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Melanie Cole (Host):  You’ve heard the term palliative care and you might wonder what’s the difference between palliative and hospice care. My guest today is Dr. Larry Boggeln. He is a palliative and hospice care specialist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Boggeln. Tell us, what is the term palliative care? What does that mean?

Dr. Larry Boggeln (Guest):   Well, Melanie, palliative means cloak or to cover with a protective cover. It comes from the Latin term palliam. The concept is to provide comprehensive care that takes care of the patient and the entire family in a situation where they are under a great deal of stress and a life-limiting illness scenario.

Melanie:  How is palliative care different than hospice? People hear this term and right away they think terminal. How does palliative care help somebody who is not terminal?   

Dr. Boggeln:  Hospice is actually a form of palliative care but it is really confined to the last six months of life; whereas, palliative care is medical treatment that can be applied to patients and families at any point in the course of an illness that could potentially be life limiting. At the time of diagnosis, palliative care could help with assembling resources for the patient and family to utilize to better address the issues that come up during the course of the illness. For example, a patient with a new diagnosis of cancer may need supplies to treat the surgeries associated with that cancer and the hospital may or may not have those supplies available but there may be private resources in the community that have them available. That’s one thing that the palliative care team can do is align the resources for the patient.  

Melanie:   Does getting palliative care, or side-along care, with your treatment mean that your treatment stops?

Dr. Boggeln:  Not at all. Palliative care is used in addition to, side by side with, the treatment attempting cure of the disease process. It just enhances the care that is available through the treating team.   

Melanie:  Tell us what’s involved in palliative care. Is it medicine? Is it outreach? Is it counseling? What’s really involved?   

Dr. Boggeln:  It’s a little bit of all that. Treatment is provided by a team of specialists--not only the physician but also a specialty trained nurse and an aide and whether it’s an inpatient or an outpatient treatment, it involves all of these team members. In addition, there’s a social worker who is assigned to the case that helps assemble those resources that actually can provide counseling services. Lastly, the member of the team that may be most important is the spiritual care advisor who either works with the patient’s faith community if they are involved in a church or organization. We also have chaplains available if they do not have affiliation with a faith community to provide spiritual counseling in existential kind of questions like, “What is life all about?” or “Is there an afterlife?” or something like that. It will help patients and families deal with the stresses that arise when they are thinking about, “Am I going to die?”

Melanie:  How is the physician that they’ve been working with for whatever their illness involved in the palliative care?  

Dr. Boggeln:  We work hand in hand with the treating physician augmenting what they have to provide and helping to fill in gaps in communication and in coordination of care and also with symptom management. Sometimes those symptoms get out of control so quickly, the treating physician isn’t ready or able to deal with it and that’s where we have expertise in dealing with those symptoms that associate an illness that is this serious.

Melanie:  The family is usually involved, in some way, Dr. Boggeln. How is the family involved in palliative care?   

Dr. Boggeln:  We believe that the family is part of the unit of care, so they are cared for just as the patient is. No matter what the situation is, family members or close personal relationships of the identified patient are affected by that illness, too. It involves anxieties and fears and hopes and sometimes irrational thoughts like anger or frustration can occur. We help deal with those feelings and deal with those senses of helplessness that sometimes occur as a caregiver. Also the stresses involved in caring for somebody who is ill are tremendous. It can be as serious as the stresses involved with actually having the illness. We provide caregiver support as well.

Melanie:  How do palliative care and hospice care go together? Is there a time when palliative care could go along with hospice care?

Dr. Boggeln: Sure. As I said, hospice is actually palliative care confined to the last six months of life. Theoretically, it should be a relatively seamless transition from the palliative care team to the hospice team and many times they’re one in the same – the personnel doesn’t change - so the patient and family are used to a particular nurse or a particular aide and they keep those same workers with them so that they can provide some continuity of care and some assemblance of reassurance to the family that it’s the same people that are working with them.

Melanie:  Dr. Boggeln, what should people with loved ones that are ill be thinking about when they are seeking palliative care?

Dr. Boggeln:  I think the first thing to look for is a team that demonstrates their caring and compassion and their willingness to go out of their way to help. Not all services are the same and my philosophy is that I treat patients as though they are my family and treat them as if they were a close relative of mine. Our entire team does that as well. What we are trying to project is a sense of caring and a feeling for the patient and family that there is hope for symptom relief; there is hope for management of the disease process and there is hope for coordination and communication with the providers that they might not have had otherwise.

Melanie:  That’s lovely. I applaud all of the great work that you do. In just the last few minutes, why should patients come to Temecula Valley Hospital for their care?

Dr. Boggeln:  The entire philosophy of Temecula Valley Hospital is patient-centered and family-sensitive care and that’s evident from the time you arrive in the parking lot until the time you are discharged and beyond until you’re going back home. Temecula Valley Hospital is a true community hospital and reaches out into the community to identify patients at risk and at need for palliative care services and tries to connect those services with the patient and family both as an inpatient and outpatient and provide a continuity of care that is missing from modern day medicine.

Melanie:   Thank you so much, Dr. Boggeln, for being with us today.  You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information, please visit TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The Hospital shall not be liable for actions or treatments provided by physicians.  This is Melanie Cole. Thanks so much for listening.