With recent focus on improving quality of life for patients with chronic diseases, better known as palliative care within the medical community, Naval Medical Center Portsmouth invited world-renown palliative care expert Dr. Thomas Smith to share his knowledge June 25.

The relatively new specialty is for patients who have a serious illness and strives to go beyond curative therapies to provide relief from the stress of a serious illness, no matter what the diagnosis. Palliative care focuses on improving each patient's quality of life - not just in their body, but also in their mind and spirit.

Smith, the medical director of the Johns Hopkins Palliative Care Unit and Program, travels around the country to speak with health care providers about the benefits of palliative care.

Dozens of NMCP doctors, nurses and social workers listened to Smith detail elements of a successful program and the research to back it up. Palliative care includes many of the elements of hospice care, but begins at the time of diagnosis, not when curative treatments are exhausted.

"There is evidence that palliative care, added alongside the usual care, really improves care," Smith said. "I grew up in oncology about 30 years ago, where there wasn't any palliative care. We had cancer treatment, and then we had hospice care at the end. Hospice care focuses on the person, spiritual growth, pain and symptom management, keeping people out of the hospital unless they really want to be there, and focus on living every day that you have. Why should patients have to wait until the last six weeks to do that? Why shouldn't we help them focus on all this at the beginning of the diagnosis?"

A typical palliative care teams include anesthesiologists, geriatric oncologists, nurse practitioners, social workers, chaplains.

The primary components of palliative care are symptom and spiritual assessment tools, pain management and education. Through assessment tools, health care providers ask questions that help solicit more thorough answers from patients about their symptoms, such as pain, fatigue, nausea and mental health. Providers then use standardized, protocol-driven methods for pain management and minimizing other symptoms. Education includes talking to patients and family members about prognosis, care options, coping with the disease, medical directives and hospice care.

"When providers use the assessment tools, patients receive more effective treatment and their symptoms are dramatically improved within 48 hours," Smith said. "When palliative care is involved, costs are reduced by 60 percent and this has been replicated in several studies. This is because patients better understand their care options, help drive their care and are selective about the care they want."

Smith said there is also a significant reduction when palliative care specialists visit patients during hospital stays. Costs are reduced by 24 percent when the patient is seen within two days and by 14 percent when patients are seen within six days.

"Depression and anxiety is cut in about half of patients, and better pain management can also change survival," Smith said. "Many patients live on average three months longer just because of pain management. When patients receive early palliative care, there is a 25 percent reduction in the death rate at one year."

The bottom line: the patient's symptoms improve, the distress to them and their family decreases and there are fewer costs associated with their care.

"Palliative care is a very important objective for the Commission on Cancer accreditation," said Lt. Cmdr. Tod Morris, department head of Hematology and Medical Oncology. "We're considered an academic cancer center at NMCP and palliative care is one of the requirements for us. We provide excellent palliative care at our hospital despite the fact that we don't have an organized palliative care service.

"We do use evidence-based practices and various scoring systems for different symptoms to ensure we are addressing the specific needs of the patient," Morris said. "We are currently rolling out a community assessment needs form and a cancer psychosocial assessment form. Our dedicated social worker in our clinic is using that resource to help with survivorship and symptom management for our patient population."

Currently, a large portion of palliative care is given by primary physicians at NMCP. According to Morris, NMCP is fortunate to have excellent internists and subspecialists who have a tremendous skillset of providing symptom management.

"For the services that are not available, we utilize local community and American Cancer Society resources and have close relationships with area hospices that help us with our palliative care needs," Morris said. "There is a tremendous amount of data that shows not only are patient outcomes better, but we will save taxpayer dollars by using services such as these in the future."

For more news from Naval Medical Center Portsmouth, visit www.navy.mil/local/NMCP/.