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School of Medicine Virginia Commonwealth University VCU Medical Center
School of Medicine profiles

October 30, 2009

Thomas Palliative Care Program

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Faculty Excellence Awards – September 2009
Educational Innovation Award

“To cure sometimes, to relieve often, to comfort always,” attributed to Hippocrates.

Palliative care is care given alongside usual care, whether curative or not. It focuses on meticulous symptom assessment and relief, hones and open communication, and medically appropriate goal setting. The VCU-Massey Thomas Palliative Care Team has helped make serious illness better for many, and has led the way nationally to prove the worth of palliative care and integrate it into usual care.

In 1999 there were no palliative care programs at hospitals over 300 beds. Today, there are more than 1300. “The VCU TPC team has been integral in this national
movement,” wrote Gordon Ginder, M.D., Massey Cancer Center Director. “They wrote three of the eight curricula used by the Palliative Care Leadership Centers (PCLC) in teaching institutions how to start palliative care programs. They have trained more oncology groups
than any other leadership center in the country. In fact, the Robert Wood Johnson Foundation only agreed to allow oncology to be a ‘target for’ palliative care if the Massey Cancer Center PCLC was involved. Now they are intimately involved in developing the Veterans Administration palliative care initiative in which essentially every V.A. facility will be required to have a palliative care program.”

The Thomas team knew early-on the immense value of palliative care, allowing end-of-life patients the ability to pass in comfort, rather than under stress in an ICU/CCU. In addition to easing patients’ struggles, the Thomas Palliative Care Program was the fi rst to document the signifi cant cost savings from palliative care, proving that the cost of care for a dying patient can be reduced up to 60 percent in the last week of life. In addition, “their published graphs showing dramatic symptom improvement provides compelling evidence for the benefit of
palliative care consultation alongside usual oncology care,” said Diane Meier, M.D., Director, Center to Advance Palliative Care (CAPC).

To broaden awareness and adoption of palliative care efforts, the Thomas team has developed both Virginia-centric and national initiatives. They launched the Virginia Initiative for Palliative Care, which allows all Virginia health care professionals to receive hands-on clinical training at VCU, and also have been central to efforts to increase education and establishment of palliative care centers nationwide through the Robert Wood Johnson Foundation-funded CAPC.

“The VCU Team played an essential role in developing our eight module CAPC curriculum,” added Dr. Meier. “VCU has been instrumental in implementing the curriculum around the country.” “Of the nearly 100 programs VCU has taught through that initiative, 100% have been confi dent that that have received the training they needed and 90% have started successful palliative care programs,” Dr. Ginder added.

Beyond education, the Thomas team continues to conduct breakthrough research. They “showed decisively that better pain management could be achieved leading to better clinical outcomes and likely improved survival,” Dr. Meier continued. “Their innovative work in dyspnea management has led to the practice changing use of nebulized fentanyl for dyspnea. They also have developed several innovative ways of treating chemotherapy induced neuropathic pain, menopausal hot fl ashes and other symptoms. Their goal is to become one of the national leading research centers.”

Congratulations to the Thomas Palliative Care Team: J. Brian Cassel, Ph.D.; Patrick Coyne, M.S.N.; Carrie Cybulski, P.M.P.; Mary Ann Hager, M.S.N.; Laurel Lyckholm, M.D.; and Thomas Smith, M.D.