Making end-of-life decisions is difficult, but something many will face. I am privileged to provide compassionate care to those confronting these decisions as they enter the unfamiliar territory of facing mortality. As the chief physician assistant (PA) in hospice and palliative medicine at Carl T. Hayden VA Medical Center in Phoenix, Ariz., I'm committed to treating those diagnosed with chronic progressive illnesses that have advanced and become more burdensome, without curative options. Most of my patients are male, typically aged 65 or older, and are part of a growing demographic that will rely on our expertise in the future.
As America's population lives longer with chronic diseases, palliative medicine is an area with a projected provider shortage of nearly 18,000 positions. With the number of Certified PAs growing 44 percent in just six short years, this workforce can help meet the demand for medical providers in this area. They are already proving themselves in specialties outside of primary care, as data from the National Commission on Certification of Physician Assistants shows that over 70 percent of Certified PAs work in highly specialized areas of medicine. At the Phoenix VA, I am one of the PAs helping to build a trained workforce as an end-of-life care certified trainer on the palliative care team. Some of my training covers:
•Facilitating end of life discussions with patients.
•Developing mature, sensitive, and effective relationships with patients, families, and other providers involved in the care of the patients.
•Managing intractable symptoms.
•Coordinating additional care, such as spiritual and psychosocial assessments, to meet holistic patient needs.
As providers, it's our role to ensure patients have the best quality of life with whatever time they have left. We need to talk with patients about what they understand about their disease process, determine what is an acceptable quality of life for them based on their values and priorities, coordinate medical support they may need, and support their overall goals of care. It takes a team to provide comprehensive palliative care, and at the Phoenix VA, allied professionals coalesce to serve those who have selflessly served us.
Though the work can be tremendously rewarding, it can also be intense and emotionally draining. Patient stories will undoubtedly affect medical providers, and they should practice and maintain self-care to prevent burnout. Delivering bad news is an interpersonal skill that must be learned and continuously honed. Through effective training and experience, healthcare professionals can become more comfortable having these difficult but critically important discussions with patients and families. I credit my own experience working in specialties such as urology, internal medicine (both outpatient and inpatient) and urgent care, to providing invaluable experience helpful to excel in palliative medicine.
Training healthcare providers to meet the demand of this rapidly growing field also supports an overarching goal to improve standards of palliative care and enact legislative change both locally and nationally. That's why I'm heavily active in PA and patient advocacy groups. As a member of Physician Assistants in Hospice and Palliative Medicine (PAHPM), I work to promote legislation related to PAs and palliative care. One piece of legislation I'm passionate about is the Palliative Care and Hospice Education and Training Act (PCHETA), a federal bill which calls for an "increase in funding for palliative care and hospice training for health care professionals, a national campaign to inform patients and families about the benefits of palliative care, and enhanced research on improving the delivery of palliative care."
As someone who served as chair of all PAs in the Phoenix VA healthcare system and as a representative to the VA Physician Assistant Professional Standards Board, I hope to help increase the scope of practice for PAs in the VA system and heighten awareness of the importance of end-of-life care.
Like most medical specialties, palliative care is an area best executed with an interdisciplinary healthcare team. With the advanced education and experience that affords flexibility of the career field, Certified PAs can bring vital expertise and skills to these palliative care teams.
Donna Seton, PA-C, has practiced palliative care since 2009. She was the first, and remains the only PA on the palliative care team at the Phoenix VA. In addition to her work at the VA, she educates medical students, residents, and PA students about palliative care, both as a preceptor and a guest lecturer at several universities in the Greater Phoenix area.
This blog is in partnership with the National Commission on Certification of Physician Assistants.