FINDING PEACE through the end

October 31, 2014

Let’s face it: Regardless of advances in medicine, technology and treatment, we have not discovered the key to living forever. In recent years that realization has launched a national dialogue on improving the care for patients who are approaching the end of life. And it’s why Providence Health & Services recently launched the Institute for Human Caring, which will enhance care and quality of life for patients and families across the five states with Providence facilities, as well as serving as a national resource for clinicians, researchers and policymakers.

Based at Providence TrinityCare Hospice in Torrance, the Institute will be led by Ira Byock, MD, as chief medical officer. “There really is a public health crisis in the way we die,” Dr. Byock says. “Simply put, many people die badly, being treated in ways they would not have wanted during the last days of life. When patients are faced with a life-threatening condition, the reflex is to bring medical treatment to bear without considering that there is a whole human being who has personal needs.”
Those needs include: support in making difficult decisions; expertly managing symptoms such as pain, constipation, fatigue; assessing the wellbeing or stress of the person’s family; educating and supporting caregivers; and extending spiritual care. “Medical advances are wonderful, but medicine still hasn’t made one person immortal,” Dr. Byock says.

“The health care industry, as a whole, is hungry for clear leadership and vision in caring for patients through the end of life. Providence has seized the opportunity.”
   —Dr. Ira Byock

Finding Peace Through The End

Central to the Providence Mission is “creating healthier communities, together.” The academic focus of the Institute is on how to recognize and foster healthy community behaviors around the realities of illness, dying, caregiving and grief. Different cultures may value different things.

“We need to find out what’s important to this patient at this inherently difficult time,” Dr. Byock says. Treating the whole person doesn’t happen unless “we know who you are and what your cultural and personal values are. The best care has to be personalized for each individual.”

Care for people nearing the end of life should center on the concept of healing—arriving at a more peaceful place before the time of death, says Glen Komatsu, MD, chief medical officer of Providence TrinityCare Hospice and medical director of TrinityKids Care.

“We see people die badly when health care providers are singularly focused on curing, not healing,” says Dr. Komatsu.

“People tend to use the terms interchangeably, but there is a difference between curing and healing. Patients want the injury fixed, the illness eradicated. Unfortunately, all diseases cannot be fixed. But healing, a much more transformative phenomena, is always possible. People who are dying can be healed even though they cannot be cured.”

Patients and families have the inner capacity to “heal” even at the far end of life, he suggests. “People heal themselves if caregivers provide the conditions for the healing to occur.”

Providing the conditions can be as simple as offering patients the full range of op­tions—not just the best disease treatments technology has to offer but also the option of palliative or hospice care.

“If we care for people in this way, caregiving is a more gratifying experience for us, the health care providers, as well as the patient,” he adds. “This mitigates against compassion fatigue, and we are more whole ourselves as caregivers.”

Before assuming his current role, Dr. Komatsu had been a neonatologist at Providence Little Company of Mary Medical Center Torrance. “I was drawn to that field because of the high stakes of that kind of medicine. But I began to realize that often treatment was being undertaken without any real regard for physical, psychological and spiritual pain.

This interest in the relief of suffering as a fundamental goal of medicine led him to change fields, accepting a year-long fellowship at Harvard to study palliative care before returning to Torrance. “Interest in this type of care has exploded in medicine and the public in the past 10 years,” Dr. Komatsu says. 

“Most medical centers, health plans, payers and health care reform advocates are very interested in palliative care,” he explains. “Providence, as a system, has embraced palliative care as a signature service that differentiates Providence from other health systems and brings our Mission to life.”

The need to improve care for patients we cannot cure also extends to pediatric services, says Terri Warren, executive director of Providence TrinityCare Hospice and TrinityKids Care, which opened in 2001 and is the largest pediatric hospice in California. “There are children living with terminal conditions,” Warren says. “They needed a version of hospice care tailored to their unique needs. We couldn’t walk away from that challenge.”

Unlike a traditional hospice program where lifesaving medical treatment is discontinued, at TrinityKids Care children can receive hospice-style care while continuing treatment. “There are a lot of organizations that provide hospice care. But at Providence our core values of respect, justice, compassion, excellence and stewardship, inspire all the work done—not just at the organizational level but at the human-caring level,” Warren says.

But it can be tough to promote “end-of-life care” as a vital medical service. “Doctors and other health care providers are human; we don’t want to see patients die,” Dr. Byock says. “The natural tenden­cy when treating a seriously ill patient is to ramp up the medical treatment. But it comes down to a length-of-life versus a quality-of-life issue.”

Part of the Institute for Human Caring’s mission will be to help the entire Providence system move more fully from talking the talk to walking the walk. 

“We get there by paying attention to the patient and their family. Are they satisfied with treatment? Was the patient’s dignity preserved? Was their pain managed? Did somebody ask about their fears? Did somebody ask about their spiritual wellbeing?” Dr. Byock says.

Providence Little Company of Mary Medical Center in Torrance has been recognized for asking all the right questions. In April the center was surveyed by The Joint Commission and was awarded Advanced Certification for Palliative Care, the first program and health system in Southern California to be recognized. 

“The health care industry, as a whole, is hungry for clear leadership and vision in caring for patients through the end of life,” Dr. Byock says. “Providence has seized the opportunity to redesign health care around the whole person and stands as a national example for what health care organizations can achieve.”

Dr. Byock is visiting programs across Providence’s five-state network to see what already is working well within Providence centers and programs, with an eye toward opportunities to extend innovative and effective approaches system-wide. He thinks of his research as listening to and learning from other caregivers and likens himself to Johnny Appleseed. “I’m collecting seeds to carry elsewhere.”

The institute is in the process of hiring researchers and program managers, and developing staff and infrastructure. “It will be a small staff with a synergy that makes the whole greater than the sum of its parts,” he explains.

He continues, “None of this is particularly expensive or esoteric. It’s the basics of human caring. With this approach, it’s more likely that people’s preferences for care will be known and respected, and that there will be fewer unwanted final days spent in an intensive care unit. Families will have the opportunity to spend precious remaining days together, completing their relationships. That’s entirely consistent with top-quality care.”