Finding Palliative Care, Near and Far

In the Washington area, palliative care is available at many hospitals; some hospital programs also serve outpatients and nursing homes. Several local hospices offer palliative care as an alternative for patients who are not yet approaching death.

The Web site of the Center to Advance Palliative Care ( http://www.getpalliativecare.org) identifies hospital-based programs by state. The National Hospice and Palliative Care Organization's Web site ( http://www.nhpco.org; click on "find a provider") also has information on palliative care options.

Here are some examples of palliative care programs at Washington area hospitals.

· At Georgetown University Hospital's Lombardi Comprehensive Cancer Center, Andrew Putnam's palliative care team sees patients in the hospital and in outpatient clinics. Some patients will fully recover; others will need more care as they near death. "When we walk in, it doesn't mean that we aren't going to treat your cancer anymore," said Putnam. "But it means that here is someone who is going to concentrate on and focus on your quality of life. We've got more knowledge about pain medicines, nausea, vomiting, constipation. . . . We've got more weapons in our armament for the symptoms than the oncologist does."

Patients elsewhere in Georgetown University Hospital have access to a palliative care consulting service operated by Capital Hospice. Capital has helped set up similar programs at several area hospitals and nursing homes.

· Since Sibley Memorial Hospital set up a palliative care service in November, acceptance has grown. "We don't want palliative care to be the booby prize [for patients]," said Christine Butler, a nurse practitioner who helps coordinate care. Other staff doctors, she said, have seen that the palliative team can manage symptoms and handle difficult conversations with families in distress. The team gets referrals from departments throughout Sibley, including the ER and the ICU.

· Providence Hospital began offering palliative care 20 years ago, well before the national trend took off. Karole Thomas, a palliative care nurse with a background in cancer care, said the team originally focused on patients close to death. But now palliative care specialists see patients closer to their initial diagnosis, as is often the case with larger, better-established programs. Thomas sees patients in the hospital, in the outpatient cancer infusion center and at the nursing home on the Providence campus.

· Holy Cross Hospital's program underwent some major changes last fall when Barbara Supanich arrived to turn a nurse-run service into a physician-directed one. "We want to be blending good palliative care with curative care," Supanich said. She also coordinates when necessary with Holy Cross's hospice.

-- Joanne Kenen