As residents, most of them will be called on to lead such meetings, which are difficult even for seasoned physicians, Quest concedes. Family meetings will come to you over and over in your career. Quest has spent her career perfecting the language she uses to converse with families, and teaching others how to do the same.
She became interested in palliative care after graduating from medical school at UC—San Francisco and realizing that no one had versed her in how to tell someone that their family member had died. Quest started the first palliative care service at Grady Hospital in and is director of the Emory Center for Palliative Care, formed in to integrate palliative care across Emory Healthcare and its affiliates, and to foster research in the field. Numerous studies have pointed to better outcomes for patients under palliative care—they often undergo fewer aggressive and expensive treatments, yet have longer survival times.
In one three-year study at Massachusetts General Hospital, advanced lung cancer patients were randomly assigned to either standard oncology care or standard oncology care and palliative care. The palliative care patients had fewer symptoms of depression and a 2. Palliative and hospice end-of-life care are slowly making inroads as medical centers look to reduce costs in the wake of health care reform.
The field began forming in hospitals about 20 years ago and became an official subspecialty of medicine in Still, confusion persists. Palliative medicine is integrating into the fabric of medicine, Quest says. Nursing, social work, and chaplaincy have already embraced palliative care concepts, and even emergency departments are using palliative care services. Emory, for example, began screening all cancer patients who come into the ED for palliative care needs in One group is holding a "family meeting" with the wife and son of a year-old man who suffered cardiac arrest and whose condition is declining.
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First-year residents often hedge. Another group must ask the family if they want to institute a do-not-resuscitate order. One student starts to say, "What do you want us to do if…" and then backtracks, having already been advised by Quest to avoid that phrase, as it has no context.
