Hospice and Palliative Medicine

StarShine Pediatric Hospice (SH) is based out of the home care division at Cincinnati Children's. SH comprises an interdisciplinary team including physicians, social workers, nurses, case managers, nurse practitioners, bereavement coordinators, expressive therapists, spiritual care providers, volunteers, nursing assistants and allied health/rehabilitation professionals focused on quality of life, optimal pain and symptom management, guidance in medical and legal decisions, skilled nursing, counseling and bereavement support, and spiritual care for patients. As an integral part of Cincinnati Children's, the pediatric palliative care program provides hospice and palliative care to patients in their individual homes. The fellow spends 4 weeks with the Pediatric Team of StarShine visiting patients in multiple settings as a member of the hospice IDT (interdisciplinary team). The fellow develops increasing comfort as a hospice team physician/member of the IDT by attending weekly hospice IDT meetings and seeing patients daily with IDT members. Initially an observer early in the rotation, the fellow becomes an integral member of the IDT during this rotation. The fellow gains increasing skill in interacting with a large IDT, recognizing and managing conflict, building relationships, exchanging relevant information efficiently and nonjudgmentally, providing and receiving constructive feedback, negotiating resource-based care decisions as a team, determining appropriate settings for patient care, making shared decisions with professional colleagues, and identifying caregivers at high risk for complicated grief and bereavement.

Christ Hospital (CH) Palliative Care Consult Team is an interdisciplinary team which sees adults with a wide variety of patient diagnoses and clinical circumstances in all areas of the hospital (ICU, oncology, heart failure, pulmonary, geriatrics, inpatient family medicine service, and nephrology). Consults range from patients who are relatively stable but coping with a new diagnosis, to patients who are very ill in the ICU and close to dying. Consulted patients and families are from a wide variety of racial, ethnic, cultural, and socioeconomic backgrounds. The fellow will function at the appropriate developmental level as a team member. The fellow will obtain information, examine the patient, and participate in meetings with the patient/family and team; including eliciting the patient’s goals for care and delivering prognostic information.

The fellow is involved in developing a treatment plan. The fellow will convey these recommendations to the primary team caring for the patient. The fellow communicates with the receiving clinician or program regarding palliative care plans when the patient is discharged. Fellows will participate in daily interdisciplinary team meetings to discuss all patients on the consult census. In addition, fellows participate in a weekly 90-minute team meeting focused on team building, continuing education, planning, and administration.

Vitas Hospice is an adult home hospice organization that cares for adults with a wide range of life-limiting illnesses, including cancer, stroke, heart disease, lung disease, liver disease, kidney disease, multiple sclerosis, ALS, Alzheimer’s and AIDS.

The fellow will function at the appropriate developmental level as a team member. The fellow will participate in the interdisciplinary team meetings and go on home visits with the supervising physician and/or hospice interdisciplinary team member (nurse or chaplain).

The fellow works directly with social work, child life, music therapy, chaplaincy, and family advisory faculty of PACT (Pediatric Advanced Care Team). This rotation includes direct patient care and informal discussions of the goals for patient interactions.

The social worker works directly with families as well as with healthcare workers and school systems in coordinating psychosocial services, providing psychosocial and emotional support for patients, families, and healthcare workers working with dying children.

The child life specialist and music therapist provide social, emotional, and developmental support to children and families by utilizing developmentally appropriate play, art, music, education, counseling, and legacy building activities while creating opportunities for memory making.

The chaplain assigned to the patient floor provides pastoral services for families from a diverse group of spiritual beliefs and religions, including spiritual interventions, support, prayer, and sacraments. The chaplain coordinates spiritual care with communities of faith and arranges any special spiritual needs of a patient and family.

The family advisory faculty brings a family perspective to committees. As an advisor to PACT, they collaborate in patient care and strategic planning.

Maple Knoll Village (MKV) is a continuing care retirement community in Cincinnati with support for seniors ranging from independent living to nursing home care. During this rotation, pediatric palliative care fellows will work with geriatric medicine physicians and the IDT at Maple Knoll Village to learn principles of caring for end stage dementia and other chronic diseases in the elderly, and to understand policies and procedures for integrating hospice care into the nursing home setting. As pediatricians in a geriatric care environment, the level of responsibility for participating in patient care activities will be tailored to each fellow’s level of experience and comfort working with seniors, but will be focused primarily on direct observation of patient care, and communicating with patients and families with one-on-one precepting from geriatric medicine or adult palliative care faculty. Learning activities will include participation in:

• Weekly palliative care IDT meetings
• Daily patient care rounds in the nursing home
• A Geriatric Evaluation Center patient evaluation
• Direct observation of outpatient geriatric patient visits
• Direct observation of hospice nursing visits in the nursing home
• Family care conferences

Hospice of Cincinnati (HOC) is a dedicated Palliative/Hospice free standing hospice in-patient facility for adults suffering from a terminal illness who have accepted hospice as a managed care benefit. Hospice of Cincinnati provides acute symptom management, respite and residential care for adult hospice patients.

The fellow will function at the appropriate developmental level as a team member. The fellow will participate in the weekly interdisciplinary care meetings. The fellow will also have an opportunity to experience grief and bereavement counseling at the Adult Grief Center and Fernside Center for Grieving Children.

The Transitional Care Center (TCC) is an inpatient rotation at Cincinnati Children's dedicated to pediatric patients with medically complex pulmonary disorders. Patients in the TCC often are hospitalized for extended periods of time due to medical complexity or resource limitations. This Long-term Care rotation (LTC) exposes fellows to patients receiving pulmonary rehabilitation for a variety of conditions including neurological, neuromuscular and other physiological conditions.

The fellow will participate at a developmentally appropriate level within the medical team for daily rounds, family care conferences and a weekly IDT meeting.

The Yellow Team (YT) rotation is an inpatient rotation at Cincinnati Children's that primarily cares for patients with special health care needs and children with technology dependent conditions. During this rotation the fellow will provide patient and family centered care which includes communicating effectively with patients and families across a broad range of backgrounds. The fellow will also be exposed to the technical and practical aspects of medical care of a technology dependent child in the home as well as the importance of a medical home that specializes in medically complex care.

During this rotation, the fellow will participate daily with an interdisciplinary team to develop and coordinate a medical treatment plan as well as utilize and communicate with subspecialty consultants that are involved in the patient’s care.