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The Future of Palliative Care with Dr. Andrew Thurston

by Eion Plenn

A soft-spoken doctor with slicked back hair, neat-rimmed glasses and dark brown eyes meets me on the oncology floor of UPMC Mercy. “He loves motorcycles,” Dr. Andrew Thurston says as we walk into the patient’s room. Darrien (patients’ real names have been changed) is propped up at 45 degrees in bed while receiving communion from the hospital chaplain. Only 35, he is the youngest patient in the cancer unit. There’s a Harley Davidson tattoo next to the bag of yellow fluids attached to his chest. Thurston says the bag is a result of a thoracoscopy, a procedure done to drain the excess fluid from the lungs due to organ damage. In Darrien’s case, it’s kidney cancer.

“I’m 125, Doc,” Darrien speaks slowly. “Last month I was 145, now I’m 125.”

“Unfortunately, weight loss is common with these things,” Thurston says. “How has your pain been?”

“Better.” Darrien adjusts his place in bed, revealing two more biker tattoos on his shoulders. Their conversation is quick—no more than five minutes—but there’s a familiarity to it, like old friends catching up. No professorial explanations of the renal system or rattling off lists of prescription meds and future scans. What Thurston and Darrien talk about is rather simple—pain management, goals after discharge and motorcycles.

Thurston is not a therapist, spiritual guru or motorcycle junkie—he is a palliative care doctor. Rather than focusing only on pathology, Thurston works to improve quality of life for patients who face a life-threatening illness and their family members.

Though palliative care has only been recognized as a medical specialty since 2006, two years after Thurston started medical school at Baylor College of Medicine, its core philosophy—symptom management and relieving suffering—has been around since the early days of medicine. In the late 1940s, British physician Cicely Saunders founded the first formal hospice, a form of treatment which provided comfort measures for patients with terminal illnesses. This was a revolutionary step in end- of-life care because physicians began to emphasize improving a patient’s quality of life, distinct from treating their illness. As the hospice movement gained momentum, a new form of care started to branch off—palliative care.

But how does palliative care differ from hospice? In Latin, the word “palliative” comes from pallium, which means to cloak. Thus, palliative care doctors “cloak,” or cover up, the symptoms of an illness without necessarily curing them. According to Thurston, “Palliative care is concurrent care. It walks alongside your regular medical manuscript—your chemotherapy, your disease- modifying therapy, your heart or lung therapy—with a focus on quality of life and individual goals and expectations. Hospice is a more specific form of care, specific for the last six months of life. Hospice is a benefit; it is a service you can enroll into or enroll out of.”

In 1990, the World Health Organization recognized palliative care as a distinct specialty which focused on improving quality of life for patients with terminal illnesses or serious injuries. According to the WHO, the goals of palliative care are to relieve patient suffering “by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” For the first time, palliative care was given its own definition in medicine.

So, what does the future of palliative care look like? At the University of Pittsburgh, it’s research. One of the up-and-coming fields, Thurston says, is palliative care in the Intensive Care Unit. The palliative research done in the ICU mainly focuses on hospital stays, using qualitative and quantitative analysis to see how palliative measures like improved communication among staff, patients and family members may positively affect patient outcomes.

In 2018, UPMC Critical Care specialist Dr. Douglass White published an article in The New England Journal of Medicine titled, “A Randomized Trial of a Family-Support Intervention in Intensive Care Units.” The trial focused on surrogate decision makers, family members who make medical decisions for their critically ill loved ones. An example is a son or daughter deciding to take their parent off life support, or a husband making the decision to transfer his spouse to hospice.

In the trial, White and his team focused on how family-support intervention (what palliative care doctors refer to as “family meetings”) may impact patient care. The results served to validate the importance of palliative techniques in health care. While the data showed that a family-support intervention did not relieve the anxiety, depression or other psychological symptoms that a surrogate decision maker may face, the surrogates’ ratings of communication quality and the patient- and family-centeredness of care improved. More so, the length of stay in the ICU for the patient shortened.

The topic of end of life care, especially in cases like the ICU, is heavy. Even today, many health care providers are uncomfortable addressing situations dealing with death. Yet, Thurston is optimistic that this will change, noting that there has been great acceptance for palliative care in his experience.

“Most people, when we are able to explain what hospice is, maybe dispel some of the myths or misperception about what it is, end up thinking that at least it’s something maybe worth trying.” The important thing to remember when conducting research, Thurston says, is to always address these most personal topics with effective communication and empathy, making the patient’s goals the nucleus of treatment.