Palliative Care Center Recognized as Model for End-of-Life Care

It will happen to each of us someday - suddenly and without warning for some, gradually or sometimes painfully for others. No one knows precisely when he or she will die, but everyone can prepare for that inevitable event, says David E. Weissman, MD, Professor of Medicine at the Medical College of Wisconsin and Director of its Palliative Care Center.

Dr. Weissman, an oncologist, is one of the pioneers in the field of palliative care for patients who are terminally ill. In 1986, he realized there was a void in the care of patients facing the end of life. "I recognized, along with others, that medicine did a great job of diagnosing and treating patients throughout their lives, but we didn't know what to do for them when they were near death," he says. That is when he began designing a program at the Medical College that offered support for patients and families nearing the end-of-life, care that was "palliative" - a term defined as caring for or protecting.

Froedtert & Medical College opened Wisconsin's first comprehensive palliative care program in 1993 and, ever since, it has served as a national model. The center includes a six-bed inpatient ward offering intensive support for patients and their families, along with a consultation service for patients throughout the hospital. The Palliative Care team helps provide relief from pain and other distressing symptoms, and helps families and their doctors make informed choices about whether to continue life-sustaining treatments. The program also offers outpatient services to patients with any life-limiting illness.

New Medical Discipline
"There really was not a separate field of palliative care until about 1990," Dr. Weissman says. "It's evolved rapidly in the last six or seven years, with the growth of education programs for physicians, nurses and other caregivers. Ten years ago, we were one of a small group of hospitals with such programs. Now, I'd estimate between 30% and 40% of hospitals have some type of palliative care program."

Last August, the Robert Wood Johnson Foundation, together with the Center to Advance Palliative Care, designated the combined palliative care programs at Froedtert, the Medical College and Children's Hospital of Wisconsin as a national Palliative Care Leadership Center - one of just six programs nationally to receive the honor. The purpose of this $750,000 award is to provide a place of training for hospitals throughout the United States to learn how to start their own Palliative Care programs.

As one of six national leadership centers, the Froedtert & Medical College Palliative Care Center will work with 100 sites around the country over the next three years. "We host visiting teams and spend 2 ½ days with them, helping them design and manage programs, plan budgets and collect data," Dr. Weissman says.

Changing the Culture of Medicine
"We're trying to change the culture," says Dr. Weissman, who is the author of three palliative medicine texts. He is the founder and editor of the Journal of Palliative Medicine, which is headquartered at the Medical College. He is also a faculty scholar in the Soros Foundation's Project on Death in America. Since the mid-1980s, Dr. Weissman and his faculty colleagues in palliative care have published more than 60 research studies focused on pain assessment and management, pain education, clinical palliative care and palliative care education.

The professional education program is designed to raise awareness and educate health care professionals from throughout the country about advances in end-of-life care through such efforts as:

• National Residency End-of-Life Education Project. Since 1998, almost 400 internal medicine, family medicine, neurology and surgery residency programs nationwide have participated in this one-year curriculum reform project.
• The End-of-Life/Palliative Education Resource Center (EPERC). EPERC is an online site providing physician-educators the ability to search by topic for educational materials. "It has become a clearinghouse for doctors from as close by as Waukesha or as far away as Zimbabwe to look up the latest information in the field of palliative care," Dr. Weissman says.
• Physician Fellowships. The Fellowship in Adult and Pediatric Palliative Care two-year program is designed to train physicians who have completed a residency in a primary care specialty such as internal medicine, family practice or pediatrics, and are considering an academic career in palliative care. Another two-year fellowship is aimed at preparing general internists for an academic career, with a focus on clinical, education and research expertise in palliative care. Participants take course work leading to a master's degree in bioethics, epidemiology or medical informatics.

In addition to its physician training, the Froedtert & Medical College Palliative Care Center educates community health professionals through such efforts as:

• On-site education. Physicians and nurses from the Palliative Care Center travel to hospices and similar sites, where they assist administrators and staff in designing their own pain management and palliative care programs. Training programs can range from a few hours to several days, depending on what the facilities require.
• Breakfast seminars. To help facilities stay current with advances in palliative care, the Froedtert & Medical College Palliative Care Center sponsors regular breakfast seminars for nurses, pharmacists and other professional team members responsible for the management of pain. Past discussion topics have included pain management, symptom control, communication, spirituality and alternative therapies.
• The Visiting Nurse Scholar Program in Pain and Palliative Care.

"We started our residency project in the 1990s," notes Dr. Weissman. "As of last year we will have trained almost 400 residency programs across the country in internal medicine, family practice, neurology and general surgery. We've extended our reach to more than 50% of the internal medicine programs in the United States. Many residencies have now added a requirement that residents be trained in palliative care, so we've had a huge impact."

The organization that accredits medical schools in the United States now requires that all such schools provide training in end-of-life care.

Barbara Abel
HealthLink Contributing Writer

For more information on this topic, see the HealthLink article 'No Code' Does Not Mean No Care.

Visit the website of the Medical College of Wisconsin Palliative Care Center.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.