Building a better life
Dr. Kathy Selvaggi and her palliative care colleagues at Butler Health System want patients to know they work to improve their patients' lives, not wait for them to end.
Selvaggi, who started the program in 2015 after coming to Butler from Boston's Dana-Farber/Brigham and Women's Cancer Center, said, “Palliative care focuses on improving quality of life for patients with serious, chronic and life-threatening illnesses.
She said, “Let me tell you how I explain it to patients. Palliative care is represented by this large circle.
“A smaller circle inside that hospice care. It's not only end-of-life we treat but we deal with serious illnesses with symptoms that need to be managed.
“End-of-life care is but a subset of palliative treatment,” Selvaggi said. “We work with patients' oncologists, cardiologists to provide patients with relief from the pain, nausea and stress of chronic illness.”
Selvaggi said palliative care concentrates on treating the whole person taking into account their physical, spiritual and emotional needs.
Selvaggi and her palliative care team — Dr. Dillon Stein, physician's assistant Lisa Doverspike hospital chaplain Mark Brown and social worker Jenna Rhodaberger — supplement the patient's existing doctors and treatment team to help the sufferer manage his symptoms and reach his goals.
The palliative care team works together with the patient's other doctors to provide an extra layer of support.
Selvaggi said, “For example, if a patient is diagnosed with a metastatic cancer, an oncologist could consult with us on pain mangement. If there is anxiety surrounding the diagnosis we could bring in Mark Brown.”
The team also has an outpatient clinic in the health system's Crossroads campus, 129 Oneida Valley Road, manned by registered nurse Terri Isacco.
Stein said his goal and that of his fellow team members is to help patients regain the strength to continue with daily life, focusing on symptoms such as pain, insomnia, vomiting, fatigue and depression.
“We find out which symptoms are the most burdensome and we manage those,” said Stein.
Degrees and titles notwithstanding, Selvaggi's team isn't limited to dosages and procedures.
“Chaplaincy is an important part of our team,” she said. “There are, at times, potent spiritual issues that need to be addressed.”
The Rev. Mark Brown, a retired Anglican minister, provides the chaplain's services for the palliative care program.
Brown said, “Occasionally I've been asked to come over and meet with a patient in the outpatient office who is wrestling with mortality or facing an illness that is likely terminal.
“There are certainly issues of grappling with a frightening or troubling diagnosis,” said Brown.
Selvaggi said, “We consult in the hospital. Patients can tell their doctors or caregivers that they want palliative care. You don't need to be in pain to ask for it.”
After the patient is discharged from the hospital, Stein said, “We can help with continuity of care. We are at the outpatient clinic three days a week. “
Stein said the team creates a program for the patient based on the patient's physical symptoms, anxiety or stress rather than focusing on the patient's prognosis.
A personalized program can also be crafted on an outpatient basis for somone, said Isacco, a registered nurse certified in palliative care who sees patients at the Crossroads campus two days a week and every other Friday.
“We get referrals from physicians, oncologists and specialists for follow-up at the clinic,” said Isacco.
“Every patient presents differently,” said Isacco. “We discuss symptom management, the goals of care and get a sense of the patient's biggest concern.”
“Sometimes we bring the families into it, said Isacco.
Selvaggi said palliative care is appropriate at any patient age and at state in a serious illness.
Stein said palliative care treats people suffering from kidney failure, anorexia, Parkinson's disease, Alzheimer's, congestive heart failure and amyotrophic lateral sclerosis.“We have patients who are in active chemotherapy who have symptoms that need to be managed,” she said. “We work with the primary care physicians to improve the quality of life,” said Selvaggi.Stein said, “We try to make it a point to integrate into their team of physicians. We are an added layer of support for the physical or emotional struggle of the patient or the patient's family,” said Stein.“Often times,” he said. “It's as simple of spending more time with the patient.“We are so integrated with the primary physicians we can spend more time and really provide support for them and the patient's family,” said Stein.And, said Selvaggi, when a patient has come to the end of treatment options, the palliative program is there. “That's not an easy conversation to navigate with an individual,” she saidAnd it's not just the patient that needs to be educated on a disease or its treatment or the treatment's side effects, said Stein, there is the patient's family to be brought into the loop.“Often the patient doesn't understand the severity of the illness or the family doesn't understand what is going on,” said Selvaggi. “We really want to make sure they are on the same page.”Brown said, “The family needs support. The patient is focused on battling the illness.”Brown said, “The team has a interdisciplinary meeting every Wednesday where we all get together, doctors, nurses, pharmacists ...”Brown said of his involvement with the palliative care program, “It is very rewarding. It covers a dimension on the spiritual end of the spectrum where chaplains can assist. I feel honored to be a part of it.”“We get to know people and understand their wishes,” said Isacco. “We are able to be helpful their entire journey wherever it takes them.”
