Dr. Isabella Stumpf (Guest): Yes. Hello, Melanie. Thank you very much for having me today. This is a great question. I would like to start with explaining palliative care, which is a medical specialty with, really, a focus on quality of life that is at any time during the serious illness and can certainly be provided alongside with a curative treatment. That is, to the second part of your question, where it also differs a bit from hospice, where the hospice care focuses more towards a comfort approach towards the end of life.
Melanie: Okay. So, one is about comfort and even ongoing care, and one is more of an end-of-life care. Tell us about palliative care, what is involved in this type of care?
Dr. Stumpf: Yes. Palliative care really focuses on improving really quality of life when one is facing a serious illness that can be either acute or chronic and progressive. It is a medical team with multiple specialists on our team from physicians, nurse practitioners, nurses, social workers, chaplains who really say, “How can we make the best out of what it is, treat symptoms and also address what the next steps are in the care; have conversations about that and add additional layers of the support?”
Melanie: Give your best advice, Dr. Stumpf, for families whose loved ones are in chronic pain or have a serious advanced illness in getting the discussion going to start the palliative care process.
Dr. Stumpf: Yes. This is a challenging topic in the sense that having the conversation oftentimes is difficult and having a palliative care team to help families to get some tools, the patient and their loved ones, how to talk about serious illness, or meet with a palliative care team to help them have conversations about how the individual is affected by the illness, how the family is affected and how can we all work together, really, to focus on quality and function, and the best living possible.
Melanie: What’s involved? Is it medication? Are there any other types of therapies that are involved in this type of care?
Dr. Stumpf: Yes.Palliative care has multiple areas that we focus on in providing of care and that’s where it’s very comprehensive focusing on pain and symptom control. We are specialized in that. We also say, “How can we help clarifying goals and discussing those about what matters most to a patient when they're facing a serious illness?” What are the values and what are they looking for and having those conversations with them and their family and helping to kind of navigate what is a challenging healthcare system at times and putting the appropriate resources in place. So, that’s kind of the overall and overarching approach that we provide in palliative medicine.
Melanie: Does the patient have to give up their own doctor, their internist, whoever they’ve been with?
Dr. Stumpf: Very good question. Absolutely not. We work very closely and it’s very important that we all work together with the primary care physician, with the primary oncologist, the primary lung doctor and cardiologist. So, we are a team and we work with the primary doctors and the patient together at any time and keep conversations very open.
Melanie: Does insurance take care of palliative care and for how long usually?
Dr. Stumpf: Yes, the palliative care is like any other specialty in the same program as other specialties. If one has a heart condition, and needs to see a heart doctor or cardiologist. It’s the same with palliative care. If somebody has a serious illness and needs to see a palliative care clinician and physician; same coverage. Yes, insurance will cover.
Melanie: What about curative treatments? Can someone still have palliative care when they're going through chemotherapy or if they have to have surgery for any reason, can they be still be involved in the whole process of palliative medicine?
Dr. Stumpf: Yes, and that’s a good distinction. Absolutely. The palliative care, really, when one is dealing with a new diagnosis and a serious illness, we should be involved early on to help navigate the system and focus on symptom control and it goes absolutely alongside curative intent. So, full treatment for any illness with hopefully a good outcome. Illness affects all of us in various ways in our family. So, I think it is important to recognize that palliative care can have a great impact early on and alongside any treatment at any time of the illness. So, it’s again, focusing on living and quality of life. There is no limitation to the treatment of any kind.
Melanie: Is this just an in-patient type of care? Can you also get palliative treatment if you’re at home?
Dr. Stumpf: Yes, very much. The palliative care essentially can be provided in any care setting. So, it is from the acute crisis situation with hospitalization in the hospital, but also, let’s say, we have facilities or nursing facilities, they have clinics, some of them are free-standing but we have our own palliative care clinic. Others are where we come to patients when they are seen and they are, let’s say, for example, heart failure clinic or COPD clinic. So, very specific, and some clinics are “embedded”, we call it. We also do home visits. So, for patients that have a hard time and we work very close with our home healthcare team. They do have palliative care specialists, nurses, nurse practitioners on their teams, and communicate. The palliative care can be provided anywhere where the patient is.
Melanie: Tell us about the multidisciplinary approach to palliative care, Dr. Stumpf. How do you bring in other practitioners to help with that whole body and all of the things they might be experiencing?
Dr. Stumpf: Yes. That is the definition of palliative care. That it is a multidisciplinary specialty because we are really addressing things such as symptoms, and psychosocial issues, emotional issues, and really allowing for the patient to express their values and goals. For that, we have different disciplines on our team: experts in symptom management, which is the clinician, physicians, nurse practitioner, physician’s assistants. We have the social workers that help with navigating the healthcare system’s layers of support and also conversations with the patient and family. Chaplains for spiritual support when one would like that during a time of crisis and serious illness. That’s how our team functions. We meet on a regular basis together and talk with the patient about what the needs are. That way, the full support can be provided.
Melanie: Is their primary care physician or oncologist or whoever is their main doctor also involved in these meetings? Do they get updates on the patient and what you’re doing for them?
Dr. Stumpf: Very much so. Yes. We clearly have a conversation with the clinician on a regular basis and similar to any other consult patient even more so where we would give update each visit and update even before oftentimes and oftentimes we talk with the primary doctor, the palliative care team, and the patient altogether and the family.
Melanie: So, speaking of the family, how are they involved in palliative medicine?
Dr. Stumpf: I think oftentimes families are affected when a loved one has an illness very much so and each individual in their own way and they have different needs. Children of adults who are ill have needs or a daughter of an elder patient caring for them at home has needs. This is where we work together and having conversations about what those needs are and how the patient and their caregiving team can be the best support.
Melanie: In just the last minute, Dr. Stumpf, give your best advice to the listeners about your field of palliative medicine, what do you really want them to know and why they should come to Maine Medical Center for their care.
Dr. Stumpf: Yes, I think palliative care can really help to kind of bridge what matters most to patients when they deal with a serious illness and the care that they get. It allows for treatments and prolonging life and making the best out of what it is with an illness and helps navigate the healthcare system and having difficult conversations. So, I think it is important for patients to reach to their primary care doctor, oncologist and directly to our palliative care teams and say, “Could we seek your help dealing with an acute situation or a progressive illness?”
Melanie: Thank you so much, Dr. Stumpf. It’s great information. You’re listening to MMC Radio. For more information, you can go to MaineMedicalCenter.org. That’s MaineMedicalCenter.org. MMC.org. This is Melanie Cole. Thanks so much for listening.