Introduction In the past three years, Indiana University Health (IUH) University Hospital Palliative Care Services has expanded its size and scope. Our mission remains to treat the suffering of patients with chronic, progressive illnesses, their families, and their providers through symptom optimization and the search for meaning. While continuing to work with patients near the end-of-life and transitioning to hospice we have increasingly been involved with complex patients whose deaths are not imminent or even expected. Our Team The team has transitioned from a part-time to a full-time physician, a new full-time nurse practitioner, a new position in a nurse clinical coordinator, increased time for out part-time social worker, and continued part-time chaplain. New Opportunities for Palliative Care IUH University Hospital sees some of the sickest of the sick including advanced liver failure, advanced pulmonary disease, and transplant patients. Our service has become involved in alleviating suffering in pancreatic, liver, renal, and multivisceral transplant patients. Our expertise in opiates has placed us in a unique position to assist with patients having pain due to opioid-hyperalgesia and narcotic bowel syndrome. In addition we have started seeing more hepatology, oncology, hematology, and pulmonary patients earlier in their disease. Out-Patient Services We have expanded our service to now include out-patient, currently by embedding within other clinics at University Hospital including seeing patient in the multidisciplinary oncology clinic, hematology, digestive and liver disease clinic, and surgical out-patient clinic. In the near future we hope to have dedicated clinic space within the geriatrics clinic.

1. University Hospital Palliative Care Services has educational
presentations for groups within the hospital, including the Lunch n’
Learn series, Nursing Grand Rounds, Anesthesia Grand Rounds,
Transplant Research Meeting, and other departments within the
hospital. Cathy Simpson is involved in Encompass and works with
new hires and communication routinely.
Nursing students, medical students, emergency medicine residents,
and palliative care fellows have all had rotations with the service at
University Hospital.
Indiana University Health University Hospital Palliative Care Services
ABSTRACT
OUR TEAM
In the past three years the IU Health University Hospital Palliative
Care Services has expanded both in staffing and in scope.
Our service has gone from one part-time to full-time physician. We
have a new palliative care nurse practitioner, our social worker has
expanded to four days per week while being involved in staff
education, and we have added a clinical coordinator registered
nurse.
We have expanded our services within “traditional” areas of
palliative care such as oncology and hematological malignancies.
We see new patient populations with suffering including cystic
fibrosis, advanced lung disease, and pre- as well as post-transplant
patients including liver, pancreas, kidney, and multivisceral.
We are increasingly involved in education both didactics and
bedside with medical students, residents, and fellows rotating with
our service.
In the past year our service has expanded to out-patient by
following-up in-patients and embedding within existing clinics.
OUR PARADIGM OUT-PATIENT SERVICES
DEMOGRAPHICS
SUMMARY
ALUMNI MEMBERS
CONCLUSIONS
Marcia Mulcahey
Nurse Practitioner
Marci relocated to Arizona to be closer to family. She is still working in
palliative care.
Wendy Siemion
Physician
Wendy is now a palliative care physician for the Veterans’ Health
Administration Indianapolis.
All patients deserve palliative care and many can be well served by
high-quality primary palliative care. However, some patients whether it
is due to specific issues or complexity require a specialized,
interdisciplinary team to optimize quality of life. Indiana University
Health Palliative Care Services remains committed to optimizing
quality of life regardless of prognosis.
In order for palliative care programs to grow they must stop identifying
themselves with death but rather with the diagnosis and treatment of
suffering. Palliative care and hospice as been associated with dying
rather than our true mission of helping patients and their families live
well in the face of progressive, chronic, or terminal disease.
Palliative care is in many ways a new model of care based on a
practice as old as Hippocrates: “Cure sometimes, treat often, comfort
always.”
The Victoria Classification of Palliative Care divides palliative care into
three phases: Blue during which active curative treatment occurs,
green during which focus is shifted away from cure and toward
comfort, and yellow which focuses on active dying and end-of-life
care. Here at University Hospital, we continue to see patients that
require help with the transition to a comfort approach or are actively
dying. In addition, as Palliative Care Services have matured, we have
seen patients with increasing life expectancy and are still pursuing
active treatment.
As our patients’ life expectancies have increased we have had to
expand the way we deliver and practice to improve quality of life.
Simply managing physical pain is inadequate in a patient that may
have much more time to enjoy their quality of life. These patients have
more complex management issues leading us to not only evolve our
paradigm of care but has also necessitated out-patient follow-up that
has subsequently expanded into out-patient referrals.
NEW OPPORTUNITIES
Mike Aref
Lead Physician
“I became a palliative care physician by accident, I have
always weighed the balance between the burden of suffering
and what the patient got out of experiencing that burden.”
Cathy Simpson
Social Worker
“I was eager to become involve in the implementation of a
palliative care program because it offers a unique opportunity
for social workers to impact the challenges that each patient
and family face with a life changing illness. The ability to work
to enhance the quality of care through the continuum of an
illness has become my passion.”
Tim Staker
Chaplain
“Soon after I became a chaplain I learned that--even with all
our technology--hospitals do not have a cure for every illness.
Bringing spiritual and emotional comfort to patients with pain
and unmanaged symptoms was exactly where I wanted to be.
To be part of an interdisciplinary team focused on this kind of
care is the most meaningful work I’ve ever done.”
Jim Luce
Administrative Lead
“It really is my life’s work. From an administrative perspective,
if I can get a place as big as IU to pay attention and change
the way it does things, it will affect not just the suffering in our
own hospital, but around the whole state. Not a bad mission.”
Emily Malecki
Nurse Practitioner
“To me, in order to make informed decisions, a patient must
have well managed symptoms and understand all of their
options. Palliative care allows me to assess and manage the
whole patient.”
Barb Nation
Clinical Coordinator
“I worked as a hospice nurse for many years, and I got to see
how much our patients and families benefited from inter-
disciplinary supportive care. Palliative care expands that
belief--that all patients with a life-limiting illness will likely do
better when they have symptom management and support.
Caring is just as important as curing. ”
Michael Aref, MD, PhD, FACP, FHM, Cathy Simpson MSW, LCSW, Emily Malecki,
RN, ACNP-BC, Barb Nation, RN, CHPN, and Tim Staker, MDiv, BCC
Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
Pulmonology
DaLD
SOPA
Multidisciplinary
Oncology
Hematology Primary Care
617-5787
Outside Palliative Care Consult
Currently embedding
in referring clinics
In the future referrals and
follow-ups will come to a
dedicated clinic
EDUCATION
Psychological Review. 1943 50, 370-396.
Curr Opin Support Palliat Care. 2008; 2(2):110-3