Anthony Tickner, DPM FRCPS, FACCWS, FAPWH In this interview, Dr. Anthony Tickner outlines the distinction between palliative and hospice care, as well as how clinicians can identify which framework is best for each, individual patient.

Transcript

Hello, I'm Dr. Anthony Tickner. I am a podiatrist and the medical director of the St. Vincent Hospital Wound Healing Center west of Boston. We are a large facility, about 350-bed hospital with an outpatient wound care center with 18 providers and a staff of nurses and residents as well.

Within the framework of wound care, how do you define palliative care?

So I think to define palliative care, we also have to look at something called hospice care. So hospice care would be comfort measures, patients that have terminal issues or cancer, etc. In the wound care world, it would be more of we're just trying to make them comfortable, we're trying to make them at ease and pain relief in those situations is very paramount. And also, making sure that we're attending to the issue at hand and making them comfortable. Palliative care is more of in between. So we have curative care, which means that we're trying to cure these people, our patients, and we're trying to get them to an end result. So if they have a wound, we're trying to get that closed. Palliative care is still trying to do that with a little bit of mixture of more compassion and more ingredients to keep that patient comfortable, but also aiming towards a curative outcome.

What factors go into determining if a palliative care pathway is appropriate for a patient with a wound?

I think what we should look at is the patient is doing all they can, they just may be too sick or they may have a lot of comorbidities. They may be in a situation where some of those disease processes in their body, whether it's MS or cancer, etc, may be pretty far along, and again, one of the hallmarks of palliative care or different types of care with patients that are sicker is that we want to make them comfortable, we want to make sure they're pain-free, and we want to respect their family and we want to respect them more importantly as well. So I think it's important to listen to them and to try to develop a program that's not only humane, but also fits into the overall spectrum of their beliefs, their family's beliefs, and maybe their religious guidance for their family as well.

Can you give an example of what might make a palliative care pathway different from a more typical or more standard wound?

So as we know, it's very difficult just to treat patients that don't have, let's say, advanced comorbidities or situations that are more serious that could decrease their lifespan. So in general, it's really tough to deal with chronic and acute wounds. And what's important to know is that, as I mentioned before, it's going to be a process that everybody needs to be involved, everybody needs to agree upon the plan. You can certainly have palliative patients that go on to cure, and they graduate, so to speak. So they're no longer palliative, which is very important to note. And also, it's not to be confused with the non-compliant or the nonadherent patient, which that's a whole other can of worms. And those patients usually go from provider to provider.

What one thing can providers do in their practice today to improve or establish palliative care as part of their care continuum?

I think it's very important to have your staff become educated and to learn what the different terminology, what that entails, and certainly not to have a patient who's non-compliant or nonadherent and say, "You know what? Well, we've tried everything. And this patient is going to become palliative," or "they are going to become something else" that I feel like that's a little bit of a cop-out. These programs are designed for patients that are very sick, may not get better with everything that we're providing them with, and we're trying to humanely give them options as we're progressing. So for the patients that don't pay attention, the nonadherent or the non-compliant patients, that would be a situation of education as well. And sitting them down and maybe graduating them in a different sense, maybe to a different provider for another set of eyes to look at that patient, to give a fresh perspective.