caused the family unnecessary upset and distress – which could have been avoided if the medical team had applied the principles of palliative care to the assessment and care.”

Ministers unveiled a five-year plan to put palliative care at the heart of the NHS in December and to ensure a greater openness around death and dying.

It comes after a Glasgow researchers found falling numbers of Scots were dying at home, despite many saying it was what they wanted.

It is more important than ever for hospices to be leading the way when it comes to developing care around death and dying, said Dr Duncan Brown, medical director at St Columba’s Hospice.

Complete Article HERE!

“Hospitals are not a good place to die”

End-of-life doula Anna Lyons on why we need to rethink our attitudes to death

By

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I’ve been with the dying many times, both in a personal capacity and as a health care professional. As an end-of-life doula my work is centred around supporting people and their families at end of life. My experiences have led me to agree wholeheartedly with the BMA in its recent report: hospitals are not the best place to die.

An overwhelming majority of us want to die at home, yet statistics show the reality is that 54% of us will die in hospital. But in my opinion, hospices are for the dying. Home is for the dying. Hospitals are not. The raison d’etre of end of life care is to help people experience a ‘good death’. We will remember how someone we love dies forever. The impact of a bad death is far-reaching. Candy Chang, creator of the ‘Before I Die‘ wall, a global art project that invites people to reflect on their lives and share their personal aspirations on a public wall, describes the fallout as creating ‘circles of mayhem’ for generations.

What is a good death?

Every person will have a different idea about what would constitute a good death for themselves or their family. Much of the debate over end-of-life care comes down to two questions:

  1. Is a good death one where the medical team did everything to save a life?
  2. Is this still true if there is little chance or no of a happy outcome?

Culturally, we have always seen a good death as one we have ‘fought’ against. It may be time to consider otherwise. Many treatments are aggressive and futile, robbing the last remaining quality of life a patient has.

Perhaps a good death is the accepted one. One where the dying person is in control, can be at home, can have their pain and symptoms managed. End of life care must be entirely individualised and person-centred, only then can we begin to offer the excellent end of life care that everyone deserves.

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The refusal of a medical team to end active treatment to the detriment of the patient was exemplified in the death of a very close friend of mine. They threw everything they had at giving him longer than his twenty-something years. They didn’t give up ‘actively’ treating him until the end. He died clinging to the belief that he was going to live. That last precious year of his life was a tragic mess of chemotherapy, life-prolonging operations and colourless hospital wards. The treatment had destroyed the very essence of who he was, long before his heart played out its final beats.

I believe if we discussed end of life issues regularly, we wouldn’t find them so tricky to broach. Issues about death and dying should be taught in schools as part of the PSHE syllabus from primary and onwards. During Year 13 tutor time when we teach young adults to fill in job application forms, we should also be filling in advance directives with them.

Issues with control at the end

In a study by the Economist Intelligence Unit, the UK was crowned the best in the world for provision of end-of-life care. The author of the report, however, said that there is room for improvement, especially in symptom control and communication. Could this improvement be guided not by government policy or hospital administration, but by changing the way we look at death?

The recent BMA report concluded that some doctors continue to treat the dying when active treatment is no longer of any benefit. One reason it suggested was because of pressure from the patient and their loved ones. This is understandable – it is often too difficult to let go of the ones we love. The report also stated it is because if doctors acknowledge there’s nothing more that can be done, that they’re admitting defeat.

chemotherapy

I knew a woman worked with the dying so when she was dying, although she knew there was nothing that could be done, she didn’t want to die. She wasn’t ready: she had a life to lead, a world to see and children to watch grow and guide. She was looked after by the same medical team she had worked alongside for many years. They couldn’t let her die either. If they let her die, they would have failed one of their own. They had to try, even though they knew it was futile. They couldn’t give up, even though they knew the treatment she would most likely shorten her life, not extend it. Her original prognosis with palliative care had given her up to a year. She died two weeks into aggressive treatment, four weeks after her initial diagnosis.

We should not see the death of a dying patient as a failure. Death is not the loss of a battle. Death is a natural part of life. If we could see it that way, we might be able to approach it differently. Our goal should be helping someone live as good a life as possible right up until the very end. No one will ever experience a “good death” if our focus is active treatment at all costs.

senior woman

The report set out that treatment at end-of-life should be ‘appropriate and proportionate’. Dying with care, deference and dignity, and on our own terms is the very least we should be able to offer. A lady I worked with lived an incredibly full life: alone and happy. She went dancing and played snooker. She cooked everything from scratch everyday. Her breathlessness became untenable and she finally went to the doctor. She had cancer, which was slow to progress even though she chose a palliative care pathway. She accepted her life-limiting prognosis with the wisdom of one who knew herself well and contemplated mortality more often than many. She died in a hospice, surrounded by her family. Hers was a peaceful death. Peaceful and on her own terms.

One aspect of the report that I feel most strongly about is that doctors should be receiving training and CPD on communication and how best to have difficult conversations. One junior doctor who was interviewed for the report said: “I found it very difficult to talk to patients about dying, prior to working in a hospice, because…as a junior doctor we’re not taught very much…”

A shift in thinking

We all have to take responsibility for communication and the decisions we make. It’s terribly difficult when we’re unwell and vulnerable to hear these truths. If we’ve never considered end-of-life until our own life’s end it’s no wonder we find it so hard. If we discussed these issues regularly we wouldn’t find them so hard. We need to break down the ingrained cultural barriers that prevent us from talking about death and dying

Let’s all take on that responsibility. Let’s talk about it: openly and without fear. It’s too much to have that conversation for the first time when we are facing death. It’s much easier to talk about it while we’re living a healthy life.
We need to ask ourselves what is a good death for us.

Why do we value quantity over quality of time? Why do we cling so dearly to the notion that a life well lived is the longest? Sometimes doing nothing is the most courageous path. Sometimes accepting there’s nothing left that can be done is the bravest choice. Some may describe such a decision as “giving up”. Pursuing treatment until the very end, on the other hand, is lauded as “being a fighter”.

doctor and patient

Do these words,”battle” and “fight”, compound medical teams’ feelings of failure when an unavoidable and imminent death is in front of them? Changing our language may help us to change the way we think. Illness and death are a part of life. Loss is not a failure: not ours, and not our doctors’. Perhaps redesigning our expectations and language at end of life could begin with Paul Kalanithi’s beautiful words:“The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.” If they did, I believe death and dying could be a richer and better experience for everyone involved.

Complete Article HERE!

A Doctor at His Daughter’s Hospital Bed

By

A Doctor at His Daughter’s Hospital Bed

I’VE been watching the monitor for hours. Natalie’s asleep now and I’m worried about her pulse. It’s edging above 140 beats per minute again and her blood oxygen saturation is becoming dangerously low. I’m convinced that she’s slipping into shock. She needs more fluids. I ring for the nurse.

I know about stuff like septic shock because for more than 20 years I was a transplant surgeon, and some of our patients got incredibly sick after surgery. So when I’m sitting in an I.C.U. in Omaha terrified that Natalie, my 17-year-old daughter, might die, I know what I’m talking about. I tell the nurse that Natalie needs to get another slug of intravenous fluids, and fast.

The nurse says she’ll call the doctor. Fifteen minutes later I find her in the lounge at a computer, and over her shoulder I see a screen full of makeup products. When I ask if we can get that fluid going, I startle her. She says she called the resident and told him the vital signs, but that he thought things were stable.

“He said to hold off for now,” she says.

“Get me two bags of saline. Now,” I tell her.

She says, “I’m calling my supervisor,” and she runs out of the lounge.

Natalie is awake and looking around when I return. Her face is that dark red that sends waves of panic through my gut.

“What’s wrong?” she says.

I’m a lousy actor.

I know I shouldn’t be my daughter’s doctor. They taught us the problems with that during my first week in medical school. It’s a really bad idea, especially in high-risk situations. There are a few exceptions; like, it’s probably O.K. to sew up your child’s cut on vacation or to hand out antibiotics for uncomplicated infections.

We doctors are also very superstitious that when dealing with family members of physicians, or of V.I.P.s, something is always going to go wrong. The more the Special Person hovers over the care of his or her loved one, the worse the complication will be. I’ve had conversations in which doctors feel they change their routine with V.I.P. patients, and it’s that disruption in routine that allows error to creep into their care.

But right now, I don’t care about any of that. I’m the one with experience taking care of really sick patients, and if I know she needs more fluids, she’s going to get them.

I break into the crash cart, a box on wheels full of stuff they use to resuscitate patients. I pull out two liters of saline solution and run both into Natalie’s IV in less than 20 minutes. Natalie’s pulse slows and her blood pressure rises. An hour later, after the nursing supervisor and on-call resident finally arrive, I’ve finished infusing a third liter. Natalie finally looks better.

This wasn’t the first time during Natalie’s illness eight years ago that I broke my promise to just be her dad. It started a week earlier when she came into the den and showed me the blood she’d coughed up. I suspect a father without my experience might have chalked it up to flu. Maybe because I was a transplant surgeon, and always considered the worst possible cause whenever a patient had a hiccup, I took her to the hospital. I was worried the blood meant she had a bacterial pneumonia, a bad one. And it did.

On the way to the hospital, Natalie took a deep breath and looked at me. “Am I going to die?” she asked. I’m convinced that she would have been dead before morning had I not been a doctor, and one who could recognize septic shock when it affected a normal teenager.

I am haunted by that moment, and others like it involving people I love. My younger son, Joe, almost died 15 years earlier from septic shock, the same kind that killed Jim Henson. He became ill while I was out of town. I flew home and by the time I arrived at the hospital, he looked deathly ill to me. I told the nurse I thought he should be transferred to the intensive care unit, but she said the doctors thought he was improving. Joe stopped breathing during the night and I have blamed myself ever since for not insisting they move him.

Over and over again during my dad’s last few years of life, I felt as if I should have just moved in with him so that I could prevent all the well-meaning doctors and nurses from killing him. Sometimes it was just because his doctors weren’t talking to one another and their conflicting prescriptions sent Dad to the hospital.

In the end, he died about 10 minutes after receiving an injection I didn’t want him to receive. From my home in Omaha, 800 miles away, I asked his caregivers not to give him a medication that I worried could be lethal but that they insisted was routine for old people like him. I thought we’d reached an agreement but while on the road to visit him the next day, I got word that his heart had stopped.

Last year my wife’s mother had colon surgery and when we went to visit her in a rehabilitation center two days after her release, I discovered that she had an abscess the size of a lemon in the wound. It was red and swollen and she said it hurt like the devil but the attendants had assured her it would get better because she was on antibiotics. We took her to the E.R. where the nice doctor used an ultrasound to look it over and told me he didn’t see any pus there. But I could see a large pocket of pus, so I asked him to call the surgeon. The surgeon probably told the E.R. doctor to humor me, but as he took a knife to the wound, no one in the room except the E.R. doctor was surprised when creamy yellow, foul-smelling pus shot out of the wound and soiled the young man’s spotless shoes.

I have more stories like this. What are the odds of that? I don’t think it’s me.

After three days in the hospital, Natalie got better. A new chest X-ray showed that there was much less fluid in her chest. Her fever resolved. They changed one of the antibiotics and the nausea she had had all but disappeared. They told her she could go home. They prescribed antibiotics for her to take at home, and removed her IV catheter.

Natalie went back to school, and the next day was interviewed by a TV reporter because she was one of the few who survived her kind of pneumonia in Nebraska. She talked about her disappointment over missing swim meets.

Natalie recovered from that illness eight years ago, but I didn’t. I stopped operating and taking care of really sick people two years later. I told myself I had become too distracted by my increasing administrative duties to be a safe doctor. I was glad to leave all that behind. Now I just want to sit on the sidelines and marvel as a new generation of doctors performs the miracles. I never again want to step in to rescue someone I love. But I will, if I have to.

Complete Article HERE!

Dying Better, Even If It Means Sooner

Delaying death with excessive, expensive end-of-life care often does more harm than good.

Focus on the simple things, not extraordinary measures
Focus on the simple things, not extraordinary measures

By

Life expectancy in the United States has increased by 30 years in the last century. Despite our longer lives, many Americans continue to fight death’s inevitability in ways that are costly socially, economically and spiritually. Our over-reliance on medical “miracles” is causing us to throw more and more money at the final year of life rather than grapple with the difficult – but ultimately more gratifying – work of approaching death more willfully by removing the sense of crisis and making the most of the moments that remain.

Defying and delaying death often remains the focus of many care providers even when patients reach their 80s, 90s and 100s. These individual decisions add up to the single greatest expenditure in the national health system: Care in the last 12 months of life accounts for over 25 percent of total expenditures for both Medicare and Medicaid. And while some studies have argued for cost savingsassociated with hospice care, others show cost neutral effects of engaging hospice in the last months of life, depending on how cost is measured and over what period of life. Meanwhile, a number of states are passing aid-in-dying laws, which will have moral, social and economic impacts, but the bills are simply directed at ending suffering; the changes in dying made possible by such laws (notably in Oregon) have not been the subject of economic analysis to date.

In short, driving down end-of-life costs will be slow because these costs are sustained by medical practice and patient choice, both social and behavioral practices subject to slow change. While this level of spending is unsustainable, there are greater costs – constantly fighting against death’s inevitability is also deeply unsatisfying.

Looking back, many sons and daughters I have worked with regret having encouraged a parent to undergo a hip surgery. Spouses regret pushing for their loved ones to be intubated, and many patients struggle to balance the suffering with the life-prolonging effects of their treatments. Such regrets are the outgrowth of an approach to death that is focused on delaying death rather than being present and accompanying loved ones as they are dying. Accessing death-delaying treatments often comes at the expense of easing discomfort and being intentional about the nonmedical ways we can help our dying loved ones.

End-of-life laborers are very clear about limiting the extraordinary measures some of their patients allow in their own lives. Their plans, shaped by their work with the dying, give clear direction about how they want to live: deliberately and without much medical intervention as they encounter illness and disease later in life. They sometimes mourn the life-extending measures that can prolong life at a very low quality and instead encourage loved ones to be present as often as possible, continue routines, tell stories, touch our dying loved ones and find ways to meaningfully connect, like looking at photos, being together in nature, listening to music or sharing a favorite food.

Although our medical advances are partially responsible for our longer years, when we begin parting with life, many end-of-life laborers remind us to focus on the mundane, not the extraordinary. They encourage family members and patients themselves to pause before pursuing treatments, to be as deliberate and purposeful about planning as possible and to enjoy those things that have always delighted or engaged them for as long as possible.

The friends and family members who are most proud of how they helped their loved ones often talk about little tokens: a friend clipped part of a favorite flower so her friend could smell her yard one more time; a daughter got the quilting club to gather in the hospice room; a son dug up a favorite book and read and read and read until he was certain his dad could no longer hear his voice.

Obviously families who seek life-prolonging measures do so for more moments with their loved ones. Unfortunately, aggressively delaying death often becomes the focus of the final weeks and days. Pursuing significant medical care often distances us from our loved ones: time spent in waiting rooms, surgical units and follow-up appointments, rather than watching the geese take off over a lake, taking that final trip to one’s homeland or reconnecting with friends who have been distant.

As more of us live longer and die slower, the challenge for many Americans will be to avoid rushing toward solutions and to live, sometimes quietly and uncomfortably, in the shadow of death’s certainty. End-of-life experts have taught me that recognizing limits might save us from some of the real damage we do to each other – asking our elders to fight on too long, to endure too many procedures and tests and surgeries and to spend too much time in the hospital instead of at home or in the garden – or holding the hand of someone who loves them.

Complete Article HERE!

In Palliative Care, Comfort Is the Top Priority

By Paula Span

Palliative Care

Last year, when an oncologist advised that Betty Chin might benefit frompalliative care, her son Kevin balked.

Mrs. Chin, a retired nurse’s aide who lives in Manhattan’s Chinatown, was undergoing treatment for a recurrence of colorectal cancer. Her family understood that radiation and chemotherapy wouldn’t cure her, but they hoped doctors could keep the cancer at bay, perhaps shrinking her tumor enough to allow surgery or simply buying her more time.

Mrs. Chin, 84, was in pain, fatigued and depressed. The radiation had led to diarrhea, and she needed a urinary catheter; her chemotherapy drugs caused nausea, vomiting and appetite loss.

Palliative care, which focuses on relieving the discomfort and distress of serious illness, might have helped. But Mr. Chin, 50, his mother’s primary caregiver, initially resisted the suggestion.

“The word ‘palliative,’ I thought of it as synonymous with hospice,” he said, echoing a common misperception. “I didn’t want to face that possibility. I didn’t think it was time yet.”

In the ensuing months, however, two more physicians recommended palliative care, so the Chins agreed to see the team at Mount Sinai Hospital.

They have become converts. “It was quite a relief,” Mr. Chin said. “Our doctor listened to everything: the pain, the catheter, the vomiting, the tiredness. You can’t bring up issues like this with an oncologist.”

Multiple prescriptions have made his mother more comfortable. A social worker helps the family grapple with home care schedules and insurance. Mr. Chin, who frequently translates for his Cantonese-speaking mother, can call nurses with questions at any hour.

Challenges remain — Mrs. Chin still isn’t eating much — but her son now wishes the family had agreed to palliative care earlier.

Perhaps it’s not surprising that many families know little about palliative care; it only became an approved medical specialty in 2007. It has grown rapidly in hospitals: More than 70 percent now offer palliative care services, including 90 percent of those with more than 300 beds.

But most ailing patients aren’t in hospitals, and don’t want to be. Outpatient services like Mount Sinai’s have been slower to take hold. A few hundred exist around the country, estimates Dr. Diane Meier, who directs the Center to Advance Palliative Care, which advocates better access to these services.

Dr. Meier said she expects that number to climb as the Affordable Care Act and Medicare continue to shift health care payments away from the fee-for-service model.

Because most people with serious illnesses are older, seniors and caregivers should understand that palliative care offers more care as needed, not less. Unlike hospice, patients can use it at any point in an illness — many will “graduate” as they recover — without forgoing curative treatment.

Like hospice, however, palliative care focuses on quality of life, providing emotional and spiritual support for patients and families, along with drugs and other remedies to ease symptoms. Its practitioners help patients explore the complex medical decisions they often face, then document their preferences.

It pays off for patients and families. In 2010, a randomized trial of 151 patients with metastatic lung cancer at Massachusetts General Hospital found that those who received early palliative care scored significantly higher on quality of life measures than those receiving standard care, and were less likely to suffer from depression.

They were also less likely to get aggressive end-of-life treatment like chemotherapy in their final weeks. Yet they survived several months longer.

Other studies have found similar benefits. Compared with control groups, palliative care patients get greater relief from the breathlessness associated with lung diseases; they’re less likely to spend time in intensive care units; they report greater satisfaction with care and higher spiritual well-being.

And they do better if they seek palliative care early. A new study conducted at the cancer center at the University of California, San Francisco, found that of 922 patients who had died, most in their 60s and 70s, those who had received palliative care for 90 days or more were less likely to have late-life hospitalizations and to visit intensive care units or emergency rooms than those who sought care later.

The reduced hospital use also saved thousands of dollars per patient, a bonus other studies have documented.

“If people aren’t in excruciating pain at 3 a.m., they don’t call 911 and go to the emergency room,” Dr. Meier pointed out.

Yet palliative care remains underused. Even at the well-established U.C.S.F. cancer center, which began offering the service in 2005, only a third of patients in the study had received a palliative care referral.

“We hear this all the time: ‘They’re not ready for palliative care,’ as if it’s a stage people have to accept, as opposed to something that should be a routine part of care,” said Dr. Eric Widera, who practices the specialty at the university.

In fact, the cancer center at U.C.S.F. adopted a euphemistic name for its palliative team: “the symptom management service.”

“We deliberately called it that because of how much ignorance or confusion or even bias there was against the term ‘palliative care,’” said Dr. Michael Rabow, director of the service and senior author of the new study.

Although 40 percent of their palliative care patients can expect to be cured, “there clearly still are both patients and oncologists who have an inappropriate association in their minds,” he said. “They still associate palliative care with giving up.”

To the contrary, palliative care can help patients live fully, regardless of their prognoses. Consider Herman Storey, a 71-year-old San Franciscan, an Air Force veteran, a retired retail buyer and manager, a patient who feels quite well despite a diagnosis of inoperable liver cancer.

His oncologist at the San Francisco V.A. Medical Center — the Department of Veterans Affairs has been a leader in this specialty — referred him to the palliative care service last fall when Mr. Storey said he didn’t intend to pursue chemotherapy.

“They wanted me to reconsider,” Mr. Storey said, “but I don’t want to get sick and tired of being sick and tired.” Chemotherapy for a previous bout of cancer had helped him survive for three years; it had also made him very ill.

Dr. Barbara Drye, medical director of outpatient palliative care at the cancer center, walked Mr. Storey through his options. The suggested chemo might extend his life by several months, she explained. It would also take a toll.

“It can cause not only nausea and diarrhea, but it affects your taste,” she said. “Food tastes like cardboard. Fatigue can markedly decrease the amount of activity someone can do.”

This time, Mr. Storey decided against treatment. A skilled cook, proud of the duck confit dinner he served guests at Christmas, he wants to continue to enjoy cooking and dining out with friends.

Besides, he has plans: In May, he expects to visit Paris for the 11th time, to mark his 72nd birthday.

Dr. Drye, who helped Mr. Storey complete his advance directives, will arrange for home or inpatient hospice care when he needs it. Until then, she sees him monthly.

She has gently suggested that he take his trip a bit earlier; he has declined. “I feel great,” he told me.

So this is also life with palliative care: Mr. Storey and a companion have rented an apartment near the Place des Vosges. A Parisian friend will throw a dinner party for him, as usual. And he’ll eat at that little Alsatian restaurant where they always remember him.

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