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Family and Social Medicine


When is Palliative Care needed?
When patients have been diagnosed with serious illness and ...

  • Pain and other symptoms interfere in the patient's quality of life,
  • Help is needed to clarify goals of care of the patient,
  • Help is needed in end-of-life planning and decision-making,
  • Families and caregivers need assistance with bereavement and grief,
  • Children in the family are affected by the patient's illness,
  • Emotional or spiritual distress is unrelieved,
  • Problems arise from advanced illness, and
  • Disease-focused treatments are no longer helping.

Palliative care can often be provided in parallel with curative treatment. It is not necessary for the patient to be in the last days of his or her illness for these needs to be met. The transition to palliative care is a process. As the end of life approaches, the role of palliative care increases subject to patients' and families' approval and acceptance of the changing goals of care.

What does our program offer?

  • Expert treatment of pain and other symptoms of chronic illness,
  • Care of psychosocial needs of patients and families, including group and individual counseling,
  • Assistance with advance care planning, discussion of goals of care, and contingency planning,
  • Bereavement services for family members,
  • Coordinated services across the continuum of care,
  • Referral to hospice, and
  • Support for professional caregivers and staff.

Where is Palliative Care provided?
The service provides palliative care consultations in both inpatient and outpatient settings. The consultation service complements the role of the patient's primary medical service. Consultations can be requested by any one involved in the care of a patient. The consult team will provide ongoing follow up in the inpatient, outpatient, and home care setting, as well as referral to hospice. We will continue to work with the patient's primary medical service to maintain continuity of care. Patients requiring acute palliative care, needing multiple or complex interventions, will be eligible for admission to the hospital palliative care unit. The inpatient palliative care unit is projected to open in late 2002.

Other Services
The Bronx Community Palliative Care Initiative (BCPCI), which functions in coordination with the PCARE Service, will offer community-based service to identify patients with significant palliative care needs early in the trajectory of their illness and provide palliative care services under the leadership of local palliative care coordinators (PCC).

The PCARE program also has an HIV PCARE team to provide support and care for patients and their families with HIV throughout the Montefiore Medical Center Network.

The PCARE service conducts educational activities to promote the knowledge and skills of healthcare providers throughout the Medical Center and at all community-based affiliated sites. These activities have as their goal the enhancement of care to patients with progressive, incurable illness across the continuum of care. This includes a program of lectures to attending physicians, nursing, house staff and social workers, participation in grand rounds, and the opportunity for professionals to develop experience with the service on elective rotations.

Current research focuses on identification of the needs of our patient populations and needs of the community surrounding our service delivery locations as well as continuous monitoring of the impact of the PCARE service on clinical outcomes.