Chances are every one of us know someone who is living with a chronic, life-limiting illness that cannot be cured. According to the Center to Advance Palliative Care, approximately 90 million Americans are living with progressive illnesses. Heart disease, cancer, stroke, diabetes and Alzheimers disease are the most common.

Even though there may not be a cure for many of these chronic illnesses, there are numerous treatment options to help each person to live their best life possible. During this stage of life care not cure the focus is placed on quality of life, symptom management and pain control, rather than continued medical tests and treatments that aim to cure the illness. This type of supportive care is called palliative care.

Understanding and meeting the physical, emotional and spiritual needs of those living with chronic and life-limiting conditions is the focus of palliative care. Palliative (which means to relieve or soothe) care is specialized care for those living with a serious issue. Palliative care improves the quality of life for both the patient and their loved ones.

Palliative care concentrates on reducing the severity of chronic or progressive disease symptoms rather than striving to halt or reverse the disease when curing the illness is not an option. The palliative care team, which includes physicians, nurse practitioners, nurses, social workers, dietitians, pharmacists and spiritual leaders), educates patients and families about treatment plans and goals while addressing and supporting their physical, emotional and spiritual wishes. This helps patients maintain a good quality of life and can improve a patients ability to tolerate ongoing medical treatments.

Palliative care is not hospice or end-of-life care but can include aspects of hospice care, such as decisions regarding long-term pain control, death and dying, and other end-of-life related issues and assists in the transition to hospice, when appropriate.

Emmalee Kennedy, M.D., is the medical director of Northern Arizona Healthcares (NAH) Palliative Care Program. She is part of a team of compassionate medical providers at NAH, Northern Arizona University (NAU and other regional health care organizations who are working to educate health care providers, caregivers and the community about the benefits of palliative care.

As physicians and healthcare providers, our goal is to cure sometimes, to relieve often and to comfort always, Dr. Kennedy said. When a cure is not possible, palliative care is there to provide support and care for the patient and their loved ones. It is important for people to know they dont have to suffer just because they have a chronic condition or life-limiting illness. Palliative care provides a team of caring experts who can help each person live life to their fullest potential each day.

New national and state palliative care protocols mean better patient-centered care

One of the newest developments in palliative care is on the administrative side rather than the treatment side.

To bring clarity about the patients wishes and ensure consistency of treatment, a medical form is being implemented nationwide: Provider Orders for Life-Sustaining Treatment or POLST. In Arizona, the form and new protocols are termed AzMOST or Arizona Medical Orders for Scope of Treatment.

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Dawn Rivas, M.S., R.N., is a doctoral student and the interim assistant director and assistant clinical professor at NAUs School of Nursing. She and Dr. Kennedy are currently members of the AzMOST task force and are working in conjunction with other state leaders to develop and implement a POLST/AzMOST program in Arizona. At present, Flagstaff Medical Center has a POLST pilot program, which is the only such program in the state; other communities are currently looking to start POLST pilot projects of their own.

POLST and AzMOST provide continuity of care across settings of care with a goal of increasing patient quality of life and improving patient satisfaction, Rivas explained.

POLST/AzMOST improves the quality of care and quality of life for chronically ill patients by creating a process that asks about, documents and honors a patients wishes for medical treatment. The patients medical orders and desires are known and carried out without requiring a new set of orders every time the patient needs medical care. All healthcare professionals must adhere to the physician-signed medical order regardless of where the patient is receiving care or who is providing the care.

The new forms and protocols centralize information on these issues, improves record keeping and transfers appropriate information between healthcare professionals and between care settings. Information includes the patients diagnosis, prognosis and desires regarding medical and life-sustaining treatments and interventions, as well as general orders about what level of invasive treatments (such as a feeding tube) a patient would consider if their condition worsened. Depending on the patients preferences, the form may also include orders for do not resuscitate, do not intubate and other life-sustaining treatments.

The forms should be printed on bright pink paper so care providers can identify them in the case of an emergency. (Do Not Resuscitate or Pre-Hospital Medical Care Directive forms are printed on orange paper.) At home, these forms should be kept where easily seen, such as on the refrigerator, or with other quickly accessible medical and legal forms.

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Palliative Care: When cure is not an option - Arizona Daily Sun