Melissa Shene Certified Registered Nurse Practitioner

Palliative care is specialized medical care for adults and children with serious illnesses. Palliate means to ease, therefore palliative care is focused on easing the symptoms of illness. Patients receiving palliative care can be in any stage of a serious illness from new onset to advanced, and may be seeking curative treatments such as chemotherapy, radiation, and/or surgical intervention. Symptoms to be eased can be social, physical, emotional and/or spiritual. Palliative care providers can include physicians, nurse practitioners, nurses, social workers, counselors, dieticians, pharmacists, and/or clergy/chaplains.

Palliative care is not hospice. Hospice patients have a life expectancy of 6 months or less. Hospice patients have decided they no longer want aggressive treatment such as chemotherapy, radiation, and/or hospitalization, or these types of measures are no longer most appropriate options, and want care that focuses on maximizing comfort and quality of life whether at home, in an extended care facility, or at a hospice residence. Palliative patients can stay on palliative care indefinitely, be discharged due to meeting goals, or some may progress to hospice. Palliative care patients, like hospice patients, do not need to be homebound, such as with home health care services. Palliative care works with the patient to determine his or her own individual goals of care. The patient is basically the “captain of the ship.” An extensive assessment is done to see what the individual patient and his/her family’s needs may be such as pain relief, counseling, advanced directives or a living will, fatigue, insomnia, anorexia (loss of appetite), assistive devices, anxiety and depression management and/or spiritual needs.

Palliative care can be provided in many places, such as in one’s own home, a local cancer center, hospital setting, or skilled nursing facility. Palliative care is a consultant-based practice. Palliative care clinicians work with the patient’s own physician, nurse practitioner or physician assistant. An order is required to receive palliative care, and the palliative care practitioner is a liaison between the patient and his or her numerous providers.

Patients that could benefit from palliative care can include those that suffer from cancer, severe heart failure, severe heart disease, advanced liver disease, kidney failure, neurologic diseases such as Parkinson’s disease, stroke, late-stage Alzheimer’s dementia, severe lung diseases such as COPD, or those with a general decline.

Examples could include a cancer patient with ongoing pain, anxiety and nausea, a heart failure patient with numerous hospitalizations for flare-ups, a child with a life-limiting syndrome, or an elderly person that has lost weight with no known cause. Palliative care practitioners work closely with the patient and their families to provide an extra layer of support beyond what their primary care providers and specialists can provide.

Melissa Shene is a CRNP, or Certified Registered Nurse Practitioner for Warren County.