Mobile Palliative Care Teams Hit the Road

Anne Walsh, one of three certified palliative care nurse practitioners on the team, said that patients often get overwhelmed with multiple providers in their home, and there can be a real or perceived duplication in services. Many patients with life-limiting illness receive the services of a 24-hour home health aide through Medicaid, but the registration process can be lengthy.

Ms. Walsh highlighted one of the program's success stories: a 77-year-old man with stage IV lung cancer who was undergoing daily radiation and was referred to the team for pain and symptom management as well as psychosocial support. Despite being on 10 different medications (including 10 Percocets per day), the patient rated his pain at 10 on a 10-point scale. He refused to contact relatives despite being unable to care for himself. “He was very proud of his independence,” she said.

The team changed his pain management regimen so that his pain score dropped to 3, and and worked with his insurance plan to get home care. They had him fill out a health care proxy form, and contacted his daughter. Ultimately, he moved to an inpatient hospice unit.

Ms. Walsh noted that a recent systematic literature review of 33 studies showed that although most patients with terminal cancer prefer home palliative care, most die in an institution (Oncol. Nurs. Forum 2009;36:69–77).

None of the speakers disclosed any relevant financial relationships.

“Each referral is unique,” said Dr. David Wollner, head of palliative medicine for Metropolitan Jewish Health System, New York. © NORMAN Y. LONO, 2009