Georgia hospitals lag behind the nation in offering palliative care, a range of services that help patients and families deal with devastating conditions and difficult treatments.
A new University of Georgia study found that just 18 percent of Georgia hospitals have palliative care programs, even though research has shown that the services can extend lives and reduce health care expenses. Nationwide, about 60 percent of hospitals have a palliative care staff.
"The people we spoke with at more than half of the hospitals didn’t even know what palliative care was," said Anne Glass, the lead researcher on the study and assistant director of the University of Georgia's Institute of Gerontology.
Services offered by palliative care programs include pain management, end-of-life care, and spiritual and psychological counseling for patients and families facing life-threatening conditions. Without such services, experts said, many patients aren't getting the medical treatments and personal support that could help them best tolerate painful treatments or diseases -- or achieve a peaceful end of life.
The programs can provide services such as a specially trained social worker who can help a patient and family understand a serious diagnosis and help them decide what treatments make sense. Palliative care doctors are experts at managing pain even among frail, elderly people who can't communicate well. A patient's spirituality is addressed through such programs, as are the complicated family dynamics that often accompany a serious illness.
"Palliative care is about living -- about living better every day for as many days as we have," said Dr. Tammie Quest, chief of the Emory Center for Palliative Care.
Formal palliative care teams are rare in Georgia, experts said, because the specialty is new and awareness of the value of the care is still growing among hospital managers. Plus, most insurance plans offer only limited coverage for palliative care, which makes it difficult for financially strapped hospitals to pay for the programs.
Many doctors -- especially beloved family physicians -- have always provided palliative care. It's a personal approach that sees the patient as a human being and not simply as a medical specimen. As medicine has evolved from a time when house calls were the norm to an age of high-tech treatments without much personal interaction, palliative care emerged as a medical specialty.
A landmark study published last year found that palliative care could not only improve someone's quality of life -- it could extend it. A group of lung cancer patients who got palliative care services, on average, lived 2.7 months longer than those in the study who did not receive the services. Another study published this year found that the services could also cut health care costs by shortening stays in intensive care as well as reducing the costs of lab work and other medical tests.
While most hospitals do not have formal programs, some in Georgia stand out.
In Atlanta, Emory University runs a comprehensive palliative care program that has teams of doctors, nurses, social workers and chaplains ready to help patients in difficult situations.
Quest said the teams see thousands of patients a year, often people with cancer or patients admitted to emergency rooms and intensive care units. While every doctor should be implementing the basics of palliative care, specialized teams are needed for the complex cases, Quest said.
Dr. Paul DeSandre is among the palliative specialists at Emory. An experienced emergency room physician, DeSandre decided to add a palliative care focus to his work after observing rushed decisions in emergency room settings that did not always make sense, given the patient's overall medical condition. Training in palliative care pushes doctors, patients and families to consider all the realities of a condition -- realities that can be complex and difficult -- when making decisions about the care.
DeSandre teaches and practices emergency medicine, as well as hospice and palliative medicine. His work involves talking through the implications of emergency procedures or trying to persuade a primary care doctor to do more to manage a patient's pain. DeSandre also helps patients discuss their diseases and make plans. It's his job to help a young mother with cancer talk about what her disease means or to help a terminally ill elderly person decide whether he or she wants to be resuscitated in an emergency.
Catherine Futrell is among his patients at Emory University Hospital Midtown. On Friday, the 48-year-old from Morrow was in a specialized unit that Emory and VistaCare Hospice run together.
Futrell's daughter, Karina, and her granddaughter, Genesis, were at her bedside. Her daughter said that a host of serious medical problems -- including HIV, diabetes and ulcerative colitis -- have left Futrell with a bleak diagnosis. She is weak but appears comfortable and has already expressed her wishes that she not be resuscitated in an emergency.
Karina Futrell said the palliative care services had given her and the rest of the family a clear understanding of her mother's condition -- and had helped them prepare for the worst, which she appreciated.
"They didn't beat around the bush," she said. "They told us straight up."
Futrell said her mother's severe pain has been controlled, and she is now peaceful and calm. She said the doctors and other staff take the time to update her and make themselves available. They have also taken calls from other family members from out of town, so the daughter doesn't have to handle all the communications.
"The burden is not all on me," she said.
A chaplain and social workers are available. And a meditation room is just down the hall. Karina Futrell said all the support has prepared her for what's to come.
"Palliative care is needed," she said, "because it's giving us our time to get ready and letting her have her last wishes."
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