We had the privilege of sitting down with Dr. Kristin Keefe, an expert in the field of palliative care, who generously shared her insights and knowledge. In this informative Q&A, we explore the fundamental aspects of palliative care, including its goals, qualifications, settings, and the critical distinctions it holds in comparison to other forms of medical care, such as hospice care.
What is palliative care?
Dr. Keefe: Palliative care is a specialized approach to healthcare that focuses on improving the quality of life for individuals facing serious illnesses or conditions, especially those that are life-limiting or life-threatening. The primary goal of palliative care is to provide relief from the symptoms and suffering associated with these illnesses, rather than aiming to cure the underlying disease. Importantly, it takes into account the physical, emotional, psychological, and spiritual needs of patients. This means addressing not only physical symptoms but also addressing the emotional and spiritual well-being of patients and their families.
Who qualifies for palliative care?
Dr. Keefe: Palliative care is appropriate for anyone at any age suffering with a serious disease such as cancer, cardiac disease, stroke, Parkinson’s disease, respiratory disease, AIDS, kidney failure, and more.
Where is palliative care delivered?
Dr. Keefe: Palliative care may be provided anywhere a patient lives, such as their home, an assisted living facility, nursing home, hospital, or rehab.
How does palliative care differ from other forms of medical care, such as hospice care?
Dr. Keefe: Palliative care can be provided alongside curative treatments and is not limited to end-of-life care. It can be initiated at any stage of a serious illness and is not dependent on a specific life expectancy. Hospice care, on the other hand, is a specific type of palliative care that is typically provided in the last stages of a terminal illness, when curative treatments are no longer effective or desired.
What are the primary goals of palliative care?
Dr. Keefe: Palliative care teams work in collaboration with a patient’s other doctors to alleviate pain, discomfort, and other distressing symptoms such as nausea, shortness of breath, fatigue, loss of appetite, anxiety, difficulty sleeping, and depression. It also helps patients gain strength required to tolerate medical treatments and manage their daily lives. The goal is to improve the patient’s overall quality of life, enabling them to live as comfortably and meaningfully as possible.
Who are the members of a palliative care team?
Dr. Keefe: The care team often involves a multidisciplinary collection of healthcare professionals, including doctors, nurses, social workers, chaplains, and others who work together to provide comprehensive care.
How does palliative care involve and support the patient’s family?
Dr. Keefe: Effective communication is crucial in palliative care to ensure that patients and their families fully understand their medical condition, treatment options, and prognosis. This facilitates shared decision-making. Palliative care also extends support to the families of patients, helping them cope with the stress and challenges that often come with caring for a loved one with a serious illness.
How does palliative care respect and address the cultural and ethical beliefs of patients and their families?
Dr. Keefe: The foundation of palliative care is to understand the whole person, not just their illness(es). I love learning a person’s story, which includes an in-depth discussion about their psychosocial, culture, spirituality, and religious beliefs and how these beliefs influence their medical decisions and their life in general. It is essential to learn how an individual defines their autonomy and quality of life. Understanding any barriers to health care by discussing various social determinants of health is paramount. After getting to know each other, it is easier to address many ethical topics that may and frequently arise over time, as a person becomes more frail from their progressive illness. Selected discussion topics include advanced care planning, the use of life sustaining treatments, as well as medications, like opioids, to manage poorly controlled pain and shortness of breath. The ultimate goal is to never cause suffering. This also requires an understanding of the landmark court cases that have established legal precedent regarding withdrawal of life sustaining treatments.
Dr. Kristin Keefe, MD
Dr. Kristin Keefe graduated from Dartmouth Medical School and went on to complete her OB/Gyn residency at Brigham & Women’s- Massachusetts General Hospitals, followed by a 4-year fellowship in gynecologic oncology at the University of California at Irvine. She has held teaching positions at Dartmouth, Tufts, University of Texas School of Medicine, and Brigham & Women’s/Faulkner Hospital and is widely published. Over the past 14 years, Dr. Keefe has served as Medical Director and CMO of hospice programs in Massachusetts, as well serving as Director of palliative medicine programs at Steward Heath Care in Boston, Seton Family of Hospitals in Austin, and most recently at Sharp Rees-Stealy Medical Group in San Diego, California.
Dr. Keefe’s interest in palliative care began with her father’s diagnosis of pancreatic cancer. She now enjoys facilitating discussions devoted to aligning patient’s goals with available medical.