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Palliative Care Relieves Suffering

It's cutting-edge, old-fashioned medicine in a hightech world. That's how Lisa Mansur, MD, FCCP, refers to palliative care - the medical specialty focused on improving quality of life of people facing serious illness.

"It's a return to what we can do for the patient and not merely to the patient," she said.

Dr. Mansur, medical director of palliative care, and her team have been doing just that since they started providing their services at BryanLGH in May 2009. They have served more than 700 patients, keeping the goal of palliative care front and center: to relieve the pain, symptoms and stress of serious illness - whatever the prognosis, at any age, at any point in the illness and along with
Palliative Care 

The goal of palliative care is to relieve the pain, symptoms and stress of serious illness - whatever the prognosis, at any age, at any point in the illness and along with treatments that are meant to cure.

Learn more about palliative care at this free seminar on July 14.

treatments that are meant to cure.

Palliative care is not limited to hospice care. "It treats people with acute, catastrophic illnesses; people who've been truly failing from a chronic disease or multiple chronic diseases; people who have repetitive hospitalizations or illnesses where they're back and forth to the ICU; and people who have a new diagnosis," Dr. Mansur said. "It has been extremely helpful for folks who are 80 and over who have more than one organ failure."

Research shows that patients do better if they get palliative care early, and it doesn't negate them receiving restorative care such as chemotherapy or other therapies - it runs alongside. In addition, a new study shows palliative care not only improves the quality of life, it actually extends it.

Dr. Mansur and her two nurse practitioners, Angela Johnsen, APRN, and Kelli Schreiner, APRN, work with patients to relieve symptoms such as pain, shortness of breath, depression, fatigue, constipation, nausea, loss of appetite and difficulty sleeping. They also help to relieve suffering through emotional and family support and communication and coordination among the patient, family and doctors in order to assure needs are fully met.

"We provide anticipatory guidance," Dr. Mansur said. "It's the process of showing patients and families - or even helping them paint - the picture of where they've been and where they are right now so we can all understand where they're going."

Experts on the palliative care team may include doctors, nurses, chaplains, social workers, physical therapists and others.

"Our team is huge, and it's based on interdisciplinary teamwork," Dr. Mansur said.  "Palliative care takes a village because as we help patients and their families understand and navigate this road of decision making, it absolutely takes everybody."

Primary care physicians, as well as specialists in all areas of medicine, have been supportive of palliative care. "The hospitalists at BryanLGH Medical Center - Inpatient Physician Associates - have been great advocates and collaborators," Johnsen said. "IPA physicians and nurses recognize when patients and families need further discussion concerning goals of care as well as assistance with symptom management."

This is just what happened in Mary Bassett's case. Linda McKellar and her brother Michael Bassett came to appreciate navigational help when their 82-year-old mother, Mary Bassett, experienced acute renal failure after open heart surgery in January 2011. She refused dialysis, the treatment to replace the function of the kidneys which normally serve as the body's natural filtration system.

"It was my view that she didn't fully understand the ramifications of refusing dialysis," McKellar said. The siblings were well aware of the consequences, though. They knew death was imminent without it. In their state of uncertainty and not knowing what to do, someone suggested they meet with Dr. Mansur.

She knew it was critical to present the facts to Mary - to help her understand she was recoverable and that it was just too early to call it quits. At the same time, Dr. Mansur and the family knew it was ultimately Mary Bassett's call.

Dr. Mansur met with Mary and her children and formulated a plan upon which they could all agree.
 Nurse Practitioners Kelle Schreiner & Angela Johnsen
Nurse practitioners Kelli Schreiner (left) and Angela Johnsen use the latest electronic medical record software to stay linked to the patient's care team.

Mary Bassett assented to do one round of dialysis and counted down each treatment and the time when she would fulfill her end of the bargain. When the results did not yield machine-free kidney function, she again resolved to do no more. Her kidneys were improving, though, and medically, she still was recoverable. Dr. Mansur met with Mary and her children again to discuss the possible next treatment plan. Following thorough conversation, all agreed on another round of treatment. After that round plus additional treatments, her kidneys began functioning on their own.

"We're not here to take a side," Dr. Mansur said. "We're here to try to show patients all options. It's what I call finding the middle ground. And usually that's the best place to end up because the patient is comfortable with his or her decision, and others can work on understanding why that is."

"Dr. Mansur got through to my mom because she gave her hope - realistic hope," McKellar said. "She told her how she saw it as a doctor who works in this field. She made sure my mother understood and did so in a very professional way.

"Mom, Michael and I felt we had a strong advocate with Dr. Mansur - someone who had credibility and who was clear and strong."

Currently, the palliative care team provides services at all hospitals in Lincoln. And coordination with hospital personnel and the patient's primary care physician is key, so all are on board with the most up-todate developments and plans.

Dr. Mansur and her nurse practitioners also use the latest electronic medical record software, which helps them provide seamless, quality care and coordination with the medical team from virtually anywhere.

"Our work with the patient isn't a one-ended process," Dr. Mansur said. "It involves a discussion with the patient, family and physicians to establish appropriate goals and expectations, to talk about options and then get them on a path that is acceptable to all."

Palliative is a big word with down-toearth roots. It's derived from a word that means to hug or to blanket with care, and that's an everyday occurrence for BryanLGH's palliative care team.

For information on how you can support palliative care at BryanLGH, please call the BryanLGH Foundation at (402) 481-8605.

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