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Rochester's Palliative Care Program achieves top national certification

In the latest development in its decades-long leadership in the area of palliative care, the University of Rochester Medical Center's Palliative Care Program is one of the first nationwide to earn advanced certification from the Joint Commission, the nation's predominant standards-setting and accrediting body in health care.

The commission's Gold Seal of Approval for the Palliative Care Program became effective last month. The University's program is only the third in the nation and the first at an academic medical center to receive this level of recognition from the commission, which launched its advanced certification program in palliative care in September.

The decision is based on rigorous review last month by experts from the Joint Commission, who evaluated the program based on standards of care for seriously ill patients and their families, including symptom management, coordination of care, and communication about treatment decisions.

Palliative care provides symptom-relieving measures and added support during all stages of serious illness; the focus is on alleviating suffering and relieving symptoms of disease at the same time that patients receive all indicated medical treatments. Timothy Quill, M.D., an international leader in palliative care and head of the Palliative Care Division of the Department of Medicine, directs the program and has worked to increase the availability of palliative care to all seriously ill patients, not just those who are facing the end of life. He estimates that about half of patients who receive palliative care recover and are not terminally ill.

Overcoming old stereotypes of what palliative care constitutes remains a priority for Quill, who is president-elect of the American Academy of Hospice and Palliative Medicine.

"Drawing upon palliative care does not mean the patient or family is giving up," said Quill, who notes that one study found that people with lung cancer lived longer if they received palliative care in addition to standard medical treatment.

"Medical treatments are always an important part of the puzzle. But many patients and families are left very frustrated by an increasingly complex health care system, where a single patient might have a dozen different medical teams involved with their care. As palliative care specialists, clear communication about which medical treatments make sense to the patient and family is our procedure of choice. Clear communication itself can provide a great deal of comfort."

In the last few years, Quill and neurologist Robert Holloway, M.D., have produced a series of publications in the New England Journal of Medicine and the Journal of the American Medical Association discussing how the sickest of patients react to the prospect of aggressive medical care when their circumstances seem dire. The results are not at all predictable, they say. For instance, they have found that many patients predict that, if faced with living in a debilitated state after a severe stroke, they would not want to live "like that." But in fact, the doctors have found that when actually in the situation, many patients who were treated aggressively expressed great satisfaction with that choice and are, unexpectedly, very satisfied with their quality of life even in the face of severe disability.

Such findings at the frontier of patient care and research are routine at URMC's Palliative Care Program, which under Quill's leadership has grown dramatically. Last year, the program provided nearly 1000 inpatient consultations and more than 300 outpatient and home consultations. The program also offers a 12-bed inpatient unit, required palliative care educational experiences for medical students and residents, and a clinical fellowship program.

Quill has helped train a generation of physicians in medical schools across the country about how to work effectively with seriously ill patients. Increasing the palliative care ranks is a top priority for Quill, who says there are not enough young physicians trained in the area.

As a result of his work, URMC and its community affiliates have more than 20 board-certified physician specialists in palliative care. The team includes clinicians from a wide range of other disciplines, including nurses, nurse practitioners, researchers, medical residents, social workers, chaplains, a music practitioner, massage therapists, and a bereavement coordinator. One such expert is physician David Korones, M.D., who specializes in treating children with cancer. In a series of provocative posts currently going online for Psychology Today, Korones is discussing how he became interested and involved with palliative care.

Quill's team has received several awards for its work, including the American Health Association's Circle of Life Citation of Honor, in recognition of its community-wide palliative care and end-of-life initiatives.

"Achieving Joint Commission certification in palliative care is a major step toward maintaining excellence and continually improving the care we provide," said Quill, who is professor of Medicine, Psychiatry, Medical Humanities, and Nursing, and director of the Center for Ethics, Humanities, and Palliative Care. "We are making a significant investment in the quality of care for our seriously ill patients and their families. This accreditation helps create a culture of excellence to improve that care even further."

Contact: Tom Rickey
University of Rochester Medical Center

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