Teaching others and ourselves
Tending to gravely ill patients can take a toll on caregivers, but that skill has not traditionally been built into medical education or postgraduate training. The Robert Wood Johnson study being conducted by Block's group, for example, revealed that fewer than 18 percent of responding students and residents had received formal end-of-life care education.
Over the past decade, however, DFCI's palliative-care experts have responded to these deficits with programs ranging from academic courses to lunchtime discussions.
Ott and several colleagues, for instance, have developed an unusual course to help oncology nurses address their own needs in this emotionally and physically draining environment. Abrahm and Block offer weekly "grief rounds" to enable interns on the oncology service at Brigham and Women's to talk about their patients who have passed away. And at Harvard Medical School, Block and her husband, Andrew Billings, MD — director of the Palliative Care Service at Massachusetts General Hospital — lead a class on "Living with a Life-Threatening Illness" that matches first-year students with dying patients (see story, Medical school course seeks to train 'doctors who heal').
Joanne Wolfe, MD, MPH, of Dana-Farber pauses in the "comfort corner" at Children's Hospital Boston, which serves families facing the end of life.
Meanwhile, the pair directs an intensive annual two-week course for medical and nursing school faculty from around the country. Offered through the Harvard Medical School Center for Palliative Care, the program provides tools and support for participants to become leaders in palliative-care education and practice at their own institutions.
"Our evaluation shows that all of those enrolled experienced the course as "transformative," Block says, "and many have made dramatic career changes into palliative care as a result."
Since an estimated 40 percent of cancer patients will succumb to their disease, Dana-Farber staff members can't help but learn about end-of-life issues from those who pass through the Institute's doors. But the palliative-care teams also play a role in raising awareness about this inevitable stage of life.
"Part of our mission is to help staff face the fact that we're all going to die," says Maureen Lynch, MS, RN, AOCN, a nurse practitioner with the team. "In the end, we're really no different from our patients. They confront us every day with our own mortality."
Patients and families who've used the service appreciate the support and information imparted by team members such as Janet Abrahm.
Carolyn Cummings-Saxton, for one, remembers how Abrahm and Halporn visited her husband regularly during his hospitalization and then, when his condition deteriorated, helped locate a residential hospice program close to the couple's Nahant, Mass., home. After "Sax" entered that program, they kept in touch by phone, supporting Carolyn's efforts to care for him and cope with her upcoming loss. Cummings-Saxton believes the comfort they provided — through expert pain medication, good communication about difficult issues, and emotional support — helped prolong the life of her husband of 43 years so he could say farewell.
"His pain was overwhelming, but when he heard from the palliative-care staff, Sax knew they would take care of him," she recalls. "It gave us time to set up hospice, have more friends and family visit, and gain some closure. It was extraordinarily important for us to have that time."
