31 October 2006

U.S. Philanthropy Boosting Training in Palliative Care

End-of-life treatment begins with communication, U.S. trainers say

By Kathryn McConnell
Staff Writer

Washington -- U.S. philanthropy is supporting efforts to help health care providers in Jordan, Mongolia, Moldova and Georgia learn how to improve the treatment they give to patients who suffer from a life-ending disease.

U.S. palliative and hospice care specialists Frank Ferris and Mary Wheeler are at the center of these efforts, supported by funding from individuals and foundations in the United States. (See related article.)

Hearing about Ferris' specialty, health care leaders in each of the four countries asked the San Diego-based physician to come to their nations to help them gain a better understanding of how to make a long-term illness and often painful dying process more comfortable for patients and their families.

Palliative and hospice care involve a range of health care specialists including doctors, nurses, social workers, home care providers, administrators, pharmacists, clergy and volunteers. Palliative care is the broader term, focusing on the relief of suffering at any time during the illness. Hospice is a component of palliative care that also focuses on the relief of suffering, caring for the patient and family during the latter stages of the illness.

Ferris' first request for training was from Jordan in 2001. Training requests from the other three countries followed. Wheeler joined Ferris as a trainer in 2004.

Ferris works at San Diego Hospice and Palliative Care. Wheeler is a specialized "advanced practice nurse" at Capital Hospice in Virginia.

Both nonprofit care centers rely on private donations to support their operations. Each organization allows its staff specialist to travel to countries to provide the needed training.

Each also helps selected health care providers and administrators from other countries travel to the United States and spend clinical time at their programs to learn about effective palliative and hospice care practices.

TEAM APPROACH TO TREATMENT

The specialists provide most of their international training at the bedside, instead of in classrooms, advocating a multidisciplinary "team approach" to providing assistance. This method of teaching gives health care providers the opportunity to overcome their "uncertainties and discomfort" as they begin to treat people who are nearing the end of their lives, Wheeler said.

Using an initial grant from an anonymous donor, Ferris and Wheeler developed their training model taking into account traditional approaches to medical treatment based on personal, cultural and religious values.

EFFECTIVE TREATMENT BEGINS WITH COMMUNICATION

Ferris and Wheeler said key to their approach is effective communication: helping health care workers feel comfortable asking patients to tell them about the intensity of their pain and what they need to be comfortable.

They said communication also involves helping patients' families describe what they need as they struggle to meet the time, physical and economic demands in helping to provide a dignified death process for their loved one, and their need to make appropriate post-death plans.

Countries wanting to improve care systems for the dying need appropriate policies that allow for the best care, Ferris said. That includes allowing for the legal manufacture or import of pharmacist-physician monitored opiates proven most effective in relieving severe, chronic pain, he said.

Ferris' and Wheeler's efforts in Jordan have led to the expansion of its King Hussein Cancer Center into a hospice and palliative care center unique in the Middle East region, they said.

The center's staff includes two physicians who participated in the San Diego Hospice Medical fellowship program, and two nurses who spent a month at patients' bedsides with staff from Capital Hospice. These clinicians, have been joined by 23 additional nurses, a social worker, a clinical pharmacist and the country's first chaplain devoted to working with terminally ill people.

The majority of palliative care patients in Jordan suffer from cancer -- primarily, breast, prostate and colon cancer -- identified most often in its later stages because of a lack of cancer awareness programs, Ferris and Wheeler said.

CANCER AWARENESS

The U.S. National Cancer Institute (NCI), part of the Department of Health and Human Services, has recognized the need for research, education and training to improve palliative care and the importance of improving communication strategies.

Addressing the lack of cancer awareness programs in the Middle East, U.S. Under Secretary of State Karen Hughes October 31 helped launch a breast cancer awareness program in Abu Dhabi, United Arab Emirates. Hughes was joined by Nancy Brinker, founder of the Washington-based Susan G. Komen Breast Cancer Foundation.

President Bush praised the dedication of U.S. health care professionals who provide comfort to people in their last days of life by designating November as National Hospice Care month.

Hospice care workers are "helping build a society that values the life and dignity of every person," according to an October 31 White House proclamation.

Bush also said the United States during November will recognize people who suffer from devastating Alzheimer's disease -- a common form of dementia -- and family members who provide daily care for their sick loved ones.

Earlier in October, Bush proclaimed the month as National Breast Cancer Awareness Month.

Bush's proclamations recognizing hospice care providers, Alzheimer's disease, family caregivers and breast cancer awareness, are available on the White House Web site.

For more on U.S. philanthropy, see "American Private Giving Outpaces U.S. Government Aid, Report Says."

For more on U.S. policy regarding health care issues, see Health.