Palliative Medicine Manages Symptoms in Chronically Ill and Terminal Patients

Greg Ayers, MD, center, consults with members of the Brookwood Palliative Care team.

Patients who are facing a chronic or terminal illness can find relief from symptoms, pain and stress through treatment provided by a palliative medicine team. The goal of palliative medicine, the newest board specialty in Internal Medicine, is to improve the quality of life for both the patient and family.

Greg Ayers, MD became board certified in palliative medicine in 2012 and formed the Palliative Medicine service at Princeton Baptist Medical Center seven years ago. He serves as medical director for the Princeton team as well as for the newly established palliative care team at Brookwood Baptist Medical Center, which began providing Palliative Medicine consultations in May. Ayers also serves as Regional Director for Curo Health Services in North Alabama and Mississippi. Curo is a national hospice service provider that serves patients across 21 states.

"Palliative medicine may be a new specialty, but doctors have actually always provided palliative care. Someone just gave it a name," Ayers says. "Physicians have always worked to relieve suffering. That's what palliative care is - relief of suffering."

Palliative care is a broad philosophy that includes hospice care. While hospice care is reserved for terminally ill patients during the last six months of life, palliative care can be employed while patients continue life-prolonging treatments through different phases of a serious illness. Treatment may include pain management, the understanding of care options toward the end of life, help at home, and emotional/spiritual support.

Ayers says palliative care is generally discussed in the context of a serious illness like chronic, progressive pulmonary disorders; renal disease; chronic heart failure; HIV/AIDS; progressive neurological conditions; cancer; etc. A team of health professionals cares for the patient and family, generally in a hospital. "With us, you get a whole team - a medical director, nurses, a pharmacist that specializes in palliative care, social services, and a chaplain," Ayers says. "I chose this field because I want to help relieve the suffering in patients with serious illnesses."

Palliative care is important for hospice patients who want an accurate prognostication for their end of life. "We have a lot of prognostication discussions with people with an advanced terminal disease, like cancer," Ayers Says. "Those are difficult conversations, but families appreciate it because it helps them make plans. The patient might want to take a last trip or see a certain loved one, so it is important to have an accurate date.

"To maximize effectiveness, palliative care should be started earlier in the disease process when the symptom burden begins to increase. And by making plans for care in advance, the family reduces stress.

We conduct family/patient conferences where we ask the patient what types of treatments he wants at the end of life. We also determine the appropriate decision maker who will speak for the patient when she is no longer able to make decisions. That is an important discussion because I have seen patients put on ventilators and medications without the consent of the patient or the family."

Studies show that palliative care makes a difference in patients' lives. "It improves quality of life, reduces time spent in the hospital, and decreases hospital readmissions. With hospice enrollment, we are also able to arrange good support services in a patient's home which can prevent a patient having to return to the hospital," Ayers says. "Patients who receive our consultations generally have fewer invasive procedures and code blues. That translates to better quality of life when you don't have to endure all those procedures at the end."

There are currently only a few palliative medicine physicians in Alabama. "Facilities are improving, but not enough doctors are trained in palliative care," Ayers says. "UAB started the first service in the state and also has a training program for physicians in the field. Nonetheless, our outstanding teams at Princeton and Brookwood have improved access to this specialty for our patients here in Birmingham. Our teams provided care for more than 110 patients at Princeton and more than 50 at the new Brookwood program in the past month alone. Getting the word out about the field of palliative care is important. We need to increase awareness among insurance companies and the media. We also need physicians to promote the specialty more. Improving public knowledge will make it easier to spread the word to the people who need this care the most."


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MD; palliative medicine specialty; Brookwood; Princeton Baptist Medical Center; , Palliative medicine; palliative care; hospice and palliative care; Greg Ayers


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