1. City of Hope: Bed Side Learning Experiences演題 35
City of Hope: Bed Side Learning Experiences
Kawata. Y1 Shirane. S1 Tsuzuki. K1 Nakahara. K1 Yazaki. T1 Yamamoto. H1 Sakamoto. Y2
1)Dokkyo Medical University 5th grade 2)Division of Language and Humanities, Premedical Sciences
Introduction
We participated in an Overseas Training Program for 2 weeks to City of Hope(COH) and learned new ideas about palliative care. COH is a National Cancer Institute and known for its excellence in cancer treatment, research, prevention and education. This poster focuses on the role of palliative care teams, how they perform these ideas and it explains some of the merits and features of this system compared with Dokkyo Medical University Hospital’s approach to palliative care.
The Art of Medicine
Changing the Idea of Palliative Care
WHO defined Palliative Care as:
An approach that improves the quality of life of patients and their families facing the problem associated with life- threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems,
COH credo: There is no profit in curing the body, if in the process, we destroy the soul.“
Studies report that good mental-body-connection prolongs
life.
Ref: Holt-Lunstad J, et al. PLoS Medicine 2010; 7: Ref: Spiegel D, et al. Cancer 2007; 110:
Possible causes Immunologic and Stress catecholamines
To actualize supportive care,
many people work alongside doctors, they include nurse practitioners, psychiatrists, psychologists, child life specialists, chaplains, and clinical social workers.
To get better outcomes,
supportive care is managed by teams.
physical and spiritual.
Improved survival ( mos. vs. 8.9 mos., p<0.02) Ref:Temel et al. Early palliative care for patients with non-small-cell lung cancer NEJM2010;363:
(Figure.1)
Approach to Supportive Care
Social Workers
Role:
Manages the patients transition into treatment programs:
Palliative Care Physicians
Role:
Communicating bad news to patients and their families.
Explaining to patients and their families the process of treatment.
Managing patients chief complaints (i.e. pain, fatigue, depression, anxiety, etc.).
Interview patients and assess major complaints and anxiety levels.
Introduce facilities and offer programs for coping with
complaints and anxieties, i.e. Couple Coping, Tai Chi, etc.
Help patients and families with practical and emotional concerns.
(Figure.2)
Case 2
Male patient suffering from AML. After remission-induEctction therapy, his disease recurred. He felt distress which was…managed by the doctor. After, the doctor recommended a bone marrow transplantation, later a donor was found and transplantation was scheduled.
Case 1
A 29-year-old woman underwent rectosigmoid colectomy and had a colostomy. Her major complaints were stomy leakage and infection causing her depression. In addition to this, there were no relatives to support her. A social worker talked with her and assessed her mental condition, reported this to her psychiatrist, who was able to treat her depression.
Notices:
This approach differs from Japan, where doctors don’t have such a close relationship or are able to comfort patients. Here the doctor- patient relationship is mostly one sided where patients just obey what the doctor recommends. We felt in COH that the doctor- patient interactions are a 2 way street bringing patients closer to their doctors.
Notices:
Social workers act as a good mediator between doctors and patients. They alleviate a patient’s emotional condition and improve the quality of doctor- patient interaction.
Discussion
We were introduced to a new model of supportive care at COH. The USA offers advanced technologies and new cancer therapies. There is gap in human resources between the COH and Dokkyo Medical University Hospital(DMUH) in providing care services. We refer to 3 points:
employed to help patients with their emotional needs, addressing these needs improves patients quality of life. In Japan because medical payments are decided by the government, professionals such as, child-life specialists, patient navigators, etc. are not included in the medical system. At DMUH, there is a difference in the practice of team medicine. Doctors manage patients from hospitalization to discharge, whereas in COH other professionals support the doctors and help the patients to be discharged earlier.
With the combination of human kindness and care provision along
with improved medical technology a better art of medicine can be achieved. We conclude better outcomes and quality of life can be realized when varied professionals are able to work together as a whole team.
Mental-body-connection prolongs life, this is a fundamental belief in COH, care teams provide this benefit.
There are many professionals within the COH medical system.
(i.e. Nurse practitioners, Child life specialists, etc.)
In COH doctors have been better trained in all manner of communications, also other specialists are integrated providing patients with whole-person care.
These 3 points may change the patients outcome. In COH not only physicians care about patients anxieties, other professionals are
Address of Gratitude
We thank all the people who were involved this in Overseas-Training-Program, especially, Dr. Matthew Loscalzo, Ms. Becky Andrews, all the staff of COH and the Overseas-Training-Program-Committee members who gave us with this opportunity. Everything we experienced for the 2 week observation will be valuable for our futures as doctors.