‘Start The Conversation’

All ages invited to join local experts in talking about end-of-life care options, to improve quality of life now.

Start the ConversationRANDOLPH – Visiting Nurse and Hospice of Vermont and New Hampshire, the Vermont Ethics Network and Gifford Medical Center’s Advanced Illness Care Team are joining to create a community discussion around end-of-life care planning.

Called “Start The Conversation,” the talk will be held on Nov. 29 from 5-6:30 p.m. in Gifford’s Conference Center at the main medical center in Randolph.

“Start The Conversation” is a public education initiative of Vermont’s Visiting Nurse and home health and hospice agencies in partnership with the Vermont Ethics Network. Collaborating with medical providers like Gifford, the talk is offered around the state. A Web site, starttheconversationvt.org, also focuses on the issue of end-of-life planning.

“In life we prepare for everything: college, marriage, children and retirement. Despite the conversations we have for these important milestones, rarely do we have conversations about how we want to be cared for at the end of our lives,” explains the site.

“Talking is the single most important thing that you can do to prepare for the death of someone you love. While difficult, the end of life can be amazingly rich. Talking about this time makes a rich ending more likely. Often such conversations are avoided out of an understandable desire to spare each other’s feelings. They need not be.”

An Advance Directive is one way to get the conversation started and experts leading this Nov. 29 talk in Randolph will talk about end-of-life options, medical decision making and how to put ones wishes in writing through an Advance Directive.

“Planning for end-of-life care before it becomes a worry is as important as all the other life plans you make. Having a plan in place makes it easier for you, your doctor and your loved ones if you are unable to tell them your health care choices because of an injury or serious illness,” explains Jared King, business development manager for Visiting Nurse and Hospice of Vermont and New Hampshire.

“Every moment is precious – especially at the end-of-life. Starting the conversation early can ensure that your choices are heard. It also means that when time becomes short, it can be spent doing what you most enjoy and not making last-minute decisions.”

As a psychologist and member of Gifford’s inpatient care management team, Cory Gould spends much of her day talking to patients about Advance Directives. “We spend a lot of the day holding discussions with family members about how to talk about death,” Gould says. “The beauty of bringing this discussion to the forefront is to improve the quality of all of our lives.”

If end-of-life wishes are known there is more opportunity to enjoy the present and erase the worry, Gould explains. Discussing how one wants to celebrate the end can also increase understanding about what matters most to that individual in life. “Thinking about death is a way of celebrating life,” Gould says.

For Gifford and its Advanced Illness Care Team, the talk will be the first in a series on death and dying. Titled “A ‘Good’ Death,” the series will look at what is a “good” death, family dynamics when death approaches, what happens when someone dies, grief and more. The series begins with “Start The Conversation.”

“Start The Conversation” is free and open to people of all ages. Registration is not required. The Gifford Conference Center is on the first floor of the medical center and marked by a green awning from the patient parking area. For handicap access, take the elevator from the main lobby to the first floor and follow signs to the Conference Center.

To learn more about this talk or the upcoming series, call Gould at (802) 728-2608 .

 

Gifford Cancer Program Earns National Accreditation

Commission on Cancer logoRANDOLPH – The Commission on Cancer of the American College of Surgeons has granted accreditation with commendation to the cancer program at Gifford Medical Center through 2013.

A facility receives accreditation with commendation following an onsite evaluation by a physician surveyor during which the facility demonstrates a commendation level of compliance with one or more standards that represent the full scope of the cancer program (cancer committee leadership, cancer data management, clinical services, research, community outreach, and quality improvement). In addition, a facility receives a compliance rating for all other standards.

Through its oncology department, Gifford in Randolph offers area patients access to an experienced oncologist, Dr. John Valentine; care from a specially certified oncology nurse; and treatment planning and options, including outpatient chemotherapy and hormone therapy for the treatment of prostate cancer.

Cancer patients and their families additionally benefit from Gifford’s specialists and surgeons and the hospital’s robust palliative care program. Gifford also has a Cancer Committee, a patient care navigator program for women undergoing breast biopsies, and data management and quality oversight. It promotes cancer prevention, screenings, and treatment to the public through patient education and outreach efforts.

“We’re honored to be accredited once again by the Commission on Cancer,” Gifford Vice President of Surgery Rebecca O’Berry said. “This accreditation is a quality indicator for patients choosing cancer care, and an indicator that quality cancer care can be found close to home at Gifford.”

Established in 1922 by the American College of Surgeons, the Commission on Cancer is a consortium of professional organizations dedicated to improving survival rates and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive, quality care. Its membership includes fellows of the American College of Surgeons and 49 national organizations that reflect the full spectrum of cancer care.

Gifford’s program has been accredited by the Commission on Cancer since 1965.

The core functions of the Commission on Cancer include setting standards for quality, multidisciplinary cancer patient care; surveying facilities to evaluate compliance with the 36 Commission on Cancer standards; collecting standardized and quality data from accredited facilities; and using the data to develop effective educational interventions to improve cancer care outcomes at the national, state, and local level.

The American Cancer Society estimates that more than 1.6 million cases of cancer will be diagnosed in 2012. There are currently more than 1,500 Commission on Cancer-accredited cancer programs in the United States and Puerto Rico, representing close to 30 percent of all hospitals. This 30 percent of hospitals diagnose and/or treat 80 percent of newly diagnosed cancer patients each year. In addition, a national network of more than 1,650 volunteer cancer liaison physicians, including internal medicine physician Jim Currie of Gifford, provides leadership and support for the Commission on Cancer Accreditation Program and other activities at local facilities.

The Accreditation Program, a component of the Commission on Cancer, sets quality-of-care standards for cancer programs and reviews the programs to ensure they conform to those standards. Accreditation is given only to those facilities that have voluntarily committed to providing the highest level of quality cancer care and that undergo a rigorous evaluation process and review of their performance. To maintain accreditation, facilities with Commission on Cancer accredited cancer programs must undergo an on-site review every three years.

Health Focus: Understanding Palliative Care

‘It’s not a death sentence.’ It’s patient-centered care.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

With three outpatient palliative care physicians, Gifford Medical Center is already offering palliative care to outpatients early in their illness. To understand the discussion, however, you must understand the meaning of palliative care.

Gifford internal medicine provider Dr. Cristine Maloney of Randolph completed a year-long palliative medicine fellowship at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. In the article below from Gifford, she explains the difference between palliative medicine and hospice medicine and why more of us may benefit from palliative care than we think.

One day last fall, David Wark of West Topsham awoke barely able to breath. “I thought I was going to die. I got up and I couldn’t catch my breath.”

Besides emergency care for a truck accident in the mid-’90s, the 58-year-old hadn’t been to a doctor in well over 20 years. But after that 2011 incident, and at the urging of his ex-wife and good friend, he called for an appointment.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

A construction worker, Wark was helping with the remodel of Randolph’s Cumberland Farms, so he called nearby Gifford Medical Center.

He got in right away, undergoing pulmonary function testing, X-rays and blood work and then sitting down with internal medicine physician Dr. Cristine Maloney.

“‘Don’t bull#@*# me. Just tell me the truth,’” Wark remembers telling the doctor.

The truth was worse than he expected. Wark, who had struggled with shortness of breath for years, suffered from tuberculosis as a child, experienced asbestos exposure and smoked since his teens, had late stage emphysema, or chronic obstructive pulmonary disease (COPD).

He didn’t know it at the time, but the diagnosis meant Wark was now a palliative care patient.

“Palliative medicine is designed for anyone who has a serious illness,” says Dr. Maloney. She lists cancer, dementia, heart failure, COPD, liver disease, renal failure, stroke, cystic fibrosis, congenital malformations and extreme prematurity as examples. “It’s any illness that has the potential to shorten your life.”

For those patients, palliative medicine focuses on providing relief from symptoms, pain and

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

the stress associated with having a serious illness. It involves listening to patients so their treatment is aligned with what is important to them. It works to enhance the patient’s, as well as their family’s or caregiver’s, quality of life through symptom management. And it includes an interdisciplinary team of caregivers helping to care for the patient’s diverse needs, not just treating his or her disease.

Palliative care is often confused with hospice care.

Hospice medicine is subset of palliative medicine, but is for patients nearing the end of life. Medicare defines hospice care as for a patient who two doctors have determined has six months or less to live and who understands that care going forward will be palliative, not curative, Dr. Maloney explains. Most private insurers have similar definitions, although sometimes allow patients to pursue both symptom management and life prolonging treatments.

Palliative care is offered early and throughout an illness. It doesn’t mean foregoing curative treatments. And it doesn’t mean giving up your primary care provider to meet with a palliative care physician like Dr. Maloney.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

Instead it is an extra layer of care, where a doctor spends time with patients to determine their wishes, help them understand their options and navigate the health care system, and answer their questions so they have better control over their disease and their care.

Long-time internal medicine physician Dr. Milt Fowler has referred patients to Dr. Maloney and Gifford’s other palliative care physicians. “My referrals to Dr. Maloney are to have her join forces with me in caring for patients with serious illnesses that would be helped by a team approach,” Dr. Fowler said.

“The palliative care specialty is young, but very useful. Patients who I have referred have felt our team approach has offered them more options and more availability. We have used this team approach both in office consults as well as with a number of home visits, which we often make together,” he said.

Research also backs what Gifford physicians have found anecdotally to be true.
“Many, many guidelines say this is the way to go. If you get patients onboard sooner, they do better,” Dr. Maloney says, citing studies from Massachusetts General Hospital and Dartmouth-Hitchcock Medical Center that found cancer patients undergoing palliative care had a better quality of life and improved mood, and, in the case of the Mass General study of metastatic lung cancer patients, slightly longer lives with less aggressive care.

This type of care also often produces less confusion and conflict with family or friends about a patient’s treatment goals, says Dr. Maloney.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

Over a longer appointment than the average doctor’s visit or over several appointments if the patient isn’t yet ready to discuss certain topics, Dr. Maloney determines a patient’s wishes by asking questions – without judgment – about treatment wishes; their home and financial resources, including family support and worries or concerns about their illness; their spiritual beliefs; if they want to know more about their prognosis; and their wishes should they be unable to speak for themselves.

“No one asks people what they want. They make the assumption they want the most care possible, which may not be the best care possible,” says Dr. Maloney, who often hears “I want to be home,” “I don’t want to travel to get treatment,” “I want to play with my grandkids” or even “I want to putter in my woodshed.”

Based on a patient’s wishes, Dr. Maloney then provides help achieving the patient’s goals to the best extent possible. That help might include referrals to a massage or music therapist, a visit with a chaplain or social worker, or help completing an Advance Directive and expressing wishes to family.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

In Wark’s case, Dr. Maloney prescribed breathing medications and recommended both that he quit smoking and participate in the medical center’s pulmonary rehabilitation program. He’s chosen not to pursue pulmonary rehabilitation yet, but has cut back on his smoking and says the medications have greatly improved his life.

“It’s a lifesaver. I can walk up my hill now,” says Wark, who is staying active with yard work and walking his Siberian husky dogs.

He knows “there’s going to come a time eventually that I’ll have to have oxygen.”

He’s OK with that. But he has also discussed that he doesn’t want the kind of aggressive care his own mother, for example, received for cancer. “I’d rather live a shorter life, but be more comfortable than receive very aggressive medications. I don’t like it. I don’t want it,” says Wark, who has signed a “do not resuscitate” order, which he’s shared with his ex-wife and keeps on his fridge.

And he remains upbeat about this illness.

“I’m not going to sit around and feel sorry for myself,” says Wark, who should have years to live. “It’s not a death sentence. You just have to deal with it and let the doctor help you.”

In addition to Dr. Maloney, Gifford’s palliative care physicians who can help are Drs. David Pattison, an internal medicine provider and pediatrician, and Jonna Goulding, a family physician. All three palliative care physicians serve on Gifford’s multidisciplinary Advanced Illness Care Team, which aims to promote and provide patient-focused palliative and hospice care both in the outpatient and inpatient settings.