Palliative Care

Palliative Care Training

From Mayo Magazine, Autumn 2004

Discuss palliative medicine with Robert Shannon, M.D., and it immediately becomes clear: palliative medicine is about life and not surrendering to a disease process.

Dr. Shannon looks forward to his new responsibilities as director of the palliative medicine fellowship at Mayo Clinic in Florida, a postgraduate program for physicians that welcomed its first Fellow in January 2005. Made possible by a gift from Community Hospice of Northeast Florida, the 12-month program is the first of its kind at any Mayo campus, and it will prepare physicians to become experts in end-of-life or chronic, non-curable disease care. Its curriculum will reflect Mayo's integrative approach to medicine, with requirements that include research projects and patient care rotations between Community Hospice and Mayo Clinic in Florida. Dr. Shannon will serve as a clinical mentor, as will Sherry King, M.D., vice president of Medical Services and director of Medical Education for Community Hospice of Northeast Florida.

It's an endeavor that Dr. Shannon simply couldn't wait to start. In fact, he already has goals of eventually expanding the program, to include three fellows and a consulting service that will be available to physicians throughout northeast Florida. His eagerness to launch and nurture the program is matched only by his gratitude to Community Hospice, whose generosity, Dr. Shannon says, will enrich the lives of many patients and families and give many physicians a new appreciation for the rewards of palliative care.

Dr. Shannon first acquired that appreciation during more than 20 years of practice in southeastern Minnesota, where he served as a family medicine practitioner, founding medical director of Hospice of Northfield, Minn., and as team physician to Carleton College and St. Olaf College.

"I worked with children, adults and seniors, and, through it all, I received a rare gift," says Dr. Shannon, who continues to see patients of all ages as a member of the Family Medicine and Sports Medicine staff in Florida. "I learned that it is equally important and rewarding to care for patients who are nearing the end of their lives as it is to assist in the birth process. The rewards are in creating memories and in helping people connect with what makes life enjoyable. If I can help a terminally ill patient enjoy a visit with family, or a movie or Shakespeare, I have truly accomplished something."

It often takes a multidisciplinary approach to achieve the results Dr. Shannon describes. Pain management, psychology, nutrition, even philosophy and bioethics, work together to achieve one goal: improving quality of life. Fellowship programs and other experiential training give palliative care physicians the knowledge to coordinate these diverse services and also to direct treatment teams.

And, for several reasons, a palliative medicine fellowship is a perfect fit for Mayo, says David Kostick, M.D., chair of Education at Mayo Clinic in Florida. Teamwork, a Mayo hallmark, is essential for the best practice of palliative medicine, which can involve many specialties. In addition, Mayo's emphasis on integrative medicine means that the fellowship program will make important contributions to many areas of patient care.

"As leaders in the treatment of cancer, neurodegenerative diseases and many other disorders that are incurable in certain forms, it is important for us to be skilled in palliative medicine," says Dr. Kostick. "This position will give our medical teams and students another go-to person who is up-to-date on the latest literature and issues that relate to quality of life for patients with chronic diseases. But beyond that, we're not just adding a position. We're creating a program that will offer lectures and other educational events that will benefit our entire medical staff. None of this could have happened without the generosity of Community Hospice of Northeast Florida, and we're extraordinarily grateful for their partnership."

Established in 1996 as a specialty with its own accreditation body, palliative medicine has become increasingly important because of the incremental improvements that medicine is making against incurable diseases. These advancements have necessitated a change in focus for medical professionals everywhere, says Dr. King.

"We had two ways of thinking about patients: curing them or giving them hospice care in the last year of their lives," says Dr. King. "But the line between those two approaches is blurring because we're diagnosing some incurable diseases earlier and developing treatments that extend patients' lives. That's where palliative medicine comes in. It's less invasive than acute care, but we're not giving up on controlling a disease process."

It's an approach that has taken hold at hospice programs and academic medical centers throughout the country, according to statistics from the American Board of Hospice and Palliative Medicine. Today, the United States is home to more than 50 fellowship programs in palliative medicine and more than 800 hospitals with palliative care programs. And nearly all of the nation's 3,200 hospice programs employ physicians on their teams.

What is palliative medicine?

Palliative medicine is the study and treatment of patients living with life-threatening or severe advanced illness who are expected to progress toward death. The care is particularly focused on alleviating suffering and promoting quality of life.

What are major components of palliative medicine?

Palliative medicine's many facets include pain and symptom management: information sharing, advance care planning and coordination of care, including emotional and spiritual support for patients and their families.

How do palliative medicine physicians work with other physicians?

Palliative medicine physicians serve as consultants, but they are often the principal treating physicians and may provide care at various levels. Their activities include, but are not limited to, directing treatment, prescribing medication, performing pain relieving procedures, counseling patients and families and participating on multidisciplinary teams.