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Innovative Honor-Providence Hospital receives award for palliative care programs in D.C.
By Debra Anscombe Wood, RN, Nurse.com
September 8, 2008
Karole Thomas (right), RN, MSN, accepts a Circle of Life Citation of Honor
at the recent American Hospital Association annual summit.
In recognition of its inventive programs to improve end-of-life care, Providence Hospital received a Circle of Life Citation of Honor at the American Hospital Association's annual summit in California.
"I was ecstatic to be recognized," says Karole Thomas, RN, MSN, director of palliative care services at the Washington hospital. "This is beyond compare and a dream, that they could see the work we are doing here and how valuable it is, and that what we are doing is making an impact on the residents of the District of Columbia."
The Circle of Life award celebrates innovation in end-of-life care and highlights programs demonstrating superior vision, depth, and scope. Presenters cited Providence's extensive history of serving an inner-city population while focusing on continuity of care in inpatient, long-term care, and home settings.
About 95% of the program's patients are black. Nationally, about 8% of hospice care is delivered to that population. "Hospice is about living until you die, but it's not something the population [in this community] gravitates to," Thomas says.
Thomas attributes the difference in percentages to the hospital's location and the staff's cultural sensitivities. The palliative care program encourages continued spiritual support from the patient's faith community, as well as providing spiritual counseling as part of the care.
A 2006 study, reported in the Journal of Hospice and Palliative Nursing, exploring the attitudes of a population of blacks toward hospice programs found this population lacks information about hospice, which results in concerns about the services, such as inadequate care; lonely and painful deaths; and high costs that would make hospice inaccessible. According to the study, hospice programs stress palliative care and acceptance of death in the terminal phases of life, whereas some blacks, as well as others in Western culture, value aggressive life-sustaining treatments.
After Thomas educates prospective patients or families that aggressive care won't change the outcome of the disease process, they are more likely to choose a plan of care that emphasizes comfort.
"The family wants to be sure that some type of care is being provided, that we are just not doing nothing," Thomas says. "They also need a lot of education regarding the disease process, and what to expect as the patient declines. Reassurance is essential."
Thomas credits several innovations she implemented since assuming her current role four years ago with helping educate people and fostering the program's acceptance in the community.
The innovations include a four-week "Breaking Bad News" series in which hospice physicians meet with internal medicine residents to discuss ways to open lines of communication with patients and families about death and to work as a team to establish care goals; a five-module caregiving support program for families taking care of loved ones in their home, which Thomas presents at hospital-associated senior centers; and a free grief recovery program, open to anyone in the community experiencing a loss. These programs help introduce members of the community to the hospital's palliative care services.
California Healthcare Foundation, based in Oakland, supports the awards. Major sponsors include the American Hospital Association, AARP, the American Association of Homes and Services for the Aging, the Catholic Health Association, the National Hospice and Palliative Care Organization, and the National Hospice Foundation. The Center for Practical Bioethics is a Circle of Life cosponsor.
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