This is the sixth and final article in a series about palliative care.

Palliative care can help relieve troublesome symptoms of serious chronic diseases, not just when you are at home, but also when you are in the hospital. Yavapai Regional Medical Center (YRMC) in Prescott recently re-launched its palliative care program. Richard Rader, the coordinator of the palliative care program there, is a nurse practitioner who is board-certified in palliative care.

He explained, "When I get called in, I go in and meet the patient and the family. That's a key part of most palliative care programs: It's not just the patient. It's the family that's involved because when somebody in the family is sick, the whole family is concerned about him."

Rader typically spends 1-1/2 to 2 hours talking with the patient and family. He reported, "I ask a lot of questions to learn what they know about their illness. I provide a lot of information about their illness. We help in the decision-making process about what they can do next. I ask what supports them to help them get through hard times - do they have a spiritual-based practice? Family? Friends? I ask about symptom management. That's one of the key things we do. We're pain management and symptom management specialists. If someone is having a lot of pain, we can help. I helped someone recently get some relief from bone pain from their cancer." Rader noted that while about 60 percent of the patients he advises are probably in about the final six months of their lives, the other 40 percent just need help with symptom management.

The hospital uses a checklist that offers suggestions about medical conditions and circumstances that might warrant support from palliative care. For example, palliative care may help people whose cancer has spread or recurred, people with advanced chronic obstructive pulmonary disease (COPD, typically chronic bronchitis or emphysema), those who've had a stroke that has reduced their functioning by 50 percent or more, and people with advanced heart or kidney disease or another life-limiting condition.

Examples of others who may benefit from palliative care include patients who have an unacceptable level of pain for more than 24 hours, have uncontrolled and disruptive symptoms such as nausea or vomiting, have landed in the emergency room or been admitted more than once within 30 days for the same condition, or have been in the hospital for a long time without improving.

Dr. Joseph Goldberger, chief medical officer of YRMC, commented, "What we envision is that almost everyone who comes into the hospital either with newly diagnosed severe illness or life-threatening illness - or someone who's had chronic disease but is getting at that point where they are frequently being admitted for symptom control, etc. - will get a palliative care consult. A lot of patients have pain and nausea and shortness of breath and confusion and dizziness and so forth. We try to alleviate those physical symptoms, but also focus on the emotional factor, which is often under-addressed, and often contributes to the misery of the whole family." Study after study, he noted, shows that palliative care improves quality of life.

What does the future hold? Dr. Goldberger commented, "We have a hospital-based palliative care program, but my vision is that it really should be a community-based program that continues when you come into the hospital, not something that starts in the hospital and continues after you leave. Why should you wait until you're hospitalized to get this care? You may

not end up needing to be in the hospital if you're getting palliative care outside the hospital. There are obvious advantages to having the program in place in the hospital. But there are bigger advantages to having palliative care capabilities in the outpatient arena.

Palliative care is so misunderstood and sorely needed."

If you'd like more information about palliative care, the Mayo Clinic offers an article called "Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative Care" at www.mayoclinicproceedings.org/article/S0025-6196(13)00452-7/fulltext.

If you or a family member find yourself in Yavapai Regional Medical Center and would like to get a palliative care consultation, what do you do?

"Just ask your doctor," Dr. Goldberger advised.