Increasingly, hospitals are making palliative care a priority; and more hospitalists are getting involved in providing these services and taking the lead on establishing and facilitating palliative care programs. Among the growing evidence that hospitalists are viewed as key players in the proliferation of hospital palliative care programs is the appointment of Steven Pantilat, MD, associate professor of clinical medicine, to the newly established Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care at the University of California at San Francisco (UCSF).
The chair is the first palliative care chair in the University of California system and only the fifth nationwide. The endowment provides funding for salary support and efforts to build clinical, educational, research, and training components of the UCSF palliative care program. “This chair is important because hospitalists are often the main source of hospital palliative care services,” explains Dr. Pantilat. “Because I am a hospitalist, I understand the needs of these practitioners.”
Numerous Plans, Expectations
Dr. Pantilat has several expectations for what the chair will enable him to accomplish. “We hope to improve palliative care for patients, contribute to the field in terms of research and educational initiatives, and help UC advance in these areas,” he says. “Our main goal is to develop a world-class palliative care program that will advance the field in terms of education, research, and patient care and to provide the highest quality care to patients with life-threatening illness. This will provide seed money to develop educational and research programs that require some early investment when they are just ideas.”
There is a tremendous need for more and better palliative care in the hospital setting. “Patients have many needs, including management of symptoms such as shortness of breath, nausea, and fatigue,” he says. “There isn’t nearly enough research or information on these problems as compared to pain. We need more studies on the best way to treat symptoms.”
Additionally, Dr. Pantilat hopes to add to the body of literature on patient-physician communication, suggesting that hospitalists and other physicians need information about how to communicate sensitive issues such as bad news and how best to support patients and families throughout illnesses and fill their palliative care needs.
“We hope to develop and encourage more education and training on these topics,” he says. Stressing that there already are good educational programs about palliative care topics, Dr. Pantilat notes the need for more instruction specific to the unique needs of hospitalized patients and the hospitalists who care for them.
Create an Interdisciplinary System
“We need systems to provide palliative care. We also need to sensitize everyone who works in the hospital to comfort care issues,” says Dr. Pantilat, adding that there also is a need for programs and systems to ensure that patients and families will get the palliative care they need when they leave the hospital. “We need to work together to create a smooth transition from inpatient to outpatient palliative care. And we need to consider how we, as hospitalists, work with patients in the outpatient setting to ensure that someone is there to take care of them and their needs.”
Many of these needs require widespread education and training. “This grant will allow us to develop more robust and innovative educational efforts that engage ways to teach all team members about palliative care,” says Dr. Pantilat. “This will include projects such as using the Web to teach students.”
Expand the Definition
Dr. Pantilat also hopes to help expand the definition of palliative care and help people understand this as a broad concept of providing interdisciplinary care for people with terminal and chronic diseases. “An important point that we hope to emphasize is that palliative care is not just end-of-life care but something designed to improve life for people with illnesses—particularly chronic illnesses—either through the treatment of the diseases or the symptoms. It is an attempt to alleviate physical, emotional, and psychological suffering and promote the best possible quality of life,” he explains.
Helping people get “past the old limiting idea of palliative care” is another key goal. “A lot of palliative care can be provided while people are pursuing curative care,” explains Dr. Pantilat. “This is an important concept to promote.”
The Hospitalist’s Role
As a hospitalist, Dr. Pantilat also hopes to promote the growing recognition of the importance of hospitalists in palliative care programs: “The beautiful thing is that hospitalists are perfectly poised to handle palliative care programs, and with training they can become palliative care providers.”
The endowed chair reflects the importance of hospitalists in the palliative care field. “Hospitalists will be increasingly important in this area, and I hope to take a leadership role,” he says. While he is pleased and honored to have the chair at UCSF, he is confident that his work will have an impact well beyond his own university. “The chair will bring much recognition to our program but also to the field of palliative care in general and the role of hospitalists nationwide.” TH
Joanne Kaldy writes regularly for The Hospitalist.