Palliative care is sometimes misunderstood. Essentially, it is a medical specialty that focuses on symptom management to provide comfort and relief. Whether it’s in the context of serious illness or at the end of life, palliative care helps patients and families transform every moment, making life the best it can be at a difficult time.
Bridget Grindahl of Fargo, North Dakota, can provide a great personal example of the benefits of palliative care.
Her treatment for cancer included a stretch of 25 days in the hospital in the care of an oncology team and also a palliative team. The palliative care team was led by Kallie Wennerberg, a nurse practitioner at Sanford Broadway Medical Center.
Grindahl needed help with her pain. Wennerberg provided it, showing up every day.
“Pain management was the biggest part of the journey for me at the time,” Grindahl said. “My life was unbearable. It consumed everything. When I was able to manage that pain better my whole life was more manageable.”
There were several hospital stays around the 25-day visit. Each time, Wennerberg would talk to Grindahl’s nursing staff and communicated what was needed and how they should deliver it. Communication with her colleagues and Grindahl herself were vital parts of the overall treatment plan.
“We’d always use a sliding scale between one and 10 – where is the pain at?” Grindahl said. “Kallie would explain to me about paying attention to the level of pain and how fast it was increasing. It was a great education.”
How palliative care works
There are many examples within Sanford Health of patients whose lives were better because of the work done by people like Kallie Wennerberg and colleagues like Melanie Fylling, a nurse practitioner in palliative care for Sanford Health in Fargo, North Dakota.
Fylling began her career in health care as a paramedic. She advanced to nursing and then kept going. While doing research during her doctoral studies, she “fell in love with palliative care.”
Over the last five years she has come up with what she calls “a two-minute elevator speech” that explains her profession to those who ask.
“Our goal in palliative care is to help our patients enjoy life while living with a difficult diagnosis,” Fylling said. “We help with symptom management, navigating difficult conversations and offer an extra layer of support. We follow patients while they are seeking some sort of active treatment and can follow for many years if needed."
We asked Fylling to share some common questions and answers about palliative care.
What is palliative care?
Palliative care helps people with serious illnesses live better and can make a big difference for patients and their loved ones.
Palliative medicine is provided by a team of doctors, nurses and other specialists who work together with a patient’s existing care team to provide an extra layer of support. It is available to patients of any age at any stage of a serious illness and can be provided alongside curative treatments.
“The main focus of palliative care,” Fylling said, “is to improve quality of life for those living with a serious illness.”
How is palliative care different from hospice care?
Palliative care is broader in scope than hospice care, which is specific to end-of-life care. More accurately, hospice is a specialty within palliative care.
“Oftentimes people believe that palliative care and hospice care are the same,” Fylling said. “With palliative care, a patient can be seeking aggressive and curative treatment at the same time. When a patient elects for hospice care, they are no longer seeking curative treatment.”
Any patient with a serious illness can receive palliative care as part of an overall treatment plan.
“You could view palliative care as being part of an overall care team,” Fylling explained. “It doesn’t have to be a situation where someone has to decide, ‘Should I bring palliative care in?’ It can be part of a collaborative plan.”
When is it time to seek palliative care?
There is not one set of specific symptoms or a particular diagnosis that means it is time for palliative care. More effectively, patients and those close to them can assess their treatment and see what elements of palliative care may help them.
Palliative care at Sanford Health helps people who:
- Require symptom management collaboration
- Need help with advance care planning
- Have been admitted to the hospital three or more times in the past year due to chronic health issues
- Have recently made multiple emergency room visits
- Are living with a serious illness
- Have declining health
“Essentially, patients need to ask: What am I struggling with in my life that is caused by my illness?” Fylling said. “Do I have symptoms of distress that are not managed as well as I would like? Do I need assistance with determining my care? Do I need assistance with advanced-care planning?”
Is palliative care available for children?
In Sioux Falls, South Dakota, and in Fargo, pediatric palliative care teams are available in an inpatient setting.
In addition, Sanford Health is nearing completion of a pediatric care clinic in Fargo. Throughout the health system, palliative care can play a key role in supporting children and their families during potentially life-limiting injuries or illness.
Children and their families have access to a whole team of supporters that can include specially trained nurses, child life specialists, pastoral care, clinical pharmacists and social workers.
How do you involve family members in a palliative care plan?
Sanford Health welcomes family members and the patient support system to be involved in palliative care visits, whether it's an inpatient or outpatient setting.
“We understand that loved ones also experience distress during these difficult times,” Fylling said. “So we really encourage their involvement and allow them time to ask their questions and express their concerns during these visits.”
When talking with people about palliative care, many patients and their families are in this situation for the first time. This unfamiliarity can add to the anxiety for both patients and their loved ones.
“A lot of times we can help with the uncomfortable, difficult conversations that people will often avoid,” Fylling said. “We can help walk them through those conversations.”
What roles do pain management and symptom control play in palliative care?
The goal of palliative care is to improve quality of life. Managing pain and controlling symptoms are very much a part of that, as Grindahl can attest.
It is very common for those receiving palliative care to receive active medical attention at the same time.
“We use our clinical expertise to manage symptoms for patients,” Fylling said. “If they’re dealing with symptoms like feeling pain or nausea or shortness of breath, for example, we can discuss different options on managing that.”
How does palliative care address patients’ physical, emotional and spiritual needs?
When the Sanford palliative care team follows patients, whether it is in an inpatient or outpatient setting, they identify a patient’s and their family’s individual needs.
“We tailor a plan of care based on those needs,” Fylling said. “That may include extra support, symptom management and education related to the disease.”
The team may also reach out to other providers based on those individual needs. This could include things like spiritual support, nutrition, physical therapy and psychology.
Grindahl is often asked about her fight with cancer and she can tell them plenty. She can tell them about listening to a woman sharing her own cancer journey on Youtube in late May of 2024 and then saying a prayer. Grindahl then went to sleep for what amounted to a whole day. When she woke up, her pain was essentially gone.
She credits God for that and calls it “a miracle.” The palliative care she received was part of that cancer journey.
“When friends or family ask how I’m feeling I tell them I no longer need pain medication,” Grindahl said “I tell them there is a whole palliative care team at Sanford that will help you with your quality of life. They have been wonderful.”
