Virginia Commonwealth University - Massey Cancer Center
Virginia Commonwealth University - Massey Cancer Center is a national leader in palliative care and has had a longstanding commitment of providing care to the un- and underinsured.
Integrated within VCU Medical Center, the palliative care program is one of six programs – and the only public hospital – designated as a Palliative Care Leadership Center (PCLC) by the Center to Advance Palliative Care (CAPC), a national organization for palliative care resources and training. PCLCs are exemplary sites in the U.S. that offer palliative care training and mentoring to other programs.
VCU’s Thomas Palliative Care Unit is an 11-bed dedicated unit that provides a focused environment for meeting patient care, research, and teaching goals. Dedicated units are a rare find for any palliative care program; not all hospitals invest in full-time staff and space for these services. Patients admitted to the unit benefit from the concentrated effort of the palliative care team, which includes physicians, advanced practice nurses, social workers, therapists (physical, occupational, and music), pastoral care staff, and volunteers. In addition to managing pain and symptoms, the unit focuses on patients’ psychosocial needs. For instance, there is a kitchen where staff and families cook comfort food like soup and cookies whenever the mood strikes. Pets are welcome, and there is a liberal visitation policy.
The team sees many more patients than are actually admitted to the unit. “Sometimes we can address the patient’s needs quickly, and they don’t need to be admitted; for example, adjusting their pain medications or meeting with the family and having them determine that hospice care is most appropriate. Sometimes, we simply don’t have beds available in the unit, and it’s a matter of who has the greatest needs,” explains Pat Coyne, clinical director of the unit.
VCU supplements its inpatient model with a consult service in which the palliative care team consults with patients throughout the hospital. Upon initial referral, a palliative care team member - usually a program fellow or advanced practice nurse - will contact the patient’s attending care team and visit with the patient and family the same day. Members of the consult team provide advice on the best ways to alleviate symptoms such as pain, difficulty breathing, nausea and vomiting. The team may suggest appropriate interventions and help clarify the goals of care. The service also helps patients and families plan for and manage issues that arise when coping with a life-limiting disease. Patients requiring aggressive symptom management may be transferred to the unit or treated by the consult team in other settings.
After thousands of consults, the program now helps patients very early in the disease process. The team works with the emergency department to manage symptoms, enabling many patients to go home comfortably without ever being hospitalized. VCU also offers a weekly palliative care outpatient clinic to address the concerns and needs of patients after discharge. The program does not offer homecare but collaborates with area homecare agencies.