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Understanding Palliative Care

The purpose of palliative care is to improve the quality of life for patients with a chronic and/or life-threatening illness. Our Palliative Care team includes a physician, a nurse practitioner, a licensed clinical social worker, and chaplains.

In this segment, Matthew Katics, DO, explains how MarinHealth Medical Center's Palliative Care team also helps patients and their loved ones navigate this difficult process and understand their options for comfort or for end-of-life care.
Understanding Palliative Care
Featuring:
Matthew Katics, DO
Matthew Katics, DO is the Medical Director of the Palliative Care Program at MarinHealth Medical Center.

Learn more about Matthew Katics, DO
Transcription:

Bill Klaproth (Host): Some people need an extra level of care and support, and palliative care can provide specialized relief and care. With us is Dr. Matthew Katics, medical director of the palliative care program at Marin General Hospital. Dr. Katics, thank you so much for your time today. So, let's start with this, what is palliative care?

Dr. Matthew Katics (Guest): Well, palliative care really at its heart is really a basic type of medicine that focuses on living well, and it really looks at quality of life, and it looks at the person being, at least as important, but I would say more important than the diseases they're faced with. So, really it's about focusing on quality of life, and really helping people to thrive as much as possible when they're facing serious illness.

Bill: So, what are some of the myths then or misconceptions surrounding this specialty, such as you know questions like, is palliative care just another term for hospice or end of life care and is palliative care ever used for non-terminal patients?

Dr. Katics: Yeah, it's a good question. I think because palliative care really focuses on people who are struggling with serious illness. There can be that false association that palliative care is only for people who are dying or it's the same thing as hospice care, and really it's not. So, palliative care is for those who have serious illness, but it is also done in conjunction with curative measures. So, there's a couple big differences from hospice care, whereas in hospice care you kind of, at a point, where the curative measures are not helpful or beneficial. And so, people elect to forego further attempts at curative measures, with palliative care that's done in conjunction with curative measures.

So, there's no limit to the types of medicine or the scope of medicine you can receive. Hospice also has a very important qualification, that to qualify for hospice care, you have to be, in what we would think, the doctors would think would be your last six-months of life. The prognosis of six months or less, and that is not the case for palliative care. There is no prognosis requirement. So, people who are receiving palliative care might be very ill, but they hopefully...the goal is that they would be completely cured and live long healthy lives. So, those are two-real important differences.

Bill: So, hospice care then is end of life, and palliative care is more for curative care, if you will. So, then what situations or maybe this is better, what conditions might call for palliative care?

Dr. Katics: So, you can think of really any serious illness, now it can be chronic illnesses, that can be acute illnesses. Some examples would be someone who has very advanced, let's say, heart failure or kidney failure or lung issues, it could be someone who has cancer in the more advanced stages or even in the beginning stages of cancer that are struggling with very difficult symptoms. So, really any serious illness is appropriate for palliative care.

Bill: And what types of treatments then are used in palliative care?

Dr. Katics: Well, so palliative care, again, is going to focus on quality of life, and the way that people are coping with the illness. So, you can imagine if you have pretty serious illness those are the folks who are going to tend to have the most suffering in different ways. If it's physical or emotional, spiritual, psychological. So, palliative care will definitely focus on the symptoms, and common symptom people are familiar with is pain or it might be breathlessness or nausea, and sometimes the good cancer treatments have pretty serious side effects, and we really want to focus on those side effects, so that can minimize them, and help people live their lives.

Symptoms go beyond the physical symptoms, and often when you are struggling with illness, there are some very difficult decisions you have to make. It can become very, very complicated. Some of the patients I see have five or six consultants, and they're all doing their part and doing good work, but it's often hard for patient and family to really understand what's going on, and how all these pieces fit together, and how to make decisions about treatments when there's really a big kind of plus and minus, there's a big weighing of the pros and cons.

So, palliative care will really help people with their understanding of the illness and kind of the care planning and coordinating with all of the different physicians, and family members involved. So, just to kind of summarize it, symptomatic management, helping with difficult symptoms. It's helping with understanding of your situation, and what's going on, what the care options are, and it's helping with planning of deciding, "Okay for me or for this individual, this is really the best path, and here's how I get everybody together and coordinate with all the different parts of that person's care and make the best plan for them"

Bill: So, it's very comprehensive then, and how does the palliative care team work with the patient's primary care physician?

Dr. Katics: Right, and I'm glad you said "team," because it is a team, and there's usually a few, four main components to the palliative care team. There's a physician or a nurse practitioner, a provider. There's a social worker, there's spiritual care and there's nursing. All of those disciplines are part of the team, and we will work with the referring physician or the primary care provider hand-in-hand. So, kind of, it just depends on each situation. There might be a referral where the where the primary physician doesn't have privileges to come to the hospital and see the patient. And so, the pilot of their team will have an extremely active role, and be calling or communicating with the primary doctor.

And it can be in an outpatient setting where there's where referral, and they'll be either direct moment-to-moment communication with the primary doctor. Often I'm on the phone with them during a patient interview when important questions come up, or there's just communication after the visit, and in planning for the next visits. Those kinds of things should be fairly similar to...if you go to another specialist, like your cardiologist, cardiologist would talk with your primary doctor. Palliative care tends to really emphasize that type of coordination of care.

Bill: Right, and then, Dr. Katics, how do you get palliative care? Do you call a physician like you, or does your primary care physician or specialists refer you? How does that work?

Dr. Katics: So, the field of palliative care is rolling tremendously. There's inpatient and outpatient programs, and most inpatient programs will require some sort of additional referral, but most hospitals also have it worked out, that any patient can ask for palliative care, and the nurses and floor clerks know about the palliative care program. So, if someone could ask directly, certainly, the Marin General Website has links to our palliative care service in our line.

If the palliative care physician is going to see someone, they would always communicate with the attending physicians well. So, the answer to your question, yes there's any... all those ways are possible to get palliative care or you can ask for it directly. You can get it through your primary physician, and the same would go inpatient and outpatient. The challenge, right now, in this period of growth for palliative care is building enough outpatient facilities and access. That's something that Marin General's working very hard on right now, to create an outpatient program.

Bill: Okay, so then is palliative care... the decision is it made then by the patient, and the patient's family or a spouse or partner, and what is the impact on the patient's family or the caregivers?

Dr. Katics: Well, yes, the decision to ask for palliative care. It can be suggested. So, certainly the attending physician can really think palliative care would help, but ultimately, we believe very strongly in-patient autonomy and empowering the patients for what they feel is right for them. So, palliative care would never be forced on anybody, but it's usually something that's...and anyway it's going to help is going to be you to help with the symptoms or clarification. So, ultimately it comes down to the patient’s choice. I would say 99 percent of the time when the patient understands what palliative is, they will accept that extra layer of help and support. The impact is really a deeper understanding of what they're facing and a much deeper layer of support, both for the physical and emotional symptoms, but also for the family and psycho-social benefit of how... I really look at that saying... It takes a village to care for someone, and with serious illness, it takes a village of caring people with their arms around their loved one who's ill to really help them do the best they can.

Bill: Right, and that's a very important benefit for the family as well as the patient. Well, Dr. Katics, thank you so much for talking with us today about palliative care. For more health tips and information from Marin General Hospital, you can join Health Connection at, MarinGeneral.org/HealthConnection, that's, MarinGeneral.org/HealthConnection. This is the Healing Podcast brought to you by Marin General Hospital. I'm Bill Klaproth, thanks for listening.