Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Mindful Palliative Care Puts a Human Face on Dying

11/5/2015 10:34:48 AM | 14 comments

Welcome to Mindfulness in Medicine, an ongoing column by best-selling author Anne Bruce, designed to cultivate leadership and collaborative relationships among hospital leaders, nurses, providers and ancillary staff. Mindfulness is a powerful leadership tool that enhances emotional intelligence in medicine. It is a tool that, when practiced, can help us develop and implement relational coaching skills and illuminate various ways to improve hospital operations and cross-departmental performance. Mindfulness also improves our capacity for decision-making and participatory medicine, all while enhancing our own health and well-being. Your comments and insights on these postings are greatly valued.  
Until my husband David was admitted to Cedars-Sinai Medical Center in Beverly Hills, Calif., with advanced-stage pancreatic cancer, I knew little about the remarkable and long-lasting benefits of palliative care. Nor had I ever seen a palliative care team in action.
It was more than impressive. It put a human touch on dying. Palliative care is more than compassion. It’s mindful medicine at work.
When the palliative care physician first met with us, I told him that I associated his specialty with the “other word” — hospice.
“Hospice?" he said. "We won’t be talking about dying today."
I thought, You’d better not.
He continued, “We’ll be talking about quality of life for your husband’s serious illness. We’ll also be talking about what our palliative care team can do for you and your family. We’re here to help, day or night, and weekends, too.”
And they were.

We designed our own end-of-life plan that fit our family’s values and beliefs.

David was what some providers refer to as a "vitalist:" one of about 10 percent of patients who believe that any life at all is worth living. He fought to stay alive to his last breath. While his loved ones wanted to support him, his struggle was painful to watch. We needed all the support we could get.
I quickly learned that our palliative care team would be coordinated by clinicians who were board-certified in hospice and palliative medicine. These healthcare providers offered to help my husband and I design our own unique plan of care based on our goals, beliefs and family values.
The palliative care team respected David's wishes. They never tried to change his mind. Instead, they focused on increasing his comfort while supporting his loved ones (who, for the most part, accepted that the end was near). I took advantage of the counseling they offered and found it very helpful.
We also learned that engaging palliative care didn’t mean saying goodbye to our medical team. The program assists patients at all stages of disease. It doesn't preclude curative treatment, and the coordination it provides helps make care safer and more effective.

Palliative care teams are as much patient advocates as they are healthcare providers.

Palliative care is personalized according to the needs and preferences of the patient. In our case, this meant more human touch, more hugs and mindfulness work.
A palliative care team member sat on the bed next to David and chatted about family. He’d rest his hands on my husband's hands, massage his neck, prop up his pillows and joke around about little things.
When the team found out I was writing a book on creative conscious engagement, they asked me to teach them some techniques and incorporated these into our care.
One doctor told me, “It’s never going to be easy, but if we give our patients and their families more guidance, counseling and compassion with mindfulness, we can make what time is left a bit easier for everyone.”

Palliative care reduces healthcare costs and improves patient satisfaction.

Palliative medicine creates a win-win for everyone involved in healthcare.
On one hand, goal-directed end-of-life care saves America’s hospitals and healthcare systems money and resources through increased integration and the elimination of unwanted treatments and procedures. Meanwhile, patients and their families get more of what they want: comfort, compassion and care coordination.
Multiple studies have found that even though palliative care programs require additional staff and administrative resources, they ultimately reduce healthcare costs while increasing patient satisfaction. An often-cited 2010 study of patients with lung cancer found better quality of life and longer survival times in those who received palliative care.

So why don’t more hospitals and physicians educate families on the benefits of palliative care during critical illness?

Professional associations and health agencies encourage clinicians to counsel patients about palliative care. And yet, too few patients and families receive this help in a timely manner.
Even as someone who interacts professionally with healthcare professionals, I was unaware of the benefits of palliative care. Frankly, it was only through my own research that I became aware of the possibilities and sought it out for my husband.
Initially, my request was not met with too much eagerness on the part of his healthcare team. This was a shortcoming, in my opinion, when our family was exploring any and all options to help him meet his challenging end-of-life goals.
Novelty may contribute to the problem. Palliative care programs were nonexistent until the 1990s, and board certification in hospice and palliative care medicine has only been available since 2006.
The culture of healthcare may also pose barriers to palliative care. Being straightforward about death and dying is tough, even for professionals. Until recently, clinical training emphasized curative care almost exclusively, and few providers learned how to talk to patients about prognoses or goals of care. Some clinicians still view non-curative care as "failing the patient" or "giving up."
I observed this discomfort as my husband grew weaker and lost the ability to communicate. I sensed that many of the caregivers who were constantly in and out of his room saw only a dying man, not truly the man he was.
I knew I had to come up with a way to consciously re-engage the healthcare team around him. I spoke to the palliative care team, and with their encouragement, headed to a nearby Dollar Store …

Shifting the paradigm of medicine with one mindful act.

When David could still talk, his stories and life experiences had amazed his caregivers. They nicknamed him “Renaissance Man,” and the name had stuck throughout his 10-week stay.
Now, armed with poster paper, colored markers and clear tape, I created a big, colorful sign to hang above my husband’s bed:
"What you may want to know about my husband, David."
Underneath, I listed some of David’s accomplishments:
  • A pilot
  • An Auburn University alum
  • A law school grad
  • A trombone player in the symphony
  • A published writer
  • A professional photographer
  • A veteran
  • A husband
  • A granddad
  • A great-granddad
I also put up a sign with something he said before he lost lucidity:
“God is love, and I have been loved.”
Doctors, nurses, social workers, technicians and pretty much everyone else who came into the room just loved it. They asked if they could take pictures of the signs with their phones to send to their colleagues and the hospital social workers.
One doctor said, “You just put a face on a dying man. I want someone to do this for me one day.”
From that moment on, everything shifted in terms of how people engaged with David.
They no longer saw him as a dying patient but a man who had led a robust and full life. And I could tell he felt their engagement.

Palliative care isn't always a comfortable subject, but it's worth talking about.

Having just experienced its benefits first hand, I really encourage providers to talk to patients about their prognosis, goals of care and especially about resources like palliative care.
It's all right to be uncertain. It's all right to feel uncomfortable. Who looks forward to giving potentially upsetting news?
But in the end, talking to patients about palliative care can make a huge difference in their lives. It can restore their dignity and empower them to live the remainder of their lives on their own terms.
And that's why palliative care, which promotes quality of life through mindfulness, creativity, and compassion, is gaining widespread acceptance.
This column is dedicated to my husband David, who passed away with the assistance of palliative care on September 8, 2015.

About the Author

Anne Bruce has provided training and performance coaching for MedAmerica and CEP America. She also serves as MBSI's Employee Development Coach and Leadership Facilitator. Anne is a bestselling author with more than 20 books published by McGraw-Hill Publishing, New York. Her next book on mindful behavior is titled Conscious Engagement and is scheduled for release in 2016. She considers her award-winning life-coaching book, Discover True North: A 4-Week Approach to Ignite Passion and Activate Potential (McGraw-Hill Publishing) to be one of her most "mindful" books to date. She also leads a popular Discover True North Expedition group on LinkedIn. Anne can be reached at 214-507-8242 or by writing to her at, or visiting her on LinkedIn or Facebook.

[Image credit: "120603-N-GI544-010" by Commander, U.S. 7th Fleet licensed under CC BY-SA 2.0, exposure adjusted]

Diane Smith
Anne, your words resonate loudly among healthcare providers, patients, and their loved ones! I have found myself in each role in various times in my life: providing for the basic needs of hospital patients as a volunteer, receiving care from nurses, doctors, surgeons and every level of hospital and clinical staff, and being the rock of support for family members and my spouse during various hospital stays - yet this is the first time I've ever been made aware of palliative care and its benefits.

As America and the 1st world ages and the great Baby Boomer generation begins to see the end of its era, the healthcare industry is struggling to shift its focus from extending life through mind-boggling technological break-throughs in surgical and pharmaceutical care to improving the quality of life. After all, who wants to live longer in misery, pain, and mindlessness?

Anne's story gives us all hope that this does not have to be our future - as aging adults, we do not need to fear the hospital, dread the hospice, or relegate our terminal illness to part-time in-home care staff who lose sight of the patient as a human being. It seems that as the medical profession advanced and has been able to control, manage, and even cure many diseases over the decades, the quality of care has declined. Gone are the days when doctors phone the patient at home following a 'sick patient' visit at the office, just to check in and see how they are doing. My dentist still does, even after a simple filling, yet I have never answered a phone call from even the doctor's staff after a bronchitis or pharyngitis diagnoses. It's always just: scratch a note on a piece of paper, mumble some sort of 'plan' and shuffle me off to the front desk where we talk payment.

Things need to change! What is medicine without the patient? And what sort of patient care is actually occurring?

Anne makes a beautiful point about conscious care, engagement, and survival rates related directly to the amount of care medical professionals truly provide to patients. Based on her story, I can see that palliative care is more than just a manner in which to provide 'end-of-life' care to terminal patients; its an ideology that should be incorporated into all levels of healthcare. Doctors and healthcare providers should have conversations with patients about their goals, habits, and aspirations - before terminal illnesses visit, before diseases become chronic, before health risks become reality. These conversations should be constant - at each annual check-in, at each physical, at each visit, whether for wellness or illness. From birth, through adolescence and adulthood, to advanced age - medical (and mental) healthcare workers should be providing 'care', consciously and purposefully engaging and connecting with their patients, showing that they actually respect their patients as human life and care about them.

We notice the difference. Well or ill; we notice. Speaking for myself, I know it's hard to find a caring and professional, well-educated and skilled primary care doctor. I can only imagine what it's like to find one in specialty fields such as oncology. Anne, you are blessed to have found these people. And through your story of your "Renaissance Man" and his caregivers, I can only hope that more healthcare professionals are inspired to lift their creative conscious, engage with their patients - and each other - and raise the bar on quality healthcare - and find their True North within their professions.
12/5/2015 4:59:55 PM

Rachel Darner
Anne, Thank you for being so open and candid about the challenges you have experienced recently. Although I never met David personally, you always spoke, and will always speak, of him as a role model, an adoring husband, and a best friend. I'm confident this poignant article will serve to continue to motivate caring healthcare providers to make modifications within themselves and in process so as to continue to support patients as people, not numbers. Thank you.
12/4/2015 12:29:34 PM

Courtney Proffitt
Anne, you certainly put a "face" on the patient for the health care team. Your article is very moving, and illustrates how powerful it can be for everyone to pull together for the win/win outcome. Your idea of creating the posters with David's accomplishments is inspirational to us all, and I hope that many people who read this article incorporate your idea for their own needs. Thank you for shedding light on this oft-neglected or ignored area of medicine. You have provided "food for thought" for us all - I know I will be thinking about your article for some time to come. Please accept my deepest condolences on your loss. AND thanks for turning the experience into a learning tool for others.
11/16/2015 1:26:02 PM

Dorothy Maples
Anne, please accept my heartfelt condolences on the loss of your precious husband, David.
Until now I knew very little about palliative care programs. This article gives credit and meaning to these uncommon resources. Beautifully, you've relayed how palliative care can absolutely re-define the quality of life for a terminally ill human being - especially someone with a strong will to live.
As you pointed out, a loved one's battle is emotionally painful to witness. Thus, support for the family members seems equally important to the overall circumstances. At the peak of a loved one's battle, having quality communication with health care professionals is paramount - a blessing if the medical personnel truly understand how to "talk to patients". Hopefully, palliative care programs will be become common resources.
Personalizing end-of-life care and empowering a loved one to live the rest of their life on their own terms is the ultimate gift. You demonstrated a brilliant decision to consciously re-engage David's healthcare team by using visual posters to portray a multitude of his accomplishments. In that moment you practiced creative, mindful caregiving.
Thank you for your generosity in sharing your personal experience and writing this inspirational documentary for the benefit of others.
11/13/2015 7:16:52 AM

Anne Grady
Thank you for writing this article, Anne. Your strength, persistence, and unconditional love for your husband is incredible. Until now, I had never even heard of palliative care. I'm grateful to know something like this exists, and I would love to see more healthcare providers talking about it. You gave David the greatest gift, the ability for his caregivers to know him as a person, not a patient. Thank you for sharing your story and for being so courageous. You and your family are in my thoughts and prayers.
11/12/2015 8:57:29 AM

Phyllis Jask
Anne, I offer you my heartfelt condolences on David's passing. Conversations about death are usually uncomfortable and emotional, sometimes messy, often accompanied by tears, and always filled with the dread of losing someone we love, which is probably why we seek to avoid them in the first place. By sharing David’s story, you've given us the gift of a conversation starter…what is palliative care and how can it help us achieve quality of life during a terminal illness? Mindful medicine equals care for the patient’s mind, body, and spirit, but it also equals care and emotional support for the patient’s loved ones. Health care professionals who embrace palliative care are providing much more than health care; they are providing comfort at a time when it’s needed most. We all have a story, and sadly, all stories must end. But they can end with dignity and grace, surrounded by abundant love.
11/10/2015 8:11:35 AM

Antoine Gerschel
Thank you, Anne, for this wonderful article! You certainly educated me about palliative care!! And as strange as it may sound, you with the palliative care team made dying worthwhile. Your idea with the posters is brilliant!! Interestingly, at the graduation of one of our children, the head of school turned to the graduating class, and gave them this recommendation: “Look at each other. This is the way you will remember each other. While other people who will meet you later will never get a hint of how you were when you were young, all of you will remember each other exactly the way you are today! Savor it.” With your poster you helped visitors see David as the much younger man you had known and who you still remember. I’m very sorry for your loss. Thank you for your inspiration.
11/9/2015 8:30:28 PM

Betty Garrett
Anne, I have walked in your shoes only on a short term basis with my husband, Gene, who was diagnosed with esophageal cancer. You have the gift to present to the forefront a subject no one wants to discuss but is a very critical part of life. Thank you for sharing your journey with us and hope this will help others not feel alone.
11/9/2015 6:11:20 PM

Lawrence Polsky
Thank you for sharing your loss for the benefit of others. I was moved to tears reading about the sign "what you should know about David". How powerful! This should be a best practice in all palatine care settings and even nursing homes.
11/9/2015 4:42:49 PM

Anmarie Miller
Thank you for such an insightful article. Anne Bruce is one of the best writers of our time. This article brings to life so many important items for all of us. I will be able to take this information and share it with others.
11/9/2015 2:46:34 PM

I spent much of the time reading this article nodding in agreement. Anne Bruce brings to light an issue so many of us face. Thank-you for your honest account of your experience. This article has touch more people then you will ever know.
11/8/2015 10:13:10 PM

Andy Myers
Anne, thank-you for sharing with us such a touching and personal story about your experiences with palliative care. I'm glad that our culture is shifting to one where in the end, death can be accepted and embraced as a step into the chapter. David sounds like a wonderful man, and the story of how you cared for him and how the palliative care team assisted you is very moving. Thank-you for such an insightful article.
11/8/2015 9:47:27 PM

Cyndy Flores
Anne, thank you for sharing your personal experience, hearing these always brings me back to the roots of why I choose a profession in health care. David was lucky to have such an insightful soul mate.
11/7/2015 9:57:48 AM

Dolly Hinshaw
Your personal experience captures the essence of end-of-life dignity. All of us in the healthcare profession need to be more intuitive to patient choices and collaborate with families to customize care plans that prove meaningful and respectful to the needs of each individual. Thank for sharing your journey. What a beautiful tribute to a very special "Renaissance Man."
11/5/2015 9:51:34 PM