Department Spotlight: Duke Palliative Care

Compassionate care, innovative teaching and pioneering research in the face of illness

Clinical Social Worker Vickie Leff and Dr. Hesham Shaban visit with patient and family during a family meeting.
Clinical Social Worker Vickie Leff and Dr. Hesham Shaban visit with patient and family during a family meeting.

Duke Palliative Care

Years at Duke: There’s been a Palliative Care department at Duke for 19 years.

What they are known for:  Often used along with curative care, Palliative Care (pronounced pal-lee-uh-tiv) is an extra layer of support that involves clinical services that improve the quality of life of patients who have with serious illnesses such as cancer, end-stage renal disease and heart failure. Palliative care provides help with decision-making and symptom management, as well as emotional and spiritual support.

This past academic year, the department conducted about 1,200 new palliative care consults, said Dr. Anthony Galanos, a Duke physician who specializes in palliative care.

 “We also help by being well trained in difficult discussions, such as delivering bad news or discussing next steps with a patient and their family when the prognosis is grave,” Galanos said.

Number of employees: 30.

Employees offer services throughout the Health System, including inpatient, outpatient and hospice care settings. The department is comprised of physicians, nurse practitioners, clinical social workers, chaplains and others.

How the department makes a difference: Staff are often called to have difficult conversations with patients and families about an illness’ progression. Should life-extending measures through surgery and machine support be stopped in favor of comfort? Is hospice an option? Are there grief and support programs to help struggling family members? These are questions palliative care staff try to help answer, Galanos said. “We provide support to people whether they have a month to live or 30 years,” said Dr. David Casarett, palliative care section chief. “Good palliative care can help people live longer.”

What the department can do for you: Palliative care is often called when symptoms like nausea or delirium aren’t responding to typical treatment. Besides easing the discomfort of such symptoms, palliative care also specializes in helping patients understand their prognosis and options. Galanos identified his work as one third symptom management, one third communication about disease prognosis and treatment, and one third educating families about end-of-life options like hospice.

Significant achievement: “I can remember when we did only 140 consults a year, back in the early 2000s. This past academic year we did over 1,200 new palliative care consults,” Galanos said. Galanos attributes the increase to healthcare staff, as well as patients becoming more educated about palliative care because the department has worked to increase visibility through training seminars. “We have reached a point where patients and families, themselves, ask for a palliative care consult,” Galanos said.

Big goal: “The big goal for us is to take the principles and skills of palliative care and integrate them into the fabric of Duke Health,” Casarett said.

Hidden Fact: Outside of work, the palliative care team remembers to celebrate good times, with regular meals together and social events. The serious nature of their work underscores the importance of having fun, Galanos said.